Gruccio, Pepper, De Santo & Ruth P.A.
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Is your workers' comp insurer refusing to pay out?

You, like most other New Jersey residents, are a hard-working individual. While on the job, you received an injury. Following protocol, you filed a claim with your workers' comp provider and sought treatment for your injury. You saw no reason as to why they wouldn't come through, but then you received word that they will not pay your claim. Now what?

When injured on the job, you expect your workers' compensation benefits to kick in. That is what they are there for, right? Unfortunately, there are never any guarantees, and you may find yourself having to fend for yourself. You may not have to, though. A denied claim is not the end of the road.

Denied, why?

There are quite a few reasons your workers' compensation provider may choose to deny your claim. Some of the top reasons for claim denial include:

  • Reported injury too long after the fact
  • Filed claim too late
  • Medical treatment deemed unnecessary
  • Employer claims injury not work-related
  • Injury not considered compensable

If you receive a confirmation of claim denial, the reason for the denial should be in that confirmation letter.

Denied, now what?

If you receive a claim denial, you have the right to appeal. If this is an option you'd like to pursue, you must do it in the allotted time frame -- generally 30 days. The window you have to do this should also be information included in your denial confirmation letter.

To appeal, you need to write to your workers' comp provider, stating your complaint, and request review of your case again. With your complaint, you'll have to provide any information you have regarding your condition, how your injury occurred and why you believe your employer wrongfully denied your claim. During the appeals process, you may have to present your case in a hearing. Thankfully, you have the right to have a legal representative present to do this with you.

Every case is different, and the appeals process may not be practical for everyone. Generally, it is still worth trying, though.

When it comes to workers' comp benefits, your provider is looking out for its bottom line, not you. You have to look out for you. Legal counsel can assist you in doing just that by taking all the steps necessary to seek full coverage for your work-related injury.

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The Law Offices of Gruccio, Pepper, DeSanto & Ruth, P.A.
817 East Landis Avenue
Vineland, New Jersey 08360

Toll Free: 877-760-1031
Fax: (856) 692-4095
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Gruccio, Pepper, DeSanto & Ruth, PA