In general, workplace injuries or accidents are covered by an employer’s workers’ compensation. Acting like an insurance, workers compensation is mandatory in most states and is distributed according to the level of risk for the particular industry and/or position. If your workers compensation claim has been denied, there may be further options available. Before you understand which steps you could take after a claim denial, you’ll want to consider some of the primary reasons why a denial might occur.
Primary Reasons for Being Denied Workers Compensation
If your workers compensation claim has been denied, one of the first things to understand is the reason why. Typically, this will be included in the denial letter and may be attributed to a number of factors such as:
- Your injury not being reported in due time
- Your claim was not filed in due time
- Your employer disputed the claim
- The injury is not compensable
- You did not seek medical treatment
- Insufficient evidence for the injury being work related
- Your injury happened while under the influence
Can I Challenge a Workers Compensation Claim?
A claim for workers compensation benefits can be denied for several reasons, it means that the insurance carrier believes your injury is not covered under New York Workers’ Compensation Law. If you receive notice that your claim is being denied, you have the right to challenge the denial.
In order to challenge the insurance carrier’s denial of your claim it is often helpful and beneficial to obtain the help of a lawyer who specializes in the area of workers’ compensation. A skilled New York work injury lawyer will be able to assist you with the filing of necessary paperwork and navigating the hearing process.
The first step in challenging the carrier’s denial of your claim is filing specific required documents. After filing the papers, it will be necessary to request a hearing to appear before an Administrative Law Judge. Once a hearing is scheduled, the parties, which include you, a representative for the insurance company, and your attorney, will appear before the Law Judge. Each side will present arguments to the Law Judge as to why your claim should be accepted or denied and, in most cases, a trial date will be scheduled. At the scheduled trial, there will be testimony, oral arguments, and a decision by the Law Judge on the compensability of your claim. This is the beginning process of a denied claim for workers’ compensation.
Adhering to the Statute of Limitations
Just as there is a specific time period for which you can file for workers compensation, you will have limited time to file an appeal if your claim is denied. The statute of limitations typically varies from state to state and can change abruptly with very little notice. Due to the nature of workers compensation claims being such a sensitive matter, it’s advisable to retain a lawyer to process an appeal against denial as soon as possible.
Talk to a Workers Compensation Attorney
Appeal deadlines are short and strict. If you miss these time periods, there is a good chance you will lose out on your rights for compensation. While you can essentially file an appeal on your own, they can be complicated and involve rules of evidence and civil procedures which you may be expected to understand. Should you not prevail during this process, you may feel hindered over the course of subsequent hearings.
If you’ve initially been denied workers compensation benefits, don’t give up. Unfortunately, insurance companies and employers may try to use anything against you in an attempt to avoid making payouts. The best course of action you can take is to have a lawyer look into your claim and let you know your options. It’s important to talk to a worker’s comp lawyer as soon as possible. He or she should have an understanding of the associated complexities and technicalities which may have been the underlying cause of the denial. To schedule an appointment with a worker’s compensation lawyer, please call us now.
Thanks to our friends and contributors from Polsky, Shouldice, & Rosen, P.C. for their insight into work workers’ compensation practice.