In New York, businesses are required to obtain Workers’ Compensation insurance for their employees. The coverage pays for all work-related injuries that occur during business hours. You may, however, be denied at any point during the process. If you were expecting your employer to cover your costly medical expenses, and you are now stuck with that burden, what happens next?
The first step in your appeal is learning why you were denied. You may feel like your injuries are covered, but you will learn the perspective of your employer or the insurance company when reviewing your case. A denial of your claim may happen if the injury was not reported in time. In New York, you must report workplace injuries that result in death in 48 hours, seven to 10 days after a non-disabling injury, and up to 21 days after an accident for retroactive benefits. Your insurance claim was not filed in time: If it is not filed in a timely manner, your claim will most likely be denied.
A claim may also be denied if your employer has successfully disputed your claim. Employers have been known to claim that injured employees were hurt during horseplay or that they were performing non-work-related tasks. The injury sustained may also not be compensable, like in case of stress-related injuries that are difficult to prove in court. If the injury in question is work related, you must show that the injury occurred at work or face the denial of the corresponding claim. Also, you must have obtained medical treatment from specifically designated physician in due time, otherwise, your employer can claim you were not truly injured.
You will likely receive a denial letter from the insurance company or your employer. The letter will clearly state a deadline for all appeals, and the letter should be provided to a knowledgeable lawyer as soon as possible. You may be able to resolve the case with your employer or the insurance carrier. If you cannot reach an agreement, you must appeal your claim immediately.
A lawyer will collect evidence about the case that resolves any issues noted in the denial. For example, you can show that the claim was filed properly, you have a work-related injury, or you received the appropriate medical care. The injury might be evaluated by an independent medical practitioner, and a lawyer will interview anyone involved in the case. The appeal will then be drafted and presented to the court after a thorough investigation.
You should not contact your employer or the insurance carrier once your lawyer has taken over the case. Anything you say could be used to deny your claim, and you do not want to cause any problems while you are recovering. Your lawyer will argue your case vigorously, and your case may go to the appropriate circuit court if the appeal is denied.
Remember, each case is unique, so contact HURT-511 for more information on workers’ comp statute and our personal injury lawyers help injured workers recover the benefits to which they are entitled by law. For a free consultation with an experienced workers’ compensation lawyer, call us toll-free at 800-4878-511 or complete our online form. Our firm handles accident and injury claims throughout all five boroughs of New York.
HURT-511 operates in all boroughs of New York including all Bronx neighborhoods, namely: Bedford Park, Belmont, Fordham, Highbridge, Hunts Point, Jerome Park, Kingsbridge, Morris Park, Morrisania, Mott Haven, Parkchester, Riverdale, Spuyten Duyvil, Throgs Neck, University Heights and Woodlawn.