You were hurt at work, you reported it, and the insurance carrier said no. Or it approved the claim and then cut off your checks or refused the surgery your doctor recommended. A denial isn't the end in New Jersey. It's often the start of the formal process, and many denied claims are won.

Why comp claims get denied

  • "Not work-related": the carrier says the injury didn't arise out of and in the course of employment, for example because it happened on a break, during the commute, or at home.
  • Pre-existing condition: the carrier blames a prior back or knee problem. In New Jersey, a work accident that aggravates a pre-existing condition can still be compensable. How pre-existing conditions are handled.
  • Late notice: the employer says it wasn't told in time. Under N.J.S.A. 34:15-17, notice given within 90 days, or actual knowledge by the employer, can preserve the claim.
  • No witnesses or inconsistent accounts
  • "Independent contractor": the company says you're not an employee
  • Disputed medical treatment: the authorized doctor says you're "at maximum medical improvement," or the carrier won't approve an MRI, injections, or surgery

Your options

File a claim petition

A formal claim petition filed with the New Jersey Division of Workers' Compensation puts your case before a judge of compensation. The deadline is generally two years from the accident or two years from the last payment of compensation (N.J.S.A. 34:15-51). For occupational diseases, the timing generally runs from when you knew the condition was caused by work (N.J.S.A. 34:15-34).

Motion for medical and temporary benefits

If the carrier won't authorize needed treatment or stopped your temporary disability checks, your lawyer can file a motion for medical and temporary benefits. These motions are given priority so injured workers aren't left without treatment or income for long. The judge can order the carrier to provide treatment and pay benefits.

Informal hearing

The Division also offers informal hearings, where a judge gives a non-binding recommendation. They can help resolve simpler disputes quickly.

Penalties for unreasonable delay

New Jersey law allows penalties when a carrier unreasonably delays or refuses to pay temporary disability or medical benefits. Under N.J.S.A. 34:15-28.1, the judge can impose an additional 25% of the amount due, plus reasonable legal fees.

Retaliation is illegal

An employer can't fire or discriminate against you for claiming comp benefits (N.J.S.A. 34:15-39.1). If that happens, it can be a separate claim.

What to do while your claim is denied

  1. Keep every letter and email from the employer and the carrier.
  2. Write down exactly how and when you got hurt, and who you told.
  3. Get names of coworkers who saw the accident or your injury afterward.
  4. Keep getting treatment. Your health insurance may cover care while the comp claim is disputed, and may later seek reimbursement.
  5. Apply for New Jersey Temporary Disability Insurance if comp benefits are denied. TDI can sometimes pay while the claim is disputed, with reimbursement from comp if you win.
  6. Talk to a workers' comp lawyer. There's no up-front cost, and fees are set by the judge and capped at 20% of the award (N.J.S.A. 34:15-64).

Check for a third-party claim

When comp is denied, or even when it's paid, ask whether someone other than your employer caused the injury. A contractor, a property owner, a driver, or an equipment manufacturer may be responsible in a separate lawsuit that includes pain and suffering. Read about third-party claims.

New to comp? See how New Jersey workers' comp works and our workplace injury page.