Navigating Disputes: What to Do When your Claims are Denied

In this episode of Workers' Comp: Know Your Rights, host Tracy Merda welcomes attorney Kathleen Dotoli, a specialist in workers' compensation and social security disability law in New Jersey. Together, they explore the intricacies of handling workers' compensation claims, particularly what to do when claims are denied. Kathleen shares her insights on filing motions, the importance of notice, overcoming preexisting condition challenges, the role of insurance adjusters, and strategies for successfully appealing denied claims. She also highlights key benefits workers may not know they are entitled to, such as wage replacement, fully paid medical care, and the ability to reopen cases under specific conditions.

 

Timestamps:

[00:05-00:32] Overview of today’s topic: handling disputed claims.

[00:32-01:45] Filing claim petitions and motions for medical and wage benefits.

[01:45-03:07] Common issues causing claim disputes and how to resolve them.

[03:07-04:00] The role of judges in workers' compensation cases.

[04:00-05:14] Common reasons insurance companies deny claims.

[05:14-06:08] The role of insurance adjusters and their relationship with employers.

[06:08-07:02] How investigations impact claim decisions.

[07:02-08:06] Criteria insurance adjusters use to approve or deny claims.

[08:06-08:45] The process of providing additional evidence for denied claims.

[08:45-10:11] Strategies for appealing or resolving denied claims.

[10:11-12:02] Importance of proper injury notification and its impact on claims.

[12:02-13:25] The value of legal representation and understanding workers’ rights.

[13:25-14:42] Key benefits available to injured workers, including reopening cases.

 

About The Show

Workers' Comp: Know Your Rights is a podcast dedicated to helping employees understand their rights and navigate the complex world of workers' compensation and related legal issues. Hosted by Tracy Merda and attorney Kathleen Dotoli,, the show features expert guests, including experienced attorneys and industry professionals, who provide actionable advice and insights on topics like filing claims, dealing with denied benefits, understanding employer obligations, and maximizing compensation. Each episode is designed to empower listeners with the knowledge they need to protect themselves and their families after workplace injuries or disputes.