Your Workers' Comp Claim Was Denied. Here's What Happens Next.
A denial from the insurance company feels like a door slamming shut. It isn't. In New Jersey, a denied workers' comp claim is the beginning of a dispute process — and with 45 years of experience on your side, it's a fight you don't have to take on alone.
Why Workers' Comp Claims Get Denied in New Jersey
Insurance companies deny claims for a range of reasons, and they don't always explain them clearly. Understanding why your claim was denied is the first step toward challenging it. The most common reasons I see in my practice include:
- The insurer disputes that your injury happened at work or is work-related
- Your employer claims you were injured outside the scope of your employment
- There's a gap between when the injury occurred and when it was reported
- A pre-existing condition is being used to minimize or eliminate your benefits
- The medical documentation doesn't satisfy the insurer's requirements
- Your employer disputes the nature or severity of your condition
None of these reasons automatically ends your claim. Each one can be challenged through the New Jersey workers' compensation dispute process.
When the Dispute Is About Whether Your Injury Is Work-Related
The most common battleground in denied workers' comp claims is causation — the insurer's position that your injury didn't happen on the job, or that your job didn't cause it. This comes up frequently with repetitive stress injuries, back conditions, and illnesses that develop gradually over time rather than from a single incident. I help injured workers build the medical and factual record needed to establish that connection clearly.
When Benefits Are Terminated Before You've Recovered
Some workers' comp denials don't happen at the start of a claim — they happen in the middle of one. If your benefits were terminated while you were still unable to work, the insurer may have acted prematurely. Employers and their carriers sometimes push to close claims before an injured worker has reached maximum medical improvement. If your checks stopped and you still can't return to work, that's worth disputing.
When the Dispute Is Over How Much You're Owed
Not every denial is a flat refusal to pay. Sometimes the insurer accepts that an injury is work-related but disputes the extent of your disability or the value of your permanency award. These disputes often involve competing medical evaluations and can significantly affect the final settlement or award you receive. I've been handling these permanency disputes in New Jersey for decades.
When Your Employer Retaliates or Complicates the Claim
Injured workers sometimes face pressure from their employer on top of the insurance dispute — being told the injury wasn't serious, being pushed back to work before they're ready, or facing other complications that make an already difficult situation worse. You have legal rights in these situations, and I can help you understand them.
How the Workers' Comp Dispute Process Works in New Jersey
When a workers' comp claim is denied in New Jersey, the dispute is handled through the Division of Workers' Compensation — not a regular civil court. The process begins with filing a Claim Petition or an Application for an Informal Hearing, depending on the circumstances. From there, the case moves through a series of hearings before a workers' compensation judge.
I handle every step of this process for my clients — preparing the petition, gathering medical evidence, presenting your case at hearings, and negotiating with the insurer's attorneys. You focus on your health. I handle the legal fight.
What I Look at When I Review a Denied Claim
Every denial is different, and the right strategy depends on why the claim was denied and what evidence exists. When you bring your case to me, I look at the full picture: the denial letter and the reason given, your medical records and treatment history, how and when the injury was reported to your employer, and whether the insurer followed proper procedures under New Jersey law. Most workers' comp cases are handled on a contingency basis, which means you pay no attorney's fee unless I recover benefits for you.
Serving Injured Workers Across Gloucester County and South Jersey
I represent injured workers throughout Gloucester County — including Woodbury, Deptford, Washington Township, West Deptford, and the surrounding communities — as well as clients across Camden, Salem, Cumberland, and Atlantic counties. If your workers' comp claim was denied anywhere in South Jersey, I'm available to review your situation and explain your options at no cost.
Common Coverage Questions
Answers Designed To Keep You Protected
What happens if my workers' comp claim gets denied in New Jersey?
You have the right to dispute the denial through the New Jersey Division of Workers' Compensation. The process typically begins by filing a Claim Petition, which initiates formal proceedings before a workers' compensation judge. An attorney can help you build the evidence needed to challenge the denial and present your case effectively.How long do I have to appeal a denied workers' comp claim in NJ?
In New Jersey, you generally have two years from the date of the injury — or from the last payment of compensation — to file a Claim Petition. Missing this deadline can bar you from recovering benefits, so it's important to act promptly after a denial.Can my workers' comp benefits be terminated while I'm still injured?
Yes, insurers can and do attempt to terminate benefits before an injured worker has fully recovered. If your benefits were stopped and you're still unable to return to work, you can challenge that termination through the Division of Workers' Compensation. I handle these disputes regularly and can evaluate whether your termination was premature.Do I need a lawyer to appeal a denied workers' comp claim?
You're not required to have an attorney, but the insurer will have legal representation working against you. Having an experienced workers' comp attorney significantly improves your ability to gather the right medical evidence, navigate the hearing process, and negotiate a fair outcome. Most workers' comp attorneys, including me, handle these cases on a contingency basis — no fee unless you recover.What if the insurer says my injury isn't work-related?
This is one of the most common reasons for denial, and it's one that can be disputed with the right medical documentation and factual evidence. I work with injured workers to establish the connection between their condition and their job duties — whether the injury happened in a single incident or developed over time through repetitive work.
You Don't Have to Accept a Denial
Law office of WIlliam A. Sheehan
Insurance companies have attorneys working to limit what they pay. You deserve the same level of representation. I've spent 45 years helping injured workers in New Jersey dispute denied claims, fight premature terminations, and recover the benefits they're owed. A denial is not a final answer — it's the start of a process, and I know how to work through it.
