What if My Workers' Comp Claim is Denied?

Posted By Katz Leidman Grossman Wolfe & Freund || 20-Apr-2016

If you were injured in a workplace accident or if you are suffering from an occupational disease, you are probably thinking, “My claim should definitely be accepted.” But, what if your claim is denied? What should you do next?

For starters, we’re going to explain which workers are covered under workers’ compensation. In New York, nearly all employers are required to provide workers’ compensation coverage.

If you work for a for-profit business, if you are a school teacher, a domestic worker who works at least 40 hours a week, or a worker compensated by a nonprofit organization, you should be covered. Those who are NOT covered by New York’s workers’ compensation law, include:

  • People who volunteer for nonprofit organizations
  • Members of the clergy
  • People who engage in amateur athletic activities
  • People who teach for a nonprofit religious or charitable organization
  • People who receive charitable age from religious and charitable organizations
  • New York City firefighters, sanitation workers and police officers
  • People who do casual chores for private residences (domestic workers)
  • Real estate salespersons
  • Certain insurance agents

Occasionally a worker’s claim will be denied because the insurance company believes that the worker was under the influence of drugs or alcohol, or intentionally being reckless when he or she was injured. In such cases, the worker’s claim may be denied.

Workers’ Compensation Hearings and Appeals

If a worker’s claim is denied, he or she has the right to appeal the decision. In this situation, the Board may conduct a hearing, which is overseen by a Workers’ Compensation Law Judge. After listening to the testimony and reviewing the evidence, the judge shall determine if the worker is entitled to benefits.

If the worker is not satisfied with the results of the hearing, he or she has 30 days to appeal the decision. This is accomplished through a Board review. A Board Panel decision can be appealed to the Supreme Court, whose decision can be appealed to the Court of Appeals.

Need more information about the claims and appeals process? Contact our office today for a free case evaluation with a New York workers’ compensation attorney!

Categories: Denials, Appeals, Hearings