If you are covered under the workers’ compensation laws of New York State, you may be unsure as to why your claim was denied after you were injured at work. The fact of the matter is that the claims process can be complicated, and the smallest mistake can restrict you from recovering your damages. As such, if you were recently denied workers’ compensation in Queens, the Bronx, or the greater New York City area, understanding why it happened is imperative to correcting the issue and recovering the compensation you deserve. Continue reading to find out how an experienced Bronx workers’ comp claim process attorney at The Law Offices of George Poulos can work on your behalf to retain this compensation.
Common Reasons Workers’ Compensation Claims Are Denied in New York State
When undergoing the claims process, there are many steps that both you and your employer must go through, and any deviation may deny or delay your benefits. Below are common reasons why your claim for workers’ compensation may be denied in New York State:
You Did Not Report The Injury In Time
New York law requires you to report your work-related injury to your employer in writing within 30 days of its occurrence. Failure to do so can result in the denial of your claim.
You Did Not File The Claim On Time
New York law requires that you file a claim with the Board on Form C-3 (Employee Claim Form) by mailing it to the appropriate district office within two years of the accident or within two years after you knew or should have known the injury was work-related. It’s important to understand that this differs from the 30-day reporting requirement.
You Did Not Immediately Receive Medical Attention
Seeking treatment for injuries promptly following an injury is critical. Delays in care can hurt the credibility of your claim, and if no medical report of the injury exists, your claim may be denied. It’s also important to understand that your medical provider is required to submit a Doctor’s Initial Report Form (C-4) to the workers’ comp insurer within 48 hours of the first treatment.
Your Employer or Insurance Carrier Disputes the Claim
There are certain circumstances under which an injury may be disputed by your employer or their insurer. This includes:
- Misconduct or horseplay
- The injury happened off the premises
- You were not engaged in work duties at the time of the injury
- Allegations of drug or alcohol impairment at the time can lead to denial
- Insufficient evidence of a work-related cause
Your Injury Is Not Considered Compensable Under New York Law
Unfortunately, some injuries may not be covered under the New York workers’ compensation law. This includes:
- Stress-related injuries without clear medical evidence linking them to your job
- Falls related solely to personal health conditions
- Injuries that occur off-site that do not occur “in the course of employment”
What to Do if Your Workers’ Compensation Claim Is Denied In New York
Learning that your compensation claim has been denied can be incredibly upsetting. However, it’s important to understand that there are steps you can take to appeal this decision to fight for your rights.
Step 1. Review the Denial Letter Carefully
Upon receipt, you should carefully review the denial letter. This will include a written explanation as to why your claim was denied, and deadlines for filing an appeal. It’s important to understand that the insurance company must provide you with this information.
Step 2. File a Timely Appeal
By New York law, you must file an appeal with the Board within 30 days of the filing date of the denial. The appeal will be heard before a Workers’ Compensation Board judge.
Step 3. Gather Supporting Evidence
Before drafting your appeal and presenting it to the court, you must gather the appropriate evidence to prove that you deserve to recover these benefits. This includes:
- Medical reports proving your injury and establishing a work connection
- Proof of on-time notice to your employer
- Witness statements
- Pay records showing that you were on the job at the time of the injury
- Accident reports
- Any photos and videos you took at the scene of the accident
Step 4. Prepare for a Hearing
Prior to your hearing, your attorney will help you prepare. This includes helping you prepare for questioning and cross-examination. At the hearing, your attorney can present evidence supporting your claim on your behalf.
Step 5. Consider Additional Appeals
In the event that the Workers’ Compensation Board Law Judge rules against you, you can escalate the appeal. You’ll need to file with a three-board panel, then the Appellate Division, before reaching the Court of Appeals
Contact Our Workers’ Compensation Firm
If your workers’ compensation claim has been denied, it’s in your best interest to connect with the Law Offices of George Poulos. Our team is an experienced Workers’ Compensation, personal injury, and Social Security Disability law firm with offices in Queens and the Bronx. We are ready to help you fight for the justice and compensation you deserve for the injuries and damages you have suffered. If you require strong legal representation, contact our firm today.