5 main reasons workers’ comp claims are denied in New York

Workers’ compensation claims support injured employees, but not all claims sail through smoothly. In New York, there are several common reasons why a workers comp claim is denied. Understanding these reasons can help you avoid potential pitfalls, and knowing how to address them can be crucial if your claim faces challenges.

The Weinstein Law Group in New York City specializes in helping workers navigate these complex situations. Call (212) 741-3800 when you’re ready to get started.

workers comp claim denied

1. Lack of evidence of injury occurring at work

A frequent cause for a workers comp claim being denied is insufficient evidence that the injury occurred while on the job. In New York, workers’ compensation is designed only to cover injuries directly related to employment.

Strategy to counter

Ensure that you report the injury immediately to your employer and seek medical treatment as soon as possible. Documentation from your doctor should explicitly link your injury to your work activities. The Weinstein Law Group can assist in gathering and presenting the necessary documentation to support your claim.

2. Missed deadlines

Timeliness is crucial in workers’ compensation cases. Failing to report the injury within the required timeframe or missing the deadline to file a claim can result in denial.

Strategy to counter

Familiarize yourself with the New York workers’ compensation deadlines. Generally, you must report the injury to your employer within 30 days and file a claim with the New York State Workers’ Compensation Board within two years. The Weinstein Law Group can help ensure that all necessary paperwork is submitted on time.

3. Dispute over the severity of the injury

Another common reason for denial is a dispute over the severity of the injury or whether the condition is work-related. Insurers might argue that the injury is not as severe as claimed or is due to pre-existing conditions.

Strategy to counter

Obtain detailed medical evaluations that clearly define the severity of your injury and its direct connection to your workplace duties. The Weinstein Law Group has experience working with medical experts who can provide compelling evidence on your behalf.

4. Failure to follow medical advice

Your claim could be denied if you do not follow the medical treatment plan your healthcare provider prescribes. Insurers see this as an indication that the injury might not be serious or that you are not committed to your recovery.

Strategy to counter

Adhere closely to your doctor’s treatment plan and keep detailed records of all your appointments and treatments. Legal counsel from The Weinstein Law Group can advise on how this adherence can be effectively documented and presented.

5. Employee misconduct

Claims might also be denied if the injury resulted from employee misconduct, such as being intoxicated at work or fighting.

Strategy to counter

It’s crucial to demonstrate that the injury was not a result of any misconduct on your part. The Weinstein Law Group can help establish a clear and factual narrative of the incident that aligns with workplace guidelines and legal standards.

Was your workers’ comp claim denied? We can help.

Having your workers’ comp claim denied can be a significant setback, but with proper guidance and proactive management, many denials can be overturned on appeal. The Weinstein Law Group specializes in helping workers across New York City navigate the complexities of workers’ compensation claims, ensuring their rights are protected and they have the best possible chance of securing the benefits they deserve.

If you’re facing a denial, seeking professional legal help promptly to assess and respond effectively to the insurer’s objections is important.