What Should I Do If My Workers’ Compensation Claim Has Been Denied?

If you feel that your employer or employer’s insurance provider wrongly denied your workers’ compensation benefits, you have the option to appeal the decision. But to do so, you must follow the proper procedure to appeal through the right channels. First, you must file the appeal with the New York Workers’ Compensation Board.

Who hears workers’ compensation appeals?

If an employee is disabled for seven days or more, the workers’ compensation insurer will begin paying benefits within 18 days or 10 days of learning of the accident if the worker hasn’t notified the employer of the accident, unless it disputes the worker’s claim. In such a case, the insurer notifies the Workers’ Compensation Board as well as the worker and his lawyer that it disputes the claim.

Insurers give their reasons for denying benefits to a Workers Compensation Law Judge, and the Law Judge conducts hearings to determine whether the denial is justified. Employees and their attorneys can submit evidence to the Law Judge or argue their cases at hearings.

What happens at appeal hearings?

Usually before appeal hearings, the Law Judge gathers and reviews medical records and other evidence used to determine if the claim is valid. Claimants or their attorneys can submit evidence to the Judge for consideration, and sometimes lawyers write briefs explaining their client’s position. At the actual hearing, both sides can present oral arguments to the Judge, and hearings can be continued until a later date if the Judge needs more evidence to make a decision.

What are the next steps in the appeals process?

If an employee disagrees with the Law Judge’s decision, he can submit an appeal within 30 days to a three-person Panel of the Workers Compensation Board. The Panel will either uphold, change or rescind the Judge’s decision or may even send the case back to the Judge. Workers may request a full Board Review if the Panel is not unanimous in its decision.

Any appeal of a Board Panel decision must be made to the Appellate Division, Third Department, Supreme Court of the State of New York within 30 days of the decision. Next, a worker may appeal the Appellate Division’s decision to the Court of Appeals.

What can I do to prepare for these appeal options?

Maintaining open communication with your treating doctor is key to a fair workers’ compensation claim. The insurer or employer gets to pick the medical providers, while employees have a right to an independent assessment if they disagree with the doctor’s impairment rating or assessment of their condition.

Employees can keep medical records, a pain journal and other evidence documenting their injuries and limitations that may help establish eligibility for workers’ comp and the benefits that it provides. Workers should speak with an attorney to help them decide whether to appeal an insurer’s or Law Judge’s decision and to prepare for the various steps in the appeals process.

Markhoff & Mittman, P.C. in New York is committed to helping employees receive fair treatment when pursuing workers’ compensation benefits. Contact our office at 866-205-2415 to get started with your appeals process or to discuss other aspects of your case. We also offer a helpful guide to navigating the workers’ compensation system in New York.

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They kept my best interests at heart. Updates on a regular basis of the status of the case and returning of calls was much more prompt after I started dealing with the same lawyers and support team.
Danielle Dexter, Workers Comp Client from Westchester County

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