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What you need to know about a workers’ comp claim denial

On Behalf of | Jul 18, 2017 | Workers' Compensation |

After suffering an injury on the job in New York, a worker may report the incident to the supervisor and seek medical attention assuming that the employer’s workers’ compensation insurance will cover the expenses and lost wages. While this may be true, there may be times when an injured employee’s claim is denied, even though he or she believes the eligibility requirements are met. Here are some reasons why, and what a worker can do about it.

The letter stating that the workers’ compensation claim was denied will include the reason for denial, Findlaw explains. Timeliness could be an issue, if the worker did not report the injury to the supervisor within the deadline, or if he or she missed the time limit for claim filing. Some injuries and illnesses are notoriously difficult to connect to a work-related incident, particularly those that develop over time, such as musculoskeletal disorders. The employer or the insurance company may dispute the eligibility of the claim for a number of other reasons, as well.

According to the New York State Workers’ Compensation Board, the injured worker can appeal the denial. The claims examiners for the Board will investigate the circumstances and may attempt to mediate a resolution between the parties. If this does not work, the authority to resolve the claim goes to a workers’ compensation law judge, who weighs the testimony of the insurance company and the worker, as well as evidence such as medical records.

The judge’s ruling to uphold the denial or set an award may not be final, as this decision may also be appealed. All of the members of the Board may be called upon to determine whether the judge’s decision should be upheld, but even after this, either party may take the case to the state’s appellate court system.



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