Yes, employers are allowed to deny workers’ compensation claims in some circumstances. However, they cannot do it without a good reason. Even if your company puts forth a justifiable explanation for rejecting your workers’ comp claim, you can still pursue the claim and have a judge make a determination on your entitlement to benefits.
If your claim has been denied or you believe your employer is trying to stop you from filing, the experienced workers’ compensation attorneys at Shulman & Hill can help you understand your rights and fight for the benefits you deserve.
Why Do Employers Deny Workers’ Comp in NYC?
- You were not an employee: The employer may deny having employed you at all or claim that you were an independent contractor. To be entitled to workers’ compensation benefits, you must be an employee of the company you worked for. However, your employer may have misclassified you to their insurance company, and their labeling you as an independent contractor or denial of your benefits does not mean that you would not be viewed as an employee under the law and be entitled to benefits.
- You were not working on the date in question or the injury did not happen at work: Workers’ comp does not cover accidents that are not related to work or that occur outside of work hours or away from your worksite, unless you were doing something related to your job duties.
- The accident did not occur: Employers may deny that the accident ever happened. This can be rebutted through evidence and testimony.
- The injury happened because of misconduct: Employers may be able to deny your workers’ comp claim if you were injured while intoxicated, engaging in rough, boisterous play, or fighting while on the job, especially if you initiated the confrontation. However, assaults and intoxication are not complete bars to compensation benefits.
- The injury wasn’t reported on time: You are required to notify your employer about any work-related injuries within 30 days. While you have two years to file a workers’ comp claim in New York, it could be disallowed if you fail to report the injury in time.
Even if your employer or their insurer says you are not eligible, that does not mean you are out of options.
When Workers’ Comp is Denied for Lack of Medical Evidence
To have a successful workers’ compensation claim, you must have medical evidence clearly showing that a workplace accident caused your injuries. This includes a full history of the accident, an injury diagnosis after an evaluation, and a medical opinion linking the two. The insurance company can also request that you be seen by their consultant for an independent medical exam, and you should be treated by specific medical providers that are coded by the Workers’ Compensation Board and familiar with the process.
If you have a pre-existing condition or prior injuries, your employer’s insurance company may attempt to argue that your injuries were caused by that rather than your work activity. This can be rebutted with medical reports and evidence, especially if you have a fully documented medical history. It’s not uncommon for people to injure the same body part more than once.
What to Do If Your Workers' Comp Claim Was Denied
A denied workers’ compensation claim is not the end. Many denied claims are ultimately approved by a Judge after a trail and testimony. To challenge a decision, you must:
- Review any denial letter. Knowing the stated reasoning will help you better understand what assertions you’ll have to challenge.
- Gather all medical records and other evidence. Getting all medical records of your treatment for your injuries, and other relevant records proving your employment (like pay stubs) or the accident’s occurrence (like an incident report) can help you to establish your claim
- Consider hiring an experienced workers’ comp attorney. An attorney can help you fully understand your legal rights and help you navigate the claims process to pursue your benefits, even if the employer and carrier are denying them.
Common Mistakes That Can Lead to Denial
Many workers’ compensation claims are denied for similar reasons. Thankfully, most common mistakes are avoidable, including:
- Delayed reporting: Notifying your employer in writing of any work-related injuries within 30 days is key to receiving timely benefits.
- Inconsistent statements: Take thorough notes about the accident and your injuries to make sure you don’t contradict yourself or undermine your own claims.
- Not following medical advice: It’s important to seek medical attention as soon as possible after a workplace accident and to closely follow any treatment plans you’re given, or your employer’s insurance company may use it against you.
- Skipping legal deadlines: Act promptly at each stage of the legal process to ensure you meet all filing requirements.
Working with a knowledgeable workers’ comp lawyer can help you avoid common mistakes and get approved as quickly as possible.
When to Get Legal Help for Your Workers’ Comp Denial
If you’re unsure why your workers’ compensation claim was denied or your employer has been pressuring you not to file, the skilled workers’ comp lawyers with Shulman & Hill can help you fight back and secure the benefits you deserve.
Contact us online or call 212-221-1000 today for a free consultation.
