Workers’ Compensation Claim Disputes & Denials
The workers’ compensation system has been set up to provide benefits to workers who have been hurt in workplace accidents or diagnosed with occupational illnesses. Despite this, however, injured workers can run into various challenges when it’s time to pursue a claim and benefits. In some cases, these difficulties may give rise to claim disputes and denials.
Understanding the issues that can cause claim disputes and denials – and knowing what to do when these problems arise – can be pivotal to protecting a claim and your rights to workers’ compensation benefits.
While the following provides important information about workers’ compensation claim disputes and how to overcome them, please don’t hesitate to contact Middlesex County Workers Compensation Lawyer James A. Hicks for insights related to your claim – and for extraordinary advocacy moving forward.
Has Your Workers’ Compensation Claim Been Disputed or Denied?
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What Causes Workers’ Compensation Claim Disputes? Why Are Claims Denied?
An employer or its workers’ compensation insurance provider may dispute workers’ compensation claims for a number of reasons. Some of the issues that may give way to these disputes can include (but are not limited to):
- Whether the injuries are work related – An employer or insurer may dispute that injuries occurred during the course of work if, for instance, there are delays in reporting the injuries (or accident) to the employer or if there are no witnesses to the incident. Such disputes may be used as leverage to deny claims.
- The nature and extent of necessary medical care – Claim disputes can also arise when an employer or insurer alleges that the injuries are as severe as a worker has alleged and, consequently, the injuries do not require any or as much medical care. This can be used to try to reduce or avoid paying medical benefits.
- When maximum medical improvement (MMI) has been achieved – MMI means that an injured worker has healed to the extent possible and that no further treatment will result in further healing or recovery. If a doctor declares a worker has achieved MMI, this means the doctor is contending that a worker may be ready to return to work, even if that may not necessarily be the case. It can also mean that a valid claim is prematurely terminated or wrongfully denied.
While some claim disputes may arise from unclear facts or mistakes made in the aftermath of a work injury, it’s also not uncommon for these disputes to the result of:
- Employers attempting to limit claims and avoid higher workers’ compensation insurance premiums
- Insurers trying to limit or avoid paying benefits in order to preserve their own profits.
What Can I Do if My Claim Is Denied?
If your claim is being disputed – or if your disputed claim has been denied, you CAN appeal to the New Jersey Division of Workers’ Compensation (DWC) by filing a(n):
- Informal claim – A judge of compensation will preside over these informal hearings and provide non-legally-binding suggestions for resolving the disputed issue(s). This informal appeals option can be helpful for resolving issues outside of more complicated, formal litigation. Typically, once a request for an informal hearing is made, the DWC will schedule the hearing within a few weeks. In many cases, these claims can be resolved within two (or less) hearings. Though workers are not required to have legal representation for these informal appeals, it is generally in their best interest to have a lawyer representing them in these hearings in order to assure their rights are protected.
- Formal claim – More involved than informal claims, formal claims must be filed within two years of the date of the accident (or the date on which an occupational illness has been discovered). Once a request for a formal hearing has been filed, an initial hearing will usually be scheduled within six months (in the county where the injured worker lives). According to the DWC, most formal claims are resolved during the pretrial process (via settlement).1 If a settlement is not worked out before trial, however, the case will proceed to trial, and the presiding judge will issue a legally binding ruling (after both sides have presented their arguments and evidence). These rulings can be subject to appeal via the Appellate Division of the Superior Court.2
Claim Disputes, Denials & Appeals: The Bottom Line
When it comes to disputes, denials and appeals related to workers’ compensation claims, the bottom line is that an experienced attorney – like Middlesex County Workers Compensation Lawyer James A. Hicks – can be your indispensable advocate, helping to:
- Guide you through these complexities and overcome the issues that can threaten your claim
- Assert your rights and protect your interest at every phase of your claim
- Bring claim disputes and appeals to the best possible outcomes.
Get Experienced Help Navigating the Claims & Appeals Process: Contact Middlesex County Workers Compensation Lawyer James A. Hicks
If your workers’ compensation claim is being disputed by an employer or insurer – or if you believe your claim has been wrongfully denied, contact Middlesex County Workers Compensation Lawyer James A. Hicks for essential insights about your legal options and the highest quality representation moving forward.
Call (732) 767-1300 or email us. The Law Office of James A. Hicks, LLC is open Monday through Sunday.
Since 2003, Attorney James A. Hicks has been certified by the Supreme Court of New Jersey as a workers’ compensation law attorney. This distinction, which is only held by about 2 percent of the lawyers in the state, means that Mr. Hicks has the experience, knowledge and skills to effectively represent injured New Jersey workers in any type of workers’ compensation case, including appeals cases.
Let Mr. Hicks explain how he can help you fight for the benefits you may deserve. From offices in Middlesex County, Attorney James A. Hicks represents injured workers and families from across the state of New Jersey.
1: DWC Information about Workers’ Compensation Claim Appeals
2: More Information about the Appellate Division