Mistakes That Can Lead to Denied Workers’ Comp Claims

A New York City workers’ compensation lawyer can help

If you sustain a serious work-related injury or illness, you should be eligible to receive workers’ compensation benefits in most cases. Unfortunately, some workers’ comp claim applications are denied, leaving the injured worker on the hook for medical expenses, lost income, and other costs.

Our New York workers’ compensation attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP understand how this system works. We know the reasons insurance companies deny claims – and what you can do if you’re in this situation.

Who decides to deny workers’ comp applications in New York?

When you’re injured on the job, it’s up to the workers’ compensation insurance company to decide whether to approve or controvert (dispute) the claim. Your employer may request that they approve or deny the claim, but since the insurance carrier is ultimately liable, they don’t have to follow the employer’s request.

How often are workers’ compensation claims denied?

Nationally, roughly 4.9 million people apply for workers’ compensation benefits each year, according to the U.S. Bureau of Labor Statistics (BLS). Of those applications, roughly 7 percent of applications for workers’ compensation benefits are denied, according to a 2018 study conducted by the insurance industry. That means about 343,000 workers’ compensation applications are denied each year.

In New York, roughly 150,000 people apply for workers’ compensation benefits each year, according to the New York Workers’ Compensation Board. In 2022, that figure was even higher as 161,808 people in New York submitted a workers’ compensation claim application.

Of those claims, 16,822 were “controverted,” which means they were denied or disputed by the insurance company. That means about 10.3 percent of workers’ compensation claim applications in New York were controverted in 2022, which is about the percentage most years. Not all controverted claims are denied entirely – some only involve the insurance company denying a portion of the claim – but either way, it’s a frustrating situation for the injured worker.

So, if your workers’ compensation claim is denied or disputed, you’re certainly not alone. We deal with this every day, and we know what’s next.

Reasons why a workers’ compensation claim might be denied

Again, if you were hurt at work, you should be eligible for workers’ comp. However, there are some issues that could lead to a claim being denied:

The injury wasn’t reported in a timely manner – If you were injured in an accident that happened at a definite moment in time, then you need to report the accident to your employer within 30 days.
The application wasn’t filed on time – For work accidents, you have two years from the date of the accident to file a claim. For work-related illnesses that happened over a period of time, the deadlines are more complicated. Either way, missing a deadline can lead to a denied claim.
Lack of medical documentation – If you don’t see a doctor right away after a work injury to get your injuries diagnosed and documented, then your claim for workers’ compensation may be in jeopardy.
The insurance company disputes whether the injury happened at work – If you weren’t on the job when the injury happened, then it’s not covered by workers’ comp.
The insurance company alleges you were intoxicated – If you were under the influence of alcohol or drugs, and your intoxication was the cause of your injury, then your claim can be denied on that basis.
The insurance company alleges that you intentionally injured yourself – While work injuries that are a result of your own carelessness (like tripping over your own feet) are covered by workers’ comp, intentionally self-inflicted injuries are not. This also applies to injuries sustained in a fight that you started.

What happens if a workers’ compensation claim is denied?

Disputes over workers’ compensation claims are handled by the New York Workers’ Compensation Board. If the dispute cannot be resolved through a settlement or other informal means, then a hearing will be held before a Workers’ Compensation Law Judge. More than 225,000 such hearings were conducted in 2022.

If you disagree with the judge’s decision, you can request a review of the decision by the Workers’ Compensation Board. From there, you can appeal to the New York Supreme Court, Appellate Division, and from there to the New York Court of Appeals. An attorney can explain all of your options and guide you through the process to appeal a denied claim.

How to avoid making mistakes when applying for workers’ compensation

There are many steps you should take to reduce the likelihood of having your workers’ compensation application denied, including:

Report your work injury as soon as possible, in writing – You have 30 days to report the injury to your employer, but we recommend that you do so much sooner than that. Remember, you must tell your supervisor, not just a coworker. Legally, you can do this verbally, but it’s best to put it in writing so you have a record.
File your workers’ compensation claim on time – You have two years from the date of the accident to file a claim with the Workers’ Compensation Board.
Carefully document your work-related injury or illness – Write down your symptoms. Take pictures of any visible injuries. Every detail matters.
Tell your doctor exactly how you feel – Don’t try to be strong and silent. If you are in pain, tell your doctor. That way, you receive the medical care you need, and your physician can accurately document your symptoms.
Follow your doctor’s advice – Do what your doctor tells you to do. This is not only best for your health, but also for your workers’ compensation claim.
Hire a workers’ compensation attorney – The sooner you have an experienced workers’ comp lawyer handling your case and advising you on your legal rights, the better.

How can a New York workers’ compensation lawyer help?

The application process for workers’ compensation benefits in New York can be confusing and overwhelming. An experienced attorney can help guide you through this system, whether it’s applying for benefits or appealing a denied workers’ compensation application.

Our workers’ compensation lawyers thoroughly understand how this system works. As your attorney, we can be there for you every step of the way and put you in the best position to get the benefits you deserve under New York law.

Get the law firm that New York trusts. Contact us and schedule an appointment with a New York workers’ compensation attorney you can count on when it matters most.

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