Denied Workers’ Compensation Claims Lawyer

Facing a Denied Claim Isn’t the End

A workplace injury can disrupt every aspect of your life—your health, your income, your sense of stability. But when you take the right steps and file a workers’ compensation claim, you expect the system to help you. If that claim is denied, the blow is twice as painful. Many workers feel frustrated, confused, and powerless. At The Law Office of Miller & Gaudio PC, we know how these cases unfold. More importantly, we know how to turn around a denied claim.

We are here to help you fight back, protect your rights, and recover the compensation you rightfully deserve.

 

Understanding Workers’ Compensation in New Jersey

What Workers’ Compensation Covers

Workers’ compensation is a form of insurance required by New Jersey law that provides benefits to employees who suffer job-related injuries or illnesses. These benefits can include:

1. Payment for necessary medical treatment
2. Wage replacement for time missed from work
3. Compensation for partial or permanent disability
4. Death benefits for surviving family members in fatal cases

Why the System Fails Injured Workers

Despite being a no-fault system, workers’ compensation is often used by employers and insurance companies as a tool to minimize costs. Many valid claims are denied simply because insurers rely on legal technicalities, incomplete records, or bias from employer-selected doctors.

 

Common Reasons for Denied Claims

1. Denials Due to Medical Documentation Issues

Insurance companies often argue that the medical evidence is insufficient. This might be because your medical records don’t clearly link the injury to your job, or because the insurance company questions the severity of your condition.

2. Disputes Over the Cause of the Injury

Employers may challenge whether your injury occurred while performing work-related duties. For example, they may claim you were “off the clock,” or that the injury was caused by a pre-existing condition rather than job activities.

3. IME Conflicts and Biased Evaluations

Independent Medical Examinations (IMEs), though labeled “independent,” are often conducted by doctors hired by the insurance company. These doctors may downplay the extent of your injury or contradict your own physician’s findings, leading to a denial.

4. Missed Deadlines or Procedural Errors

Failing to notify your employer on time, filing your claim too late, or not completing the correct forms can all be reasons for rejection. These are fixable issues—if addressed quickly with legal help.

5. Surveillance and Social Media Evidence

Insurance companies may hire investigators to follow you or review your social media for activities they claim contradict your injury. Even innocent activities—like lifting light bags or attending a family event—can be twisted to suggest you aren’t truly injured.

 

What to Do Immediately After a Denied Claim

Read the Denial Letter Carefully

Your denial letter will outline the reason for the denial. Sometimes the reason is simple to fix (such as a missing medical form). Other times, it reflects deeper challenges. Either way, the letter is the key to determining how we will build your appeal.

Contact a Workers’ Compensation Attorney

Don’t attempt to navigate the appeal process alone. Time matters, and your first response can determine whether your case stays alive. Our firm offers a free consultation to review your situation and map out your next steps.

 

The Appeals Process in New Jersey

1. Filing a Claim Petition

In New Jersey, the first step to contest a denial is to file a Claim Petition with the Division of Workers’ Compensation. This allows your case to go before a judge, who will independently review the facts.

2. Pretrial Conferences and Hearings

Once your claim is filed, it may go through informal or formal hearings. Informal hearings may resolve simple disputes, while formal hearings are full legal proceedings where both sides present evidence and arguments.

3. Gathering Evidence to Strengthen Your Case

We work closely with medical providers, vocational experts, and accident reconstruction specialists if necessary. Our legal team builds a solid record to support your claim, including second opinions and testimony from co-workers or supervisors.

4. Judicial Decision and Further Appeals

If the judge rules against you, you may still appeal to the Appellate Division of the Superior Court. We guide clients through each level of the appeal system, ensuring every opportunity is explored.

 

How The Law Office of Miller & Gaudio PC Can Help

We Provide Immediate Legal Support

From the moment you reach out to us, we take action. We examine your denial, identify the weak points in the insurer’s case, and file the appropriate legal documents quickly.

Strategic Case Building

We don’t just gather paperwork—we build strategy. Our attorneys prepare your case as if it’s going to court, from day one. This approach often leads to faster settlements or stronger positions in negotiation.

Full-Service Representation

We handle every interaction with the insurance company, employer representatives, and medical providers. You won’t have to answer another confusing letter or phone call alone. We’ll be with you at every hearing, every step of the way.

No Upfront Fees

We represent workers’ comp clients on a contingency fee basis. That means you pay nothing unless we recover benefits for you. Our compensation is a percentage of your recovery, as regulated by New Jersey law.

 

Real Case Scenarios We Handle

1. Denials After Return to Work

We help workers who attempted to return to work too early and were later denied benefits because their injuries worsened or recurred.

2. Claims Involving Repetitive Stress Injuries

These include carpal tunnel syndrome, back injuries, and other conditions that develop over time. These cases are often denied initially but can be won with proper evidence.

3. Denials Based on Surveillance

We challenge cases where surveillance footage or social media posts are misinterpreted and used unfairly to deny claims.

4. Pre-existing Conditions

If your employer claims your injury is unrelated to work due to a pre-existing condition, we’ll provide medical evidence to prove the connection.

5. Missed Deadlines

We work with clients who believe their case is lost due to a missed deadline. In some situations, legal exceptions apply, and a case may still be revived.

 

Frequently Asked Questions

What should I do immediately after my workers’ compensation claim is denied?
If your claim has been denied, the most important step is to consult a qualified workers’ compensation attorney right away. Do not ignore the denial or attempt to navigate the appeal process on your own. Time limits apply, and acting quickly allows your attorney to preserve your rights, collect necessary evidence, and file the appropriate appeal before deadlines expire.

How long do I have to appeal a denied workers’ comp claim in New Jersey?
In most cases, you have two years from the date of your injury or the last compensation payment to file a formal claim petition with the New Jersey Division of Workers’ Compensation. However, certain types of appeals or procedural challenges may have much shorter deadlines, particularly if the denial is based on a missed filing requirement or procedural technicality. That’s why it is crucial to act quickly once you receive a denial letter.

Can I appeal a workers’ comp denial without a lawyer?
Yes, you can legally file and pursue an appeal without a lawyer. However, the workers’ compensation appeals process is complex and adversarial. You will be up against experienced insurance defense attorneys, and success often depends on medical evidence, legal argumentation, and procedural accuracy. Having a knowledgeable attorney by your side dramatically increases your chances of success.

What are my chances of winning an appeal after my claim was denied?
The likelihood of success depends on the specific facts of your case, including the reason for the denial, the strength of your medical evidence, and whether deadlines were met. Many denials are based on procedural issues, incomplete documentation, or questionable medical reports—problems that can often be corrected with legal intervention. Our firm has successfully reversed denials in a wide range of situations, and we can give you a realistic assessment during your initial consultation.

What role does an Independent Medical Examination (IME) play in the denial?
An IME is often requested by the insurance company and conducted by a doctor of their choosing. These exams are supposed to be neutral, but in reality, the findings often favor the insurer’s position. If the IME doctor minimizes your injuries or contradicts your treating physician, that report can be used to justify a denial. We regularly counter these biased opinions with stronger medical evidence and, when necessary, additional evaluations from trusted independent specialists.

 

Contact The Law Office of Miller & Gaudio PC Today

A denied claim can feel like a full stop—but it’s just a pause. At The Law Office of Miller & Gaudio PC, we transform setbacks into strong appeals. We fight back with legal knowledge, strategic preparation, and a deep commitment to our clients.

Contact us today to schedule a free consultation or submit your case information online. Your time to appeal may be limited, so don’t wait. Let’s secure the benefits you deserve—and rebuild your path to recovery.