Denied My Ordinary Disability Pension?
October 12, 2024
Receiving an ordinary disability pension should provide financial relief when an injury or illness prevents a public employee from continuing their duties. However, many applicants face denials despite genuine claims. If your application for an ordinary disability pension was denied, understanding why and how to challenge that decision is critical.
At Feeley & LaRocca, LLC, we represent public employees, including firefighters, police officers, teachers, and other state employees in New Jersey, who have been denied the pensions they rightfully deserve. Read on to learn more about why denials happen and how to proceed if you’ve faced one.
Why Was My Ordinary Disability Pension Denied?
Denials of ordinary disability pensions often stem from issues related to eligibility or documentation. Below are ten common reasons:
- Insufficient Medical Evidence
The pension board typically requires robust medical evidence demonstrating that you are permanently disabled from performing your job duties. Applications lacking sufficient or clear documentation often face rejection. According to N.J.S.A. 43:16A-6, applicants must provide detailed medical records and evaluations showing that their disability prevents them from performing their regular job duties.
- Incomplete Medical Evaluations
Medical reports that fail to explicitly state the permanence of your disability or its impact on job performance may result in denials. The Division of Pensions and Benefits often requires evaluations from specialists familiar with your condition.
- Failure to Meet Job-Related Criteria
Ordinary disability pensions are granted based on the inability to perform essential job functions. If the board believes your disability does not preclude you from working in a different capacity within your role, they may deny the claim. Under N.J.S.A. 43:15A-42, the disability must directly impair the performance of your official duties.
- Insufficient Employment History
Public employees must meet minimum service requirements to qualify. For example, New Jersey law stipulates that applicants must have at least four years of service under N.J.S.A. 43:16A-6. Gaps in employment or miscalculations of service time can lead to denial.
- Application Errors
Errors in filing or incomplete forms can lead to an immediate denial. Precision and thoroughness in the application process are crucial. The Division of Pensions and Benefits requires all forms to be accurately completed within specified deadlines to avoid rejection.
- Missed Filing Deadlines
Failure to file within the required timeframes can lead to an automatic denial. Under N.J.A.C. 17:1-1.3, appeals or applications must meet specific deadlines to be considered valid.
- Disputes Over Disability Origin
The board may question whether your disability is job-related or pre-existing. If they believe your condition is not directly linked to your employment, they may deny your claim.
- Lack of Supporting Documentation
Beyond medical records, the board may require supporting documentation, such as incident reports, supervisor statements, or witness testimonies. Missing these elements can weaken your case.
- Contradictory Evidence
Evidence that contradicts your disability claim, such as reports of physical activity or inconsistencies in medical records, can result in denials. Providing consistent and accurate information is critical.
- Rejection of Prior Claims
A history of previously denied claims without addressing the board’s concerns can lead to continued rejection. Addressing these issues thoroughly in subsequent applications or appeals is essential.
If your application was denied, reviewing the denial letter carefully is essential. It will outline the specific reasons for the decision and guide your next steps.
Steps to Take After a Denial
A denial doesn’t mean your case is over. Here are the steps you can take to pursue your rightful benefits:
Step 1: Request a Review or Appeal
The first and most crucial step is to request a review or formally appeal the decision. The denial letter will typically provide instructions on initiating an appeal. Appeals allow you to present new evidence, clarify medical conditions, or correct procedural errors.
This is your opportunity to address the specific reasons for denial directly. Seeking assistance from a disability attorney in Winfield Park, NJ, ensures that your appeal is comprehensive and effectively presented. The appeal process has strict guidelines so adhering to these requirements is critical.
Step 2: Gather Comprehensive Medical Documentation
The strength of your case lies in the quality of your medical evidence. Work closely with your healthcare providers to gather updated medical records, detailed evaluations, and any necessary treatment histories. Focus on obtaining expert opinions that specifically address the issues raised in your denial letter.
For example, if the board questioned the permanence of your disability, your documentation should clearly establish its chronic nature and impact on your ability to perform job duties. The New Jersey Administrative Code emphasizes that evidence must come from licensed practitioners and include clear references to the disabling condition.
