Workers’ Compensation in New Jersey is the primary recourse for most work-related injuries, regardless of fault. This system is designed to cover medical expenses, a portion of lost wages and permanent disability, if applicable. However, just because you were hurt at work doesn’t always guarantee that your work injury claim won’t be denied.

Common Reasons for Workers’ Compensation Claim Denials in New Jersey

Whether your workers’ compensation claim in New Jersey will be denied depends on several factors specific to your situation and understanding these can help you avoid issues or address them if your claim is denied:

Injury Not Reported Promptly
- While there are also 14 and 30 day notice requirements which could impact your claim and raise doubts about whether the injury occurred at work, New Jersey law requires you to report a workplace injury to your employer within 90 days of the incident or from when you knew or should have known the injury was work-related.
Injury Not Work-Related
- Claims are often denied if the injury is deemed to have occurred outside the scope of employment. This includes injuries during recreational activities, commuting (unless specific exceptions apply), or personal tasks unrelated to job duties.
- For instance, if you were injured during a lunch break while off company premises, the insurer might argue it’s not compensable unless the activity was directly tied to your job.
Insufficient Medical Documentation
- A lack of clear medical evidence linking your injury to your job can lead to denial. You need comprehensive medical records showing the injury’s cause and its connection to workplace activities.
- Failing to seek immediate medical care or not following prescribed treatment can weaken your claim, as insurers may question the injury’s severity or legitimacy.
Pre-Existing Condition
- If the insurer believes your injury stems from a pre-existing condition not aggravated by your job, they may deny the claim. You must prove that work activities worsened or triggered the condition.
Disputed Employment Status
- Workers’ compensation covers employees, not independent contractors. If your employer disputes your status as an employee, your claim could be denied. Ensure you have documentation (e.g., employment contract, pay stubs) to prove your employee status.
Missed Filing Deadlines
- You must file a formal Claim Petition with the New Jersey Division of Workers’ Compensation within two years of the date of injury, the date of last compensation payment (including medical treatment), or, for occupational illnesses, the date you became aware of the condition’s link to work.
- Missing this statute of limitations will almost certainly bar your entire claim.
Suspicion of Fraud or Intentional Injury
- Claims may be denied if the insurer suspects you intentionally caused the injury or exaggerated its severity. For example, inconsistencies in your account or lack of witnesses can raise red flags.
Non-Compliance with Medical Treatment
- Failing to follow medical advice, such as skipping appointments or disregarding treatment plans, can lead to denial. Insurers may interpret this as evidence that the injury isn’t serious or work-related.
Employer Lacks Insurance
- If your employer is uninsured, your claim may face complications. However, you can seek benefits through the Uninsured Employers Fund (UEF), which covers temporary disability and medical expenses, though the process is more complex.

Other Situations That Can Lead to Denied Claims

Intentional or self-inflicted injuries are not compensable. However, the Supreme Court found that “employee’s death by suicide is compensable where the original work-connected injuries result in the employee’s becoming dominated by a disturbance of mind directly cause by his injury and consequences, such as extreme pain and despair, of such variety as to override normal rational judgment.” Kahle v. Plochman, Inc., 428 A.2d 913 (N.J. 1981). In that case, worker suffered an injury, which led to back surgery and a dependency on potent medications. She never returned to work, developed a convulsive disorder from drug withdrawal, arachnoiditis, a neurogenic bladder, anemia, iron deficiency and cystitis and ultimately committed suicide.

Willful misconduct, “horseplay,” are not compensable. However, employees who do not participate in, but are innocent victims of, horseplay by fellow employees have compensable claims for any injuries sustained. Trotter v. Monmouth County, 365 A.2d 1374 (N.J. Super. Ct. App. Div. 1976).

Injuries involving drugs and/or alcohol are not compensable when the injuries are the natural and proximate result of intoxication or the unlawful use of controlled dangerous substances. However, the employer is required to prove that the intoxication was the sole and proximate cause of the injury to defeat a claim on that ground. Cellucci v. Bronstein, 649 A.2d 1333 (N.J. Super. Ct. App. Div. 1994), certif. denied, (1995). Basically, if the injured employee can point to any contributing cause other than intoxication, he can still receive workers’ compensation benefits. Warner v. Vanco Mfg. Inc., 690 A.2d 1126 (N.J. Super. Ct. App. Div. 1997), certif. denied, 697 A.2d. 544 (N.J. 1997).

Seek the Assistance of an Attorney Immediately After an Injury

Meeting early with an attorney who specializes in New Jersey Workers’ Compensation will help you avoid the pitfalls that can result in your comp claim being denied. They will assist in making sure all injuries were reported appropriately and that prompt medical care and other benefits are provided. They will deal with the headaches that come with all personal injury claims so you can focus on getting better and back on your feet.

Contact a New Jersey Workers’ Compensation Lawyer at the Law Offices of Michael S. Williams to Avoid a Denied Claim

If you have been injured on the job and need help with your claim, a Workers’ Compensation lawyer at the Law Offices of Michael S. Williams is here for you. Call 732-351-2800 or contact us online to schedule a free initial consultation. Our offices are located in Tinton Falls and New Brunswick, New Jersey and we serve not only clients in Monmouth and Middlesex County, but throughout the state.