Why Was My Workers' Compensation Claim Denied?

New York’s workers’ compensation system allows employees who suffer injuries in a workplace accident to obtain benefits to pay for medical expenses and lost wages so they can recover. Unfortunately, it is not uncommon for employers and insurance companies to deny legitimate claims.

The truth is that employers and insurers make a profit when they deny valid claims. Employers want to avoid increased insurance rates, while insurance companies want to protect their bottom line.

The following are common reasons why workers’ compensation claims are initially denied:

  • You didn’t report your injury in time – According to New York law, you are required to report the accident and your injury to your employer within 30 days. If you fail to report on time, your employer or the insurance company can claim your injuries did not happen on the job. It is best to notify your employer of the incident as soon as it happened so they can start the claims process.
  • You didn’t receive medical treatment – In order to obtain your entitled benefits, you need the medical records to prove the severity of your injury. Without medical documents that support your claim, the insurance company can deny your benefits by claiming your injury is nonexistent. Additionally, you need to be treated by a medical provider approved by your employer and the insurance company. However, you can seek a second opinion from your own physician.
  • Your employer disputes your claim – Your employer may claim you weren’t performing job duties when the injury occurred, engaged in some form of misconduct before the accident, or your injury wasn’t caused by a workplace accident. You need to collect evidence and obtain witness accounts to support your claim.
  • There were no witnesses when the accident occurred – If there weren’t any witnesses who can support your side of the story, the insurance company may attempt to say the accident didn’t occur the way you claimed. Fortunately, you can still back your claim with medical records and other forms of evidence from the scene.
  • You were under the influence of alcohol or drugs – If alcohol or drugs were involved in your accident, you are prohibited from making a workers’ compensation claim. Your employer is allowed to perform a test to determine if alcohol or drugs were in your system when the incident happened. If tests confirm you were intoxicated, you claim will be denied.
  • You didn’t provide a statement or release your medical records – The insurance company may want you to provide a recorded statement or release your medical records; however, it may not be in your best interest to provide such information, especially without consulting an attorney first. Alas, the insurance company can use your lack of cooperation to deny your claim.

If your workers’ compensation claim was initially denied, do not give up. First, your letter should tell you the reason for denial. If you were denied due to a simple error, contact the claims adjuster to see if you can resolve the issue. On the other hand, you can appeal your denial with the help of an experienced attorney.

If you have been denied workers’ compensation benefit in New York, contact our New York City workers’ comp attorneys at Lurie, Ilchert, MacDonnell & Ryan LLP today.