What To Do If Your Workers’ Comp Claim Is Denied

If you suffer a workplace accident or injury, your best bet for recovery is to file a claim for workers’ compensation benefits, which include both medical benefits and lost wage benefits. However, the workers’ compensation claim process is filled with hurdles and pitfalls for claimants to overcome, and claim denials are common. While a denied claim is frustrating, it does not necessarily mean that you are out of luck. Our workers’ compensation attorneys can shepherd your claim through the hearing and appeals stages to ensure that you receive the benefits to which you are entitled. 

Common Reasons Why Workers’ Compensation Claims Are Denied 

No two workers’ compensation claims are alike. However, the reasons for denied workers’ compensation claims typically fall into one of a few buckets. The most common reasons why workers’ compensation claims are denied in New York include: 

• • You missed a deadline: Workers’ compensation claimants must observe strict deadlines during the claims process. Generally, you must report your injury to your supervisor within 30 days of its occurrence and file your workers’ compensation claim within two years of the date the accident occurred. Failure to meet either of these deadlines can result in a denied claim. 
  • You delayed medical treatment or failed to seek it: You should seek medical treatment for your work injury as soon as possible because your doctor will need to file a report with the Workers’ Compensation Board. Without that medical evidence, your workers’ compensation insurance will likely deny your claim. Furthermore, delaying or failing to seek medical care can exacerbate your injuries. Your workers’ compensation insurance can use that to deny your claim, arguing that your injuries are due to your failure to seek medical care rather than the accident itself. 
  • You made errors in your claim form: Workers’ compensation claimants are required to submit Form C-3 to begin their claims with the Workers’ Compensation Board. Your claim may be denied if there are material errors or inconsistencies in the information you submit with this form. 
  • Your injury is not work-related: Workers’ compensation benefits are available only for injuries that are work-related. Generally, a “work-related” accident is one that arises out of or within the scope of the worker’s duties. Claiming workers’ compensation for non-work-related accidents — including commuting accidents and injuries — will result in a denied claim. 
  • You were engaged in wrongdoing at the time of the accident: Not all work-related injuries are eligible for workers’ compensation. The three main categories of non-eligible accidents are accidents in which the injured worker was impaired by drugs or alcohol, accidents that were the result of prohibited horseplay, and accidents that occurred due to intentional behavior (e.g., workplace violence)

If your workers’ compensation claim was denied for the above reasons — or any other reason — you should speak to a workers’ compensation attorney who can help you get your claim back on track. 

Step 1: Workers’ Compensation Hearings 

If your employer or your workers’ compensation insurance carrier denies your claim, the claim becomes contested. The party that denies the claim will notify the Workers’ Compensation Board, providing the reasons why it is denying the claim. The Workers’ Compensation Board will then schedule a hearing with a workers’ compensation law judge to be attended by the injured worker, a representative from the insurance company, and the injured individual’s workers’ compensation attorney. During the hearing, the judge will hear arguments from both sides and examine any evidence each side presents (including witness testimony). At the conclusion of the hearing, the judge will issue his or her ruling, either allowing the claim or denying the claim. 

Step 2: Appeals

A denied claim at the hearing stage may seem like the end of the road, but it is not. If the workers’ compensation law judge denies your claim, there are several levels of appeal you may pursue. 

First Level Appeal: Workers’ Compensation Board

If your hearing doesn’t go your way, you may appeal the judge’s decision to the Workers’ Compensation Board within 30 days of the date it is filed. Here, a panel of three Board members will review the judge’s decision and may affirm it, modify it, or overturn it. If the panel’s decision is not unanimous, you may request a review by the full Workers’ Compensation Board. 

Second Level Appeal: Appellate Division 

If you are dissatisfied with the Board’s decision, you may proceed to the second level of appeals by appealing the decision to the Appellate Division of the New York Supreme Court. There, the court may affirm the Board’s decision, modify it, or overturn it. 

Third Level Appeal: Court of Appeals 

If you are dissatisfied with the Appellate Division’s decision, you may appeal your case one final time to the New York Court of Appeals. 

How a Workers’ Compensation Attorney Can Help You With a Denied Claim 

Arguing your case at a hearing or appealing a denied claim to the Workers’ Compensation Board is significantly more complicated than filing an initial claim. This is because the arguments at each stage become more complex. You’re not just arguing that you’re entitled to benefits — at the appellate level, you’re also arguing that the workers’ compensation law judge or Board panel made the wrong decision, and to do that, you need to have a comprehensive understanding of the intricacies of New York workers’ compensation law and procedure. Workers’ compensation attorneys have that knowledge, as well as extensive experience wielding it on behalf of claimants at all levels of the appeals process, and thus are able to present much stronger arguments than you would be able to present on your own. 

Our Workers’ Compensation Attorneys Can Fight for Your Claim 

If your workers’ compensation claim was denied, don’t panic — it’s not over yet. You may still be able to obtain benefits at the hearing or appeals stages. To get your claim back on track, please contact a workers’ compensation attorney at Turley, Redmond & Rosasco by using our online form or calling us at 631-582-3700.