Can a Workers' Compensation Claim Be Denied?

Posted By Katz Leidman Grossman Wolfe & Freund || 11-Aug-2016

Before workers’ compensation laws were created, injured workers would have to file a lawsuit against their employers to collect damages when they were injured in a work-related accident. During this arduous legal process, injured workers had to prove that their employers were negligent and this was no easy task.

With the arrival of the Industrial Revolution, machine-use exploded and industrial accidents were common and widespread. Fortunately, lawmakers realized that workers needed a faster, more efficient way to collect damages after suffering a workplace injury. With the need for statutory change, workers’ compensation was born.

Today, workers’ compensation is a no-fault system, meaning an injured or ill worker can collect workers’ compensation regardless of their own degree of fault. Even if a worker accidentally injured themselves, they could still collect workers’ compensation benefits with no questions asked.

Under the modern workers’ compensation system, when a worker is suffers a workplace injury or an occupational disease and he or she collects workers’ compensation, they cannot sue their employer. By collecting workers’ compensation benefits, the employer is shielded from employee lawsuits.

Reasons Why a Workers’ Comp Claim Can Be Denied

In New York, most workers are covered by their employer’s workers’ compensation insurance. If a worker was injured on the job, or if their illness is an occupational disease, their workers’ compensation claim should be approved.

However, workers’ compensation is not automatically guaranteed. There are occasions where a workers’ compensation claim is denied, and sometimes the “reasons” can be called into question by an experienced attorney. Usually, a workers’ compensation claim is denied for one of the following reasons:

  • The employer or insurance company says the injury is not work-related,
  • The insurance carrier says that the illness is not an “occupational disease,”
  • The employer argues that the worker was under the influence of drugs or alcohol at the time of injury,
  • The employer argues