A claim denial can be frustrating and stressful when a workplace injury keeps you from working. We can help no matter where you are in the claims process. If you have not yet filed your initial claim, contact Shulman & Hill today. If your claim was denied, it may not be too late to fix it. Below are the basic steps in the appeal process.
Application for Board Review
The first step in an appeal is to notify the New York Workers’ Compensation Board in writing that you disagree with the denial. You have 30 days from the filing date of the Decision to file your Application for Board Review. Among other things, your application must include the following:
- Your case numbers
- Your insurance carrier’s name
- Supporting evidence
- Whether an attorney fee is requested
If you miss the deadline, you could lose your right to apply for a board review. If you have an attorney, they must use the Application for Board Review (Form RB-89).
Administrative Decisions
The Board also issues administrative decisions for undisputed claims. If objected to, the Board may refer the case to conciliation, a hearing, or modify the decision. Administrative decisions are reviewed by a Workers’ Compensation Law Judge (WCLJ) and are not finalized until at least 30 days have passed.
Conciliation
If you disagree with an administrative decision, the Board may refer your case for conciliation. This is normally reserved for cases that do not require a full hearing for resolution. During the conciliation process, the Workers’ Compensation Board will issue a Proposed Decision to resolve the dispute.
At least 30 days must pass before a conciliation decision becomes final. You can file a written objection during this period, and your case will be referred to a hearing before a WCLJ.
If you do not have an attorney, a WCLJ must approve the conciliation agreement. Without an attorney on your side, you could lose out on significant benefits without the option to appeal. Our knowledgeable New York City workers’ compensation lawyers can advise you of your rights, protect your interests, and ensure your conciliation agreement is fair.
The Formal Hearing
If your case is complex or any issues are disputed, the Board may refer it to a hearing before a WCLJ. You may have the opportunity to present evidence, such as:
- Medical records
- Doctor statements
- Eyewitness testimony
- Photos and videos
You have the option to attend the hearing virtually and the right to have an attorney represent you. The WCLJ may uphold, modify, or reverse the denial of any benefits. With over a decade of experience, our attorneys know what types of evidence you will need to present a strong case to the WCLJ.
Appealing Beyond the Formal Hearing
If you disagree with the WCLJ’s decision, you may file an appeal within 30 days to a three-member Board Panel. If you disagree with its decision, you can request a review by the Full Board. As a last resort, you may file an appeal through the judicial system. The New York Supreme Court, Appellate Division, and Third Department hears workers’ compensation appeals.
Tips for a Successful Appeal
Although there is never a guarantee of how your appeal may resolve, you can increase your chance of success by doing the following:
- Start gathering evidence as early as possible.
- Answer all questions on any paperwork truthfully and completely.
- File your appeal within the deadline, usually 30 days.
- Prepare ahead of time so you know how to answer questions at hearings.
- Hire experienced New York workers’ comp attorneys.
Let Shulman & Hill Help With Your Workers' Compensation Appeal
If your claim has been denied, you may still be able to get the benefits you deserve. No case is too significant, complex, or challenging for our experienced attorneys. Call us today at (212) 221-1000 or contact us online to schedule your free consultation.
