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5 Common Mistakes Causing Insurance Claim Denial

New Jersey has been a pioneer by enacting laws protecting injured workers and their families since 1911. Unfortunately, most people do not know they are entitled to workers’ compensation benefits, let alone have any idea what is necessary when making a claim. According to the Steven Cohen, Esq., Chairman of Davis, Saperstein & Salomon’s Workers’ Compensation Division, “Mistakes are the number one reason so many claims get rejected every year. If an employee is injured while at work, no matter who is at fault or what caused the accident, they are entitled to file a Worker’s Compensation Claim. This is simply an insurance benefit available to the injured worker, but the claim process is complicated for individuals attempting to file without the help of a workers’ compensation attorney. Mistakes are completely avoidable…if you know what they are.” Below, Cohen explains five common mistakes to watch out for if injured on the job.

Common Mistake 1: Failing To Properly Report Your Accident

The most important thing to do if you are injured on the job is to report the injury to your employer. Many employers have an accident policy in place that can be referenced in their employee manual. If this is the case, it is
incredibly important to follow those guidelines set out in the manual. If there is no written accident reporting policy then I find that the best thing to do is to let everyone know about your injury…and that would include co-workers, supervisors, and/or anyone in the human resources department.

The law generally requires an injured employee notify their employer of the work injury within 30 days of the
accident. There are, however, exceptions to this rule. Specifically, and most commonly, if the employer, an agent,
or representative had actual knowledge of the accident, then the employer is also deemed to have notice of the
injury, whether it was in writing or not.

Common Mistake 2: Failing to give a Full and Accurate History

I cannot stress this enough: If you fail to tell the medical providers where you are injured and how you were hurt, you could not only be harming yourself physically but legally as well. We all know that it is important to advise the doctors of all our complaints so they can give us the proper treatment but it is equally important to your claim for benefits.

When an insurance company is investigating a claim they may take statements from the injured person and witnesses, but they may also closely read the medical records. They are looking to see what the injured worker told the doctors and nurses as to how they were hurt and what parts of their body was injured.

For this reason, when discussing your accident and injuries with any medical provider, be clear and detailed when discussing the nature of your injuries and how they occurred. Always, always, always identify where you were hurt and if there was anything unusual that caused your injuries.

Common Mistake 3: Failure to File a Formal Claim Petition

In New Jersey, there are certain time limitations that dictate when an injured employee can pursue a workers’ compensation claim. In order to help protect your right to compensation, an Employee Claim Petition needs to be filed with the NJ Division of Workers’ Compensation generally within two years after the injury occurs. If a Claim Petition is not filed within the appropriate time period, you may lose your rights to further benefits.

Although the time limit is two years in most cases, it may be different in various circumstances. For example, some injuries are only discovered year after exposure to harmful substances, such as asbestos, changing the time limitations.

If workers’ compensation benefits have already been provided, then the period to file a claim petition is two years from when benefits were last given for your claim.

Common Mistake 4: Failure to Comply with Medical Treatment

The workers’ compensation insurance company or an employer generally has the right to direct the medical treatment of the injured worker in New Jersey. This means they get to choose the doctor and tell them what treatments you should and shouldn’t receive. If you have been injured and you are out of work receiving weekly benefits from a workers’ compensation insurance company, it is very important that you comply with the recommendations of the treating physicians—especially when it comes to attending medical appointments and therapies. If you miss medical appointments, you may jeopardize your benefits.

Common Mistake 5: Failing to Return to Work When Authorized

When an authorized doctor releases you to “full duty” work, your temporary total disability benefits will end. At this time it’s critical to immediately call your employer to notify them you have been given a “return to work full duty” and that you intend to report for work immediately. If you are returned to “temporary light duty” work, you should make sure you clearly know exactly what temporary restrictions the doctor has placed on your activities. The restrictions should be in writing and you should ask the doctor for a copy of whatever temporary restrictions were prescribed.

If your employer informs you that temporary light duty work is unavailable for you, then temporary total disability benefits through the compensation carrier (insurance company), must continue until either you can resume full duty work or the light duty restriction is lifted or becomes a “permanent” light duty restriction.

Filing a workers’ compensation claim is your right as an employee, but doing it alone can commonly lead to an insurance denial. If you have questions, Steven Cohen, Esq. is always available for a free and confidential consultation to help workers’ understand their rights.