19 Mar Workers’ Comp Claim Denied? Here’s What to Do

Workers’ Comp Claim Denied? Here’s What to Do

Having your workers’ compensation claim denied can feel devastating, especially when you are struggling with injuries, medical bills, and the inability to work. But a denial is not the end of the road. In New York, you have the right to appeal a denied workers’ compensation claim — and with the help of an experienced attorney, many initially denied claims are successfully overturned. This guide explains why claims are denied and what steps you should take to fight back.

Common Reasons Workers’ Compensation Claims Are Denied

Understanding why your claim was denied is the first step to overturning it. The most common reasons for denial include the following situations. The insurance carrier may dispute that your injury occurred at work or in the course of employment — they may claim it happened outside of work hours, during a personal activity, or while you were violating a workplace policy. They may argue that your condition is a pre-existing condition not caused or aggravated by your work, or that you failed to report the injury within the required 30-day window. Failure to file the C-3 form with the Workers’ Compensation Board, unauthorized medical treatment, or lack of medical evidence supporting the work-related injury are also common denial reasons.

Step 1: Understand Your Denial Notice

When the insurance carrier disputes your claim, they must file a notice with the New York Workers’ Compensation Board identifying the specific grounds for denial. Review this document carefully to understand exactly what the insurer is contesting. This will guide your appeal strategy. If you don’t fully understand the notice, an attorney can explain it and help you develop a response.

Step 2: Request a Hearing

If your claim is denied or disputed, you can request a hearing before a Workers’ Compensation Law Judge (WCLJ) by contacting the Workers’ Compensation Board. You will receive a hearing date, at which you and the insurance carrier will both have the opportunity to present evidence. Having an attorney represent you at this hearing is strongly recommended — the insurer will be represented by experienced defense counsel, and the rules of evidence and procedure can be complex.

Step 3: Gather Strong Medical Evidence

Medical evidence is the cornerstone of a workers’ compensation claim. Make sure you are treating with a doctor authorized by the Workers’ Compensation Board. Provide your doctor with a full account of how your injury occurred and how it affects your ability to work. Obtain detailed written opinions from your treating physician linking your injury to your work activities. If the insurance carrier has had you examined by their independent medical examiner (IME) and that examiner disputed your claims, your treating physician’s testimony can help counter those findings.

Step 4: Compile Supporting Evidence

In addition to medical evidence, gather all documentation supporting your claim. This includes witness statements from coworkers who saw the accident or its aftermath, your own written account of how the injury occurred, time sheets and work records placing you at the work site at the time of injury, any safety reports or inspection records related to the hazardous condition, and prior documentation of the dangerous condition that caused your injury.

Step 5: Appeal to the Workers’ Compensation Board Panel

If the Workers’ Compensation Law Judge rules against you, you can appeal to the Workers’ Compensation Board Panel, which is composed of three Board members. They will review the record and determine whether the WCLJ’s decision was correct. Further appeals are possible to the Appellate Division of New York State Supreme Court and beyond.

Why You Need an Attorney for a Denied Claim

Appealing a denied workers’ compensation claim is a formal legal process with strict procedural rules and deadlines. Insurance carriers are represented by experienced defense attorneys and will vigorously defend every aspect of the denial. Having an experienced workers’ compensation attorney on your side significantly improves your chances of a successful appeal. Your attorney will gather evidence, prepare your case, represent you at hearings, cross-examine the insurer’s witnesses, and advocate for your full benefits.

Contact Our Workers’ Compensation Attorneys

If your workers’ compensation claim has been denied in New York, don’t give up. The experienced workers’ compensation attorneys at Tannenbaum, Bellantone & Silver, P.C. know how to fight insurance carriers and win. We have helped injured workers across Long Island successfully appeal denied claims and secure the benefits they deserve. Contact us today for a free consultation.