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How NJ Employers Avoid Paying for Workers’ Compensation

Why is it so hard for some employees to secure workers’ compensation payouts? How is it possible for so many claims to get denied or delayed?

Employers have certain “statutory defenses,” scenarios they can raise to avoid paying worker’s compensation. They will often attempt to invoke these defenses whenever possible to keep their own costs low. These defenses will also be raised when they deny the claim. Employers and workers’ compensation insurance companies generally hope you’ll accept their decision instead of fighting their ruling. 

The acceptable defenses are:

  1. The employee’s injury was self-inflicted, though death by suicide is compensable if the plaintiff can prove the suicide was caused by a disturbance of mind caused by a work-related injury and its consequences severe enough to override national judgment. The plaintiff must also prove there is an unbroken chain of causality between the work issue and the suicide. 
  2. The employee was intoxicated or under the influence of controlled substances. The employer must prove, by a preponderance of the evidence, that your intoxication was the sole source of your injury.
  3. The employee was traveling to or from work, and the employer is thus protected by the going and coming rule.
  4. The employee wilfully failed to make proper use of employer-furnished PPE.
  5. The employee was engaged in horseplay at the time of the accident. 
  6. The employee was an independent contractor, not an employee. 
  7. The injury or illness was not a workplace illness or injury.
  8. The claim is fraudulent.

There are plenty of gray-area cases where a win or a loss depends on the smallest of legal technicalities. Certain claim types are often more susceptible to triggering statutory defenses. Occupational disease claims, cardiac claims, and psychiatric claims all typically trigger battles over the real cause of these issues. 

If your employer has denied your claim you will need to work with a workers’ compensation lawyer right away. You should never just accept that the employer is in the right and you are in the wrong, but you will not be able to argue this case or push your claim on your own. Fighting with the insurer by phone or email is only going to get you so far. 

Fortunately, Talone Law has an excellent track record of challenging statutory defenses and showing why you deserve to be compensated in full.

Need help? Contact our law firm to get started today. 

See also:

How Occupational Disease Cases Work in New Jersey 

7 Signs Your NJ Workers’ Compensation Insurance Company is Acting in Bad Faith

Is Suicide Compensable Under Workers’ Compensation Death Benefits? 

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The Law Office Of Albert J. Talone
The Law Office Of Albert J. Talone is committed to providing for those with Workers Compensation cases throughout New Jersey.
302 N Washington Ave #101
New Jersey
United States

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