My workers’ compensation claim was denied. What now?

New York law requires that nearly all employers provide workers’ compensation coverage for their employees. Yet this does not mean every workers’ compensation claim is accepted.

Many workers’ compensation administrators accept claims, but the reality is that sometimes claims are denied. When that happens, a skilled attorney’s help can be invaluable. Indeed, working with experienced counsel from the outset may reduce chances of rejection.

Why claims are rejected

There are many reasons why an insurer could deny a claim. These include, but are not limited to:

• An opinion that your injury or illness suffered is not work-related
• Failing to inform your employer of your injury or illness in a timely fashion
• Not filing the claim within the time required by the law
• Not seeking or receiving medical treatment for the injury or illness

The process

A carrier’s denial of your claim is not the end of the story.

A lawyer can examine the facts of and evidence in your case and determine the next step after the carrier’s denial. A hearing can be requested and the outstanding issues of your claim would be presented to an administrative judge who would examine evidence, possibly hear testimony, and make decisions about your case and your entitlement to awards.

If you win your case, you will be entitled to medical treatment for your injuries, and the judge may direct awards for your lost time from work. 

If you lose your case, you can appeal in writing within 30 days. A three-member panel of the board then will hear your appeal. Three outcomes are possible:

• The panel can uphold the judge’s ruling
• The panel can modify the ruling
• The case can be referred for further judicial consideration

These steps can delay the resolution of your case. Meanwhile, an insurer can withhold paying some of your benefits. As a result, timely action on your part, and good legal representation, are essential at every stage of the process.