What Happens if My Jones Act Claim Is Denied?

As a seaman, sailor, or other worker on board most vessels in US waters, you have certain rights under federal legislation if you’re hurt on the job. You’re likely wondering, “What happens if my Jones Act Claim is denied?” When that happens, you can still receive benefits if you learn how to appeal your case.

By putting your trust in an experienced New Orleans Jones Act lawyer, you can gather powerful evidence and correct any errors to boost the strength of your claim and get the benefits you deserve. 

Following the right steps and taking your case as far as you can can get complicated and require legal representation. Keep reading to understand how to take action.

Potential Reasons Why Your Jones Act Could Be Denied

Insurance providers review every Jones Act case closely, trying to determine if it’s valid before paying out compensation. This means they might find something that gives them a reason to send you a denial letter.

Some of the reasons why your Jones Act claim was denied might include:

• You don’t qualify under Jones Act requirements (see the next section for who is eligible).
• There wasn’t enough proof that your injury occurred at work.
• You didn’t provide adequate medical evidence of your injuries.
• You left out information on the form or included incorrect information.
• You didn’t report the injury to your supervisor or manager within 30 days.
• You were engaged in horseplay, fighting, or other prohibited activities when you got hurt.
• You hurt yourself on purpose or neglected to take proper safety precautions. 
• You were drunk or under the influence of illegal substances when you were injured at work. 

A maritime injury lawyer can review your application and help you understand the reasons for the denial and how to address them. Some can be fixed by collecting the necessary medical or other records and submitting them or by correcting any incorrect information. 

Others, such as claims you were negligent on the job, require a more aggressive approach to show who is at fault instead of you, if possible. 

Understanding Who Is Eligible to File a Jones Act Claim

Congress passed The Jones Act (Merchant Marine Act of 1920) to provide benefits to individuals who work on vessels and floating structures that operate in U.S. ports and waters. Those who qualify must spend at least 30% of their hours working offshore, performing jobs that are essential to the vessel’s function. The vessel must also be owned by an American citizen or company and be U.S.-flagged.

To be eligible for a Jones Act claim, you must work in a U.S. port within three nautical miles of the coastline that falls under the definition of navigable waters.

The Act primarily covers seamen and sailors working on vessels that transport passengers or cargo between U.S. ports. Even if you don’t work on the ocean, maritime law does cover accidents that happen in rivers and lakes.

Those who don’t fall under the protection of the Jones Act can seek benefits from either their employer’s workers’ compensation program or the Longshore & Harbor Workers’ Compensation Act (LHWCA).

The LHWCA ensures dockworkers have remedies under maritime law, especially those engaged in cargo loading and unloading, shipbuilding, ship breaking, ship repair, and oil and gas rig work. If you’re still not sure whether you qualify for a Jones Act claim, speak with a skilled maritime injury lawyer for help. 

Appealing Your Jones Act Claim When It Is Denied

After your Jones Act claim is denied, you should take immediate action to begin an appeal. You may be able to figure out what to do by reading the letter, but if you’re unsure, it’s wise to schedule a free consultation with a Jones Act attorney who can examine the reasons with you. Their background in these cases allows them to get your appeal underway as quickly as possible.

If your Jones Act claim is denied for paperwork mistakes, you may be able to speak with the claims examiner and get the problem cleared up. If you need to submit additional medical information, this might also be something you can handle on your own.

However, if your denial is for more complicated reasons, you will want a seasoned attorney on your side because you likely will have to go to court.

All Jones Act claims fall under U.S. federal jurisdiction, according to Article III, Section 2 of the United States Constitution. Despite this, there are state laws that might impact your claim, and the details of your case determine what laws apply. Your New Orleans maritime injury attorney can manage the aspects of your case and prepare it for trial while you focus on getting better.

You May Need to File a Lawsuit if Your Jones Act Claim Is Denied

Many claim denials depend on whether the employer’s insurance company thinks you were fully or partially at fault for your injuries. In these cases, it’s best to work with an attorney and file a formal lawsuit to secure the compensation and other benefits you deserve.

Maritime employers have a number of defenses they can use to reduce or deny what they pay you, even though the Jones Act specifically requires them to provide maintenance and cure after you’re hurt.

Maintenance pays for your daily living expenses, such as housing, food, and utilities. Cure covers your medical costs and other expenses, such as medication, travel to your appointments, and therapy.

You are also eligible for partial wages until you reach maximum medical improvement, meaning you’re as recovered as you are expected to get.

If you can demonstrate your employer was negligent and their actions led to your injuries, you can file a lawsuit to recover full compensation, including more than maintenance and cure.

If a third party was responsible for your accident, you can also seek financial relief from them through a lawsuit. Because maritime injury trials are so complex, your first priority after getting hurt should be getting medical attention and then calling a qualified Jones Act lawyer.

Call Us to Discuss What Happens When Your Jones Act Claim Is Denied

At Scott Vicknair Injury Lawyers, our team stands ready to help you manage what happens when your Jones Act claim is denied. During your free case review, we will listen to your situation and answer your questions.

Contact us today and learn more about what to do next from a top–tier New Orleans Jones Act lawyer.