If you’ve been injured at work in New York, filing a workers’ compensation claim is supposed to help you cover medical bills and lost wages while you recover. However, what happens when your claim is denied? A denied workers’ compensation claim can feel like a setback, but it’s not the end of the road. In New York, there are steps you can take to appeal the decision and fight for the benefits you deserve.
Common Reasons for a Workers’ Compensation Claim Denial
Understanding why your workers’ compensation claim was denied is the first step toward challenging the decision. Some of the most common reasons for a claim denial in New York include:
- Insufficient Medical Evidence: The insurance company may argue that there isn’t enough evidence to prove that your injury is work-related or that your condition warrants benefits.
- Missed Deadlines: In New York, you must notify your employer of your injury within 30 days and file a workers’ compensation claim within two years. Missing these deadlines can result in denial.
- Disputed Work-Relatedness: Your employer or the insurance company may claim that your injury wasn’t caused by work-related activities, especially if there’s no clear incident that led to the injury.
- Pre-existing Conditions: If you have a pre-existing condition, the insurance company might argue that your current injury isn’t related to your work but rather to a previous condition.
- Injury Not Covered: Some injuries, such as those caused by horseplay or being under the influence of drugs or alcohol at work, are not covered by workers’ compensation.
Once you know the reason for your denial, you can begin gathering the evidence and documentation needed to appeal the decision.
Steps to Take After Your Workers’ Compensation Claim is Denied
Don’t give up if your claim is denied. In New York, you have the right to appeal a denied workers’ compensation claim. Here’s what to do:
1. Review the Denial Letter
After your claim is denied, you will receive a letter explaining the reasons for the denial. It’s important to review this letter carefully and understand the specific reasons cited by the insurance company or your employer. This will help you focus on addressing the issues that led to the denial.
2. Gather Additional Evidence
One of the most common reasons for claim denials is a lack of sufficient medical evidence. If this was the case for your denial, you’ll need to gather more detailed medical records, reports, and possibly statements from your doctor that explicitly link your injury to your work activities. Keep copies of all medical documentation, including test results, treatment records, and any recommendations from specialists.
If your claim was denied due to a dispute about the work-relatedness of your injury, consider gathering witness statements from coworkers or supervisors who saw the incident or can testify to the work conditions that led to your injury.
3. File a Request for a Hearing
If you believe your denial was unjustified, you can request a hearing before the New York Workers’ Compensation Board. To do this, you must file an appeal by submitting Form RB-89 (Application for Board Review). This must be done within 30 days of receiving the denial letter.
At the hearing, you’ll have the opportunity to present evidence to an administrative law judge who will review your case and make a decision. It’s important to be well-prepared with all necessary documentation and a clear explanation of why your injury qualifies for workers’ compensation benefits.
4. Consider Legal Representation
While it’s possible to appeal a denied workers’ compensation claim on your own, working with an experienced workers’ compensation attorney can significantly increase your chances of success. A lawyer will understand the complexities of New York workers’ compensation law and can help you build a strong case by gathering the necessary evidence, meeting deadlines, and representing you at hearings.
An attorney can also negotiate with the insurance company on your behalf, potentially leading to a settlement before the case goes to a full hearing.
What Happens After the Hearing?
After your hearing, the administrative law judge will issue a decision based on the evidence presented. If the judge rules in your favor, you may receive the benefits you are entitled to, including coverage for medical treatment and a portion of your lost wages.
If the judge rules against you, you can appeal to the Workers’ Compensation Board panel for a further review. If necessary, your case can continue through higher levels of appeals, including the Appellate Division of the New York State Supreme Court.
Don’t Give Up on Your Workers’ Compensation Benefits
Being denied workers’ compensation benefits in New York can be frustrating, but it’s important to remember that a denial is not final. Many claims are initially denied due to errors or insufficient evidence, but with persistence and the right legal help, you can successfully appeal and receive the benefits you deserve.
If your workers’ compensation claim has been denied, our experienced workers’ compensation attorneys at Shafran & Rock can guide you through the appeals process and help you fight for the benefits you need. We have a deep understanding of New York’s workers’ compensation laws and can build a strong case to support your claim.
Don’t wait. Contact us today to schedule a consultation and learn more about how we can help you appeal your denied workers’ compensation claim.