Workers Compensation
Construction workers on scaffolding rig
Helping the Injured Seek Justice and Financial Compensation.

Denied Workers’ Comp Claims

Not all workers’ compensation claims are approved. In fact, some valid claims may be denied or seriously undervalued by workers’ comp insurance providers in an attempt to increase profits by avoiding high payouts and keeping employer premiums. Fortunately, New York workers’ compensation claimants who have had their claims denied are entitled to certain remedies.

 

Workers’ Compensation Lawyer Serving New York

At Napoli Shkolnik PLLC, we represent New Yorkers who have had their workers’ comp claims denied. Filing a claim can be complicated, and it’s easy to forget to include key supporting documentation or to accidentally fill out the wrong information, resulting in a denial. There is also the chance that a workers’ comp insurance provider or employer may wrongly deny a valid claim. In any scenario where a client’s claim has been denied, our firm stands ready to take the necessary steps to appeal the denial.

We have a long history of representing the injured in New York, including securing a landmark settlement of more than $816 million on behalf of firefighters, police officers and other first responders suffering from exposure to toxins at the World Trade Center disaster site after the September 11, 2001 attacks on the U.S. We have secured more than $3 billion for our clients in settlements and verdicts and our attorneys have more than 150 years of combined legal experience. To find out how a New York workers’ compensation lawyer can help you, please contact our offices for a free and confidential case review. You can also read on for more information.

 

Why are claims denied?

If your claim was denied, you are not alone. A large quantity of New York workers’ comp claims are denied the first time around, and sometimes for simple reasons. Missing information and a lack of supporting documentation are two of the most common reasons for a denial, as this may lead the insurance company to believe that the injury was not work-related, that it was not severe enough to warrant workers’ compensation coverage, etc. There are other reasons for a claim to be denied as well, which an employer or insurance provider may bring up in an attempt to avoid paying a claim. Following are several of the reasons that a workers’ comp claim may be denied:

  • The injury for which the worker is seeking benefits is a pre-existing injury and should therefore not be covered by workers’ compensation.
  • The worker is an independent contractor, not an employee and is therefore not covered by workers’ comp laws.
  • The injury was not work-related (did not occur at the workplace or was not associated with the worker’s normal job duties).
  • The worker did not notify the employer, in writing, of the incident within the required 30-day timeframe.

Any of these or other defenses to workers’ compensation claims can be challenged; it is a matter of taking the appropriate measures to appeal the denial.

 

What can I do if my workers’ comp claim was denied?

If a workers’ comp claim is denied, the first level of appeal is a hearing before a Workers’ Compensation Law Judge, who may hear testimony and review evidence to render a decision as to whether the worker should receive benefits.

If the claim is denied by the Judge, the next step will be to file an appeal with the New York State Workers’ Compensation Board. This must be done within 30 days of receiving the Judge’s decision. If an application for a Board review is approved, three Board Members will review the matter and may confirm, modify or rescind the decision made by the Judge or may return the case to the Workers’ Compensation Law Judge.

If the claim is still not approved, the claimant’s next step will be to appeal the Board Panel’s decision with the Appellate Division, Third Department, Supreme Court of the State of New York. This must be filed within 30 days of the Board Panel’s decision.

The final level of appeal for a denied workers’ compensation claim is to file an appeal with the Court of Appeals.

 

Talk to an Attorney at Napoli Shkolnik

Appealing a denied workers’ compensation claim is no easy feat, but with our experience in this field and our understanding of the claims process, including what information is needed for the Board to approve a claimant for benefits, the team at Napoli Shkolnik can succeed where others have failed. To learn more about our services and your options, contact a New York workers’ comp attorney at your earliest convenience. We look forward to hearing from you.