Common Causes of a Rejected Workers’ Compensation Claim

In New Jersey, as in all states, there are only two requirements to qualify for workers’ compensation benefits: you must show that you suffered an injury, and you must prove that the injury occurred during the course of your employment. It would seem, then, that collecting work comp benefits should be relatively easy and straightforward. In reality, as many as half of all potential claims are initially denied. Here are the most common reasons why an application for workers’ compensation benefits may be denied:

You didn’t report the injury to your employer in a timely manner—You have the responsibility of notifying your employer in a timely manner. Your employer must then submit a claim with the workers’ compensation insurance company.

Your application for benefits was either filed too late or did not include all required information—If the workers’ compensation insurance company receives an application for benefits that has missing information or that has been submitted after the cutoff date, it will likely deny the claim. You need to make certain your employer notifies the insurer in a timely manner. An attorney will help ensure that happens.

You were injured while engaged in horseplay or some other conduct specifically prohibited under company policy—If you were doing something that had no relationship to your job, your claim may be denied

You didn’t go to an authorized medical provider—You will ultimately be allowed to choose your own doctor, but you must initially be examined by a physician approved by your employer or the work comp insurance company

You were hurt while on a meal break—If you leave the premises for any type of meal, you are no longer performing work-related acts. However, if you take your lunch into the break room onsite, you may qualify for work comp for any injury suffered there.

You were impaired by drugs or alcohol at the time of the accident

Your employer can show that the injury was pre-existing or did not occur while you were working

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing and able to protect your interests before a judge or jury. Contact our office online or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

By Mark Cintron

Reasons Why Your Work Comp Claim May Be Denied

Common Causes of a Rejected Workers’ Compensation Claim

You didn’t report the injury to your employer in a timely manner—You have the responsibility of notifying your employer in a timely manner. Your employer must then submit a claim with the workers’ compensation insurance company.
Your application for benefits was either filed too late or did not include all required information—If the workers’ compensation insurance company receives an application for benefits that has missing information or that has been submitted after the cutoff date, it will likely deny the claim. You need to make certain your employer notifies the insurer in a timely manner. An attorney will help ensure that happens.
You were injured while engaged in horseplay or some other conduct specifically prohibited under company policy—If you were doing something that had no relationship to your job, your claim may be denied
You didn’t go to an authorized medical provider—You will ultimately be allowed to choose your own doctor, but you must initially be examined by a physician approved by your employer or the work comp insurance company
You were hurt while on a meal break—If you leave the premises for any type of meal, you are no longer performing work-related acts. However, if you take your lunch into the break room onsite, you may qualify for work comp for any injury suffered there.
You were impaired by drugs or alcohol at the time of the accident
Your employer can show that the injury was pre-existing or did not occur while you were working

Contact the Cintron Firm

About the Author

Mark J. Cintron is the firm’s founding partner. Mark’s experience for the past decade has been rather unique. It has allowed him to gain the practical knowledge and exposure not afforded to most attorneys his age. It is this experience that provides him complete confidence to meet all your legal needs.