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How to fight a denied workers' compensation claim

If you receive an injury on the job in New York, your employer's workers' compensation insurance should cover your expenses and lost wages. However, sometimes the company will deny a claim. When this occurs, you have a good chance of overturning the decision if you fight back by appealing the denial. 

According to the Claims Journal, some common reasons a company may deny a claim include:

  • Pre-existing conditions
  • No evidence of the injury
  • Use of drugs or alcohol
  • Untimely reporting of accident
  • Misrepresentation
  • Cause of injury is unknown
  • No defined injury
  • Not related to work
  • Intent to injure oneself

The industries which have the highest volume of claims are healthcare, manufacturing and waste management services. An analysis of denied claims demonstrate it is not in a company's best interest to deny a claim because more than 65% of them convert to paid claims within a year, and this costs money. This information also shows it is usually worth fighting a denial.

FindLaw discusses the process for appealing a denial. The first step should be to simply talk with your employer in the event it was a mistake that can be easily corrected. The next is to send an appeal letter to New York's board of workers' compensation. You may want to attach documentation, such as a time sheet or medical records, if it will help your case.

Because it can be a complicated process, it is often best to consult with an attorney who deals with these types of claims. This improves the chances of the claim converting to one that pays for your expenses, including your legal ones. 

 

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