When you suffer an injury at work, it’s natural to assume that you’ll be covered by workers’ compensation until you’re ready to return. But unfortunately, some workers file a claim that ends up getting denied. If you’re currently in this situation, you may be wondering what to do next.
Fortunately, a denied claim is not always the end of the process. You have the right to appeal a denied workers’ compensation claim in New York. Experienced Albany workers’ compensation lawyer Paul Giannetti has helped countless clients appeal denied claims. He understands how the process works and is prepared to help you fight for the benefits you deserve.
To learn more about appealing a denied workers’ compensation claim in New York, contact Paul Giannetti, Attorney at Law, for a free consultation at (518) 346-7777.
Common Reasons Workers’ Comp Claims Are Denied
A New York workers’ compensation claim may be denied for various reasons. Here are some of the most common justifications for denials we see at our Albany workers’ compensation law firm.
The Injury Was Reported Too Late
According to the New York State Workers’ Compensation Board, injured employees should notify their employers and seek medical care immediately after a work-related injury. Employees are also required to notify their employer of the injury in writing within 30 days. If an injured employee fails to meet their requirements, they put themselves at risk for a denied claim.
Application Not Filed by Deadline
Although it’s best to start the claims process right away, in New York you have two years from the date of your injury, or the discovery of your injury, to file a claim. Work-related illnesses that develop gradually due to exposure to hazardous substances like asbestos generally have a two-year window from the date you were diagnosed with the illness.
If you miss this two-year deadline, you will lose your chance to file a workers’ comp claim.
Issues With Medical Documentation
A New York workers’ compensation claim requires extensive medical documentation for your injury. This is why seeing a doctor immediately after the injury is crucial both for your health and your claim. If you delay treatment or fail to provide sufficient medical documentation for your claim, there is a good chance it will be denied.
Insurance Company Disputes
Workers’ compensation is an insurance-based system, and insurance providers of all types look for ways to deny claims and increase their own profits. These companies may employ several types of arguments to dispute the validity of your claim.
The insurance company may argue that your injuries are related to a pre-existing condition and are not truly work-related, that they are not as serious as you claim, that you were intoxicated, or that the injury was intentionally self-inflicted.
Experienced Albany workers’ comp lawyer Paul Giannetti understands the tactics these insurance companies use and is prepared to help you fight back against them.
What to Do After Receiving a Workers’ Comp Claim Denial in New York
If you receive a New York workers’ comp denial, remember that you still have a chance to get coverage. However, your next steps are critical for your claim.
Continue Getting Medical Care
Your health is the most important thing, so continuing treatment should be the top priority. Doing so is also important for appealing a denied claim. If you stop getting treatment, the insurance company will argue that your injuries are not as serious as your claim and that they were correct in denying your initial claim.
Maintain Documentation of Your Injuries
You will need to provide as much documentation as possible if you want to appeal the denied claim. Make sure to keep copies of all medical documents, bills, insurance correspondence, and communication with your employer.
Consider Contacting a New York Workers’ Comp Lawyer
Although you have the right to file a claim on your own, it is generally best to do so with assistance from an experienced New York workers’ compensation lawyer. The appeals process is complex, as even minor mistakes can result in an appeal being denied.
Prepare for Appeal
You will need to prepare extensive documentation and meet all deadlines to have a chance at successfully appealing your denied claim. A workers’ comp lawyer can help you prepare everything you need to appeal a denied claim and guide you through the appeals process.
Appealing a Workers’ Compensation Denial in New York
You have the right to appeal a denied workers’ comp claim in New York, but you must meet the stringent appeal requirements of the New York State Workers’ Compensation Board. Here is an overview of what you’ll need to do and what to expect during the appeals process.
Application Requirements
You must file an appeal within 30 days of the filing date of the judge’s decision to deny your original claim. Filing this appeal initiates an administrative review of the judge’s decision.
If you have hired an attorney, you are required to file the appeal through the required workers’ comp appeal form – Form RB-89, Application for Board Review. The form must be filled out completely, and you have the right to attach a legal brief detailing your reasons for appealing the denial.
According to the NYSWCB, your application must contain the following:
- Your name and address
- The WCB case number
- The claim admin’s claim number
- The insurance carrier’s name
- The carrier code number
- The reason for appealing
- Hearing dates
- The date of the injury and leave from work
- The appellant (party filing the appeal
- All evidence, including transcripts, documents, and exhibits
- Any new evidence
- A list of objections made at the initial hearing
- Whether awards are being paid during the pending appeal
- Whether an attorney fee has been requested
Notice Requirements
You must provide a notice of the appeal to all parties of interest, including:
- Self-insured employers
- Private insurance providers
- No-fault insurance carriers
- Special funds
- The State Insurance Fund
Failure to serve any of these parties with notice may be considered defective service, and your application is likely to be rejected. You must provide proof that the appeal has been served on all other parties of interest. These parties have the right to file a rebuttal and must also provide you with notice if they choose to do so.
How the New York State Workers’ Compensation Board Decides on Appeals
Your appeal will be reviewed by a Board panel of three board members. They have the option to agree with the initial denial decision, to change a part of that decision, or to reverse the decision entirely. They also have the option to schedule additional hearings before arriving at a resolution.
While the appeal is pending, the insurer has no obligation to pay lost wage benefits. The insurer has the option to accept a part of the decision while appealing another part of the decision. If an insurer does accept part of the decision, it must pay the accepted portion of the benefits while the appeal is pending.
If your appeal is denied, you still have the option to file further appeals with the Appellate Division and/or the Full Board. To do so, you must file either the Application for Reconsideration or Full Board Review (Form RB-89.2) or Rebuttal of Application for Reconsideration/Full Board Review (Form RB-89.3).
How an Albany Workers’ Compensation Attorney Can Help
A dedicated Albany workers’ compensation lawyer can provide invaluable legal guidance throughout the appeals process.
Helping You File and Submit All Paperwork
The NYSWCB has strict paperwork requirements and deadlines. Even small errors can jeopardize your claim. Your attorney can help you avoid common mistakes, fill out all paperwork accurately, and ensure that everything is filed within all deadlines.
Gathering Evidence and Documentation
Your attorney knows what evidence is necessary to file a successful appeal and how to obtain it. They can gather all relevant evidence of your injury, medical documentation, and other documents that will be necessary for presenting your case during hearings.
Representing You in All Hearings
Injured workers lack the legal knowledge to effectively represent themselves during appeals hearings. Your attorney will be your legal advocate in court. They will present the best argument possible to the board based on the circumstances of your case and help you fight to get an unjust denial overruled.
Filing Further Appeals
If your appeal is rejected, you can still continue the legal fight. Your attorney can help you prepare for further appeals with higher courts.
FAQs
What Percentage of Workers’ Comp Claims Are Denied in New York?
According to data from the New York State Workers’ Compensation Board, approximately 10% of claims are controverted, which means they were either denied or faced insurance company resistance.
What Happens During an Appeal Hearing?
You and your attorney have the chance to present your case before a judge, including all evidence supporting the appeal. The judge will make a decision based on the case you’ve presented and the opposing party’s arguments.
Learn More From an Albany Workers’ Compensation Denial Attorney
Has your New York workers’ compensation claim recently been denied? This does not mean your chance to obtain benefits is over. Experienced Albany workers’ comp lawyer Paul Giannetti is prepared to help you appeal the denial and fight for the benefits you deserve. Learn more in a free consultation by calling (518) 346-7777.