When Can My Employer Deny Workers’ Compensation?

what to do if your employer denies your workers comp claim

You expect your employer to cover your medical costs if you are ever injured on the job. While workers’ compensation is in place to protect employees, employees must meet certain eligibility requirements. Many employees do not realize that there are some situations in which they could be denied workers’ compensation rights. Understanding these situations can assist you in taking the appropriate steps following a work-related injury. Continue reading to find out when your employer can deny workers’ compensation.

Understanding the Workers’ Compensation Process

Workers’ compensation is a type of coverage that protects employees who are injured while at work. Typically, in order to be eligible for workers’ compensation, you must meet the following criteria:

You must have been employed at the time of the accident
Your employer must be required to carry workers’ compensation and had it at the time of the accident
The injury must be work-related

You must meet all New Jersey state deadlines for submitting an application for compensation

If you are injured on the job, it is best to notify your employer immediately. Then, they can provide you with information on how to proceed. For example, you may be required to receive medical care from an approved medical provider. Your employer can also notify you of important timelines to ensure that you stay within New Jersey’s workers’ compensation statute of limitations.

Reasons for Denied Workers’ Compensation Claim

If you are denied for your workers’ compensation claim, it is likely that the reason why falls into one of these:

You failed to provide notice: New Jersey requires injured employees to report their accident within 90 days of the accident. Additionally, some providers may prefer that you notify them even earlier than this.
You are not covered: You must be included in the workers’ compensation coverage in order to collect benefits. Some employee agreements, like contractors, are considered self-employed, and might not be eligible for coverage.
Intentional injury: The injury from the accident must be accidental. If the workers’ compensation representative claims that the injury was due to intentional self-injury or other workers injuring you, then they will deny your coverage.
Your injury is not work-related: The injury must be work-related. This means that it was experienced while completing work duties during work hours. If the representative claims that the injury occurred before work or during non-related work tasks, they will deny your claim.
Failing to seek medical care: Immediate medical care is needed not only to prove that you are dealing with an actual injury, but to be able to connect it to the work accident. It is best to report the accident as soon as possible so you can seek the medical care that you need.

Your Options Following a Workers’ Compensation Denial

If you received a workers’ compensation claim denial, you might still have options available. The workers’ compensation lawyers at Birkhold & Maider, LLC can evaluate your case, identifying the cause for denial. In some cases, additional information can be submitted in order to move the case along.

Contact a Union County Workers’ Compensation Lawyer to Discuss Your New Jersey Workplace Injury Case

A workplace injury can be devastating, particularly if it prevents you from returning to work for an extended period of time. Although New Jersey workers’ compensation laws are supposed to provide you with reimbursement for medical expenses and replacement pay for missed time at work, it is not always easy to get the workers’ comp benefits you deserve. That is why you should speak with a knowledgeable workers’ compensation lawyer about your situation and get guidance throughout the claims process. The experienced workers’ compensation attorneys at Birkhold & Maider, LLC represent clients in Essex County, Hudson County, Mercer County, Union County, and all across New Jersey. Call 973-784-8583 or fill out our online contact form today to schedule a free consultation about your work injury case. Our main office is located at 189 Franklin Avenue, Suite 1, Nutlet, NJ 07110, and we also have an office in Hamilton.

The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.