Workers’ compensation is a critical safety net that provides financial support and medical benefits to workers who are injured on the job. However, not all claims are successful, and workers’ compensation claims are denied for a multitude of reasons. At Nappa, Monterosso & Poznansky, our workers’ compensation lawyers help injured workers throughout the greater New York City area get the benefits they need. Here, we explain why some claims are denied and how to avoid common mistakes that may jeopardize your case.
Failing to Notify Your Employer in a Timely Manner
One of the most common reasons for a workers’ compensation claim denial is the failure to notify your employer about your injury within the required time frame. Under New York workers’ compensation law, employees must inform their employer within 30 days of an accident or injury.
If you submit a claim after this 30-day window without notifying them, your employer or their insurance company may assert that the injury report is too late and cast doubt on the validity of your claim. This can result in a workers’ compensation denial, even if your injury is legitimate.
To avoid this problem, promptly notify your supervisor or employer in writing after a workplace injury. Providing as much detail as possible about the incident can help strengthen your claim. It’s also important to keep a copy of this report and document any other communications related to your injury.
Disputes About Whether an Injury is Work-Related
Another common issue that can result in a denial is a dispute about whether an injury is work-related. For a workers’ compensation claim to be successful, an employee’s injury must occur while they are performing work-related duties. An employer or insurance company may argue that the injury happened outside of the scope of employment if there’s ambiguity about the time, location or nature of the injury. For example, if you’re hurt during a break or while commuting to or from work, your injury may not be considered compensable under New York law. In rare cases, a claim may be denied if an employee is hurt while violating company policies or engaging in horseplay on the job.
Pre-Existing Conditions
One of the excuses insurers often use for workers’ compensation denials to claim that an employee’s pre-existing condition is the cause of an injury, not work. For example, if someone has existing back pain that’s exacerbated by a work-related incident, the insurer may argue that any new symptoms are simply due to the prior condition and not the result of a workplace injury. Countering these claims can be challenging. To prove that your pre-existing condition was aggravated by a work injury, you must establish a clear link between the two.
In cases involving pre-existing conditions, it’s a good idea to have an experienced workplace injury lawyer by your side. Your attorney can gather supporting medical documentation that shows how your condition changed after the work injury. They may also consult with medical experts who can explain how the injury has worsened your pre-existing condition. Keeping a journal documenting your symptoms and how your daily life has been affected can also provide supporting evidence for your workers’ compensation appeal.
Insufficient Medical Evidence or Discrepancies
All workers’ compensation claims must be supported by medical evidence. This includes a diagnosis and treatment plan created by a healthcare provider. If you don’t seek medical attention after an injury or fail to follow through with prescribed treatments, your workers’ compensation claim will be denied.
In addition, if there are discrepancies between a doctor’s report and a worker’s account of how an injury happened, an insurer may deny their claim. For example, if a worker tells their employer that they hurt their back lifting a heavy box but later tells a doctor that a slip and fall accident caused their injury, the inconsistency may be interpreted as an attempt to file a fraudulent claim.
Seeking medical attention from an approved healthcare provider as soon as possible, being transparent about how your injury occurred, and following the prescribed course of treatment that supports your recovery is vital to avoiding a workers’ compensation denial.
Missing the Deadline for Filing a Workers’ Compensation Claim
Although you’re required to notify your employer of an injury within 30 days, New York’s statute of limitations for filing a workers’ compensation claim is two years. This means that you must file a claim either two years from the date of the injury or the date when you became aware that an occupational disease or injury was work-related.
Filing after the two-year deadline has elapsed can result in an automatic denial of a claim. In cases involving occupational hearing loss and conditions such as those related to asbestos exposure, timeframes and deadlines for filing a claim may be different. Our Staten Island workers’ compensation attorneys keep track of all deadlines and can determine whether any exceptions apply to your case.
Minor Injuries that Don’t Require Medical Treatment
Minor injuries that do not require medical treatment or time off work may not qualify for workers’ compensation benefits in New York. For example, if you sustain a small cut that doesn’t need medical attention or keep you from working, your workers’ compensation claim will likely be denied.
However, it’s important to be aware that seemingly minor injuries can worsen over time. That’s why it’s vital to report your injury in a timely manner, no matter how insignificant it may seem. Documenting your injury with your employer can protect your rights if your condition ends up getting worse later.
Drug or Alcohol Use
New York workers’ compensation law allows employers to contest claims if they suspect that an employee was impaired while performing work duties. If a drug or alcohol test is administered after an injury is positive, the insurance company may use it as grounds to deny a claim.
Lack of Witnesses
When an injury occurs in a situation with no witnesses, it can be difficult to prove that it happened as reported. Reporting your injury to a supervisor immediately, informing coworkers, and taking photographs and video of the accident scene can help bolster your claim. If available, surveillance footage such as video from security cameras can also be helpful in proving that your claim is valid.
Filing a Claim After Leaving a Job
Filing a workers’ compensation claim after retiring, resigning, or being terminated can result in added scrutiny. An employer or insurer may argue that your injury occurred after your employment ended or is related to a different job. To prove that your injury is connected to your former position, it’s essential to have comprehensive documentation like medical records, witness statements, and other relevant evidence. If you’re thinking of filing a claim after leaving a job, our NYC workers’ compensation lawyers can evaluate your case and help you understand your options.
How Our Workers’ Compensation Attorneys Can Help
If your claim is denied, you can request a hearing before the New York Workers’ Compensation Board (WCB). Our workers’ compensation lawyers have served workers in the greater NYC area for more than 30 years. We guide you through the appeals process, represent your interests, and protect your rights every step of the way. Attorney and Partner Rolando Cubela is proud to assist our Spanish-speaking clients.
Contact Our Workers’ Compensation Attorneys in the Greater NYC Area
At Nappa, Monterosso & Poznansky, LLP, we know that a workers’ compensation denial can turn your life upside down. Whether you need assistance with a new claim or workers’ compensation appeal, we can help. To schedule a consultation with a workers’ compensation lawyer in the greater New York City area, contact us or call 718-273-9000 today.
