What to Do if My Workers’ Comp Claim Is Denied?

When the Workers’ Compensation Board of New York denies your claim for workers’ compensation, it can be a frustrating feeling, particularly if you believe you did everything right in filing your claim. You might find yourself on the internet, searching terms like, “What to do if my workers’ comp claim is denied?”

If this sounds familiar, it is time to get in touch with a New York workers’ compensation lawyer. It’s important to understand that you still have some options after a denial of your claim, including going through an appeals process. Tucker Lawyers, PC in New York is ready to help with your appeal.

What Happens if Workers’ Comp Is Denied in New York?

After a denial of a workers’ compensation claim in New York, you will not receive any benefit payments from an insurance company. This clearly is not the desired outcome, as it leaves you facing mounting financial problems. Hopefully, the appeals process will help you win the settlement you deserve.

If your New York workers’ comp claim was denied, contact an experienced New York workers’ compensation lawyer as soon as possible. The majority of denied appeals are not overturned. However, an experienced lawyer may be able to identify what went wrong with your claim and provide the court of appeals with the evidence they need to see to rule in your favor.

It’s also important to understand that when we file an appeal on your behalf, it does not mean you’ll start receiving benefits immediately. The insurance company does not pay benefits while your appeal is moving through the process. To receive the benefits you deserve, we have to win the appeal. If we win your appeal, we will attempt to go back and recover the benefits you should have had from the time the original decision occurred.

What Steps Occur During a Denial of New York Workers’ Compensation?

If you intend to appeal, it helps to first understand what steps occur during a denial of a workers’ compensation claim. When the New York Workers’ Comp Board (NYS WCB) hears your claim, it can approve or deny it. Should the board deny the claim, you will receive a letter explaining the reasons for the denial. You can either accept the denial or you can file an appeal.

[callout] When filing an appeal, you have a 30-day window to start the process. It is important that you meet the deadline, or you will lose your chance to appeal.

At this point, you likely will want to have representation on your side. You can be certain the insurance company will have legal representation during the appeals process. Hiring your own attorney will help you even the playing field. Our team of workers’ comp lawyers knows how to prepare the information in the appeal case to give you the best chance of winning. We will ensure that your case meets all deadlines and follows all procedures.

Once our lawyers get involved in your case, we’ll work to understand what element of your claim led to the denial. In some cases, certain documentation may have been missing, incomplete, or incorrectly filled out. Even a small error in the application can lead to a New York workers’ comp claim denial.

In other cases, the medical documentation you provided might not have met the criteria for “qualifying documentation” required by the NYS WCB. Once we know what went wrong, we will work to amend any error, gather the necessary documentation, and prepare to represent you to the board during the appeals process.

Why Do Workers’ Compensation Claims in New York End Up Being Denied?

New York workers’ compensation claims are denied for several reasons. One of the most common is incomplete or incorrect documentation. At the beginning of January 2023, the  New York State Workers’ Compensation Board released its 2022 annual report. The report reveals that over 11 million workers’ compensation claim documents were received by the NYS WCB.

However, less than 200,000 claims were reviewed by the board. The reason for this was attributed to issues with incomplete documentation. If a workers’ comp claim is regarded as incomplete, it isn’t processed. According to the NYS WCB, “complete” documentation requires, at minimum, a formal notice of the injury by an employers’ workers’ comp insurer and valid medical documentation.

One of the best ways to win an appeal after a denial of your worker’s compensation claim in New York is to fully understand why the denial occurred in the first place. Without a full understanding of why the board denied your initial claim, it’s difficult to come up with arguments that show why you should win an appeal.

We will use our years of experience in handling all kinds of workers’ comp claims, including appeals, to prepare for your appeal hearing. In cases where we’re appealing an initial board decision, we will look closely at the original decision. We will collect evidence that shows why you deserve a settlement. We take the time to understand how we can represent you in the most successful manner before the appeal judges.

Common Reasons Why New York Workers’ Comp Claims Receive a Denial

There are quite a few different reasons for the denial of initial workers’ compensation claims. Even in an appeal, some of these reasons may be too much to overcome. However, our team knows how to argue against many of the reasons for a denial. Through our gathering of the facts in your case, we can work hard to win your appeal and to counteract the original decision.

Some of the most common reasons for denying workers’ comp claims include:

  • Not notifying your employer of the injury accident within 30 days
  • Failing to seek medical attention for the injury from a doctor
  • Failing to fully follow your doctor’s orders for treatment
  • Purposely injuring yourself
  • Drinking or taking drugs on the job before your injury
  • Blaming the workplace for an old injury.

Even if the board determined that your claim failed because of one of these reasons, we may be able to prove otherwise through our investigation. If co-workers claim that you caused your own injuries, for example, they could be lying to cover up their own negligence in the case. We can seek additional testimony about the accident to try to discredit these lies.

How Many New York Workers’ Comp Claims Are Denied?

The New York State Workers’ Compensation Board uses the umbrella term “controverted” to describe both denied and disputed claims. According to the board’s 2022 annual report, a total of 161,808 New Yorker workers’ compensation claims were reviewed in 2022. Of those claims, 16,822 were controverted.

When examining the data on appealed cases, an even grimmer picture emerges. In 2022, a mere 16% of appealed cases were eventually reversed, providing injured New York workers with the injury compensation they needed. Meanwhile, 84% of appeals were unsuccessful, with the court of appeals upholding the decision to deny the workers’ original claims.

For the small percentage of workers who successfully make it through the appeals process, it is safe to assume that the majority probably had a skilled workers’ comp attorney on the case. Once a claim is denied, achieving a successful appeal can be extremely difficult without a workers’ comp lawyer working to understand what went wrong and offering an alternative approach. 

This means that you have a decent chance of winning your workers’ compensation appeal, and we are ready to help. We will ensure that your claim follows all of the rules and deadlines. Many people who lose the appeal fail to follow the proper guidelines. Our team will not let this happen in your case.

Let Tucker Lawyers PC Help With Your NY Workers’ Comp Claim Denial

When you are wondering what to do about a denied workers’ comp claim, it can be a fearful time. You’re unsure whether you will have the ability to go back to work any time soon, and you also have medical bills to pay. You believe you deserved to win your workers’ comp claim, so you may have some feelings of anger and frustration, too.

If you are searching online for “What to do if my workers’ comp claim is denied?” it’s time to take action — before it’s too late. The team at Tucker Lawyers understands this and is ready to help. Our team will study the facts in your case and listen to your concerns about losing your initial claim. If you hire us to take on your appeals case, we will represent you to the best of our ability. We will prepare fully for every eventuality, using the facts to show why the initial decision was in error. Just because the initial case did not go your way, it doesn’t mean the appeal will go the same way. We will work hard to achieve a new result in your favor.

Call us at (516) 399-2364 as soon as possible for a free review of your workers’ compensation initial case or appeals case. We work on a contingency fee basis, which means we do not receive any payment ahead of time. You do not owe us any money if we do not win a judgment for you. Our fee is a percentage of the final settlement amount in the case.

john tucker

Managing Attorney John. J. Tucker, Esq.

John has personally handled thousands of clients who were victims of another’s negligence and fights relentlessly for their rights. John enjoys bringing closure to a client’s matter so that the injured party can move forward with their life. His background enables him to evaluate complex liability related claims and bring resolution to claims in a record time frame. [ Attorney Bio ]

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