Step 3: Understand Legal Deadlines
Time is of the essence when appealing a denial. New Jersey law requires applicants to file appeals within 45 days of receiving the denial letter, as outlined in N.J.A.C. 17:1-1.3. Missing these deadlines can jeopardize your case entirely. Mark your calendar and prioritize completing all necessary forms and evidence gathering promptly. Consulting a Winfield Park, NJ pension disability attorney ensures that your appeal meets all deadlines and procedural requirements without unnecessary delays.
Step 4: Consult With an Experienced Attorney
Consulting an experienced Winfield Park, NJ Police pension attorney can significantly enhance your chances of overturning the denial. At Feeley & LaRocca, LLC, we have a proven track record of assisting public employees through the appeals process. Our attorneys understand the nuances of New Jersey’s disability pension system and can craft a compelling case on your behalf, addressing both legal and evidentiary challenges.
Step 5: Prepare a Detailed Appeal Package
A successful appeal requires a well-organized package that includes all necessary documentation. This package should not only address the issues raised in the denial letter but also highlight your eligibility under New Jersey statutes. Your attorney will help ensure that the appeal package includes clear and convincing evidence, comprehensive medical reports, and a persuasive argument explaining why you qualify for the pension.
Step 6: Request a Hearing
If your initial appeal is denied, the next step is requesting a hearing before an administrative law judge. This process allows you to present your case in greater detail and include testimonies from medical professionals and other relevant witnesses. A skilled attorney will represent you, ensuring that all evidence is effectively presented and advocating for your rights.
Step 7: Utilize Witness Testimonies
Witness testimonies can strengthen your case significantly. This might include colleagues, supervisors, or others who can attest to your job duties and how your disability affects your performance. These statements should align with the medical evidence provided, creating a cohesive argument that supports your claim.
Step 8: Address Board Concerns
Carefully review the denial letter to understand the board’s concerns and criticisms. Address these concerns point by point, whether they relate to insufficient evidence, questions about the origin of your disability, or procedural errors. Proactively resolving these issues demonstrates your commitment to pursuing a legitimate claim.
Step 9: Explore Additional Legal Remedies
If all appeals and hearings fail, you may have the option to take your case to a higher court. This step requires thorough preparation and a clear understanding of legal precedents. Your attorney will evaluate whether pursuing further legal action is in your best interest.
Step 10: Stay Persistent and Informed
Persistence is key to successfully overturning a denial. Keep track of your case’s progress, stay informed about legal updates, and maintain regular communication with your attorney. Demonstrating your commitment to obtaining the benefits you deserve can make a significant difference.
According to the New Jersey Division of Pensions and Benefits, approximately 20% of disability pension applications are denied annually due to insufficient evidence or procedural errors. Of these denials, nearly 40% are overturned on appeal when additional evidence or proper legal representation is provided.
For public employees like police officers and firefighters, disability claims often hinge on proving the connection between their job duties and the disabling condition. Studies show that first responders experience higher rates of musculoskeletal injuries, with approximately 25% of claims stemming from on-the-job injuries.
If your ordinary disability pension has been denied, don’t wait to seek legal guidance. The sooner you act, the stronger your case will be. Feeley & LaRocca, LLC, is ready to assist with your appeal and fight for the benefits you deserve.
Can You Reapply After a Denial?
Yes, you can reapply, but it’s often more effective to appeal the decision first. Reapplying without addressing the issues raised in your initial denial may lead to the same result. Before reapplying, carefully analyze the denial letter to understand the specific reasons for rejection. By addressing these points with updated evidence or more precise documentation, you improve your chances of success.
Additionally, an appeal gives you the opportunity to formally challenge the decision, often with the assistance of an attorney who can advocate on your behalf. Appeals also provide a structured platform to present new evidence, which is more impactful than simply reapplying. Working with an experienced Winfield Park, NJ pension disability attorney ensures that your subsequent efforts are targeted and effective.
Secure Your Benefits With Feeley & LaRocca, LLC
An ordinary disability pension denial can feel overwhelming, but you don’t have to face it alone. Feeley & LaRocca, LLC, has the experience, dedication, and knowledge to help you challenge the decision and secure the financial support you need. Take the first step toward protecting your future—contact us today to schedule a consultation.