Getting a workers’ compensation denial letter feels like a punch to the gut, especially when you’re already dealing with an injury and lost wages. You followed the rules, reported your injury, and filed your claim on time. So why did the insurance company say no?
Our friends at The Edelsteins, Faegenburg, & Blyakher LLP discuss these denials regularly with injured workers across New York. A workplace injury lawyer can help you understand what went wrong and how to fix it. The good news is that a denial isn’t the end of the road. Most denials can be appealed, and many workers who appeal successfully get the benefits they deserve.
Common Reasons for Workers’ Comp Denials
Insurance carriers deny claims for all sorts of reasons, some legitimate and others questionable. Understanding why your claim was denied is the first step toward fixing the problem.
Missed Deadlines
New York has strict time limits for reporting workplace injuries. According to the New York Workers’ Compensation Board, you generally need to notify your employer within 30 days of your injury. Miss that window, and your claim could be toast. Filing deadlines matter too. You have two years from the date of injury to file a formal claim in most cases. Wait too long, and you lose your right to benefits.
Injury Disputes
Sometimes insurance companies argue that your injury didn’t actually happen at work. They might say:
- The injury occurred outside of work hours
- You were doing something unrelated to your job duties
- The incident never happened the way you described it
- Your injury developed over time and isn’t work-related
These disputes often come down to documentation and witness statements.
Pre-Existing Conditions
Insurance carriers love to blame pre-existing conditions. Just because you had back problems before doesn’t mean your workplace injury isn’t real or compensable. The question is whether your job made the condition worse or caused a new injury on top of an old one.
Medical Documentation Problems
Weak or incomplete medical records sink many claims. If your doctor’s notes don’t clearly connect your injury to your workplace incident, the insurance company will pounce on that gap. Vague diagnoses or missing treatment records give them ammunition to deny your claim.
Employment Status Questions
Independent contractors and certain types of workers don’t always qualify for workers’ comp. Insurance companies sometimes deny claims by arguing you weren’t really an employee when you got hurt.
What You Can Do After a Denial
Don’t panic and don’t give up. You have options.
Request a Hearing
You can appeal your denial by requesting a hearing before a Workers’ Compensation Law Judge. This isn’t like going to court for a lawsuit. The process is more informal, but you still need to present evidence and make your case. The hearing gives you a chance to submit additional medical records, witness testimony, and other evidence that supports your claim. Many workers win on appeal because they provide documentation that was missing from their initial claim.
Gather Stronger Evidence
Take a hard look at why your claim was denied. If it was medical documentation, get more detailed records from your doctor. Ask your physician to write a letter specifically explaining how your injury relates to your work duties. If witnesses saw your accident, get written statements from them. Photos of the accident scene or your injuries can help too. The more evidence you have, the better your chances on appeal.
Get Legal Help
Workers’ comp insurance companies have lawyers working for them. You should too. An attorney who handles these cases knows what evidence matters and how to present it effectively at your hearing. Many workers don’t realize they can have legal representation during the workers’ comp process. You’re not required to go it alone.
Moving Forward
A workers’ comp denial doesn’t have to be the final answer. Most workers who appeal their denials with proper evidence and legal support get a second chance at the benefits they need. Don’t let a rejection letter stop you from pursuing what you’re owed. If your claim was denied, discuss your appeal options with legal counsel. The sooner you act, the better your chances of turning that denial into an approval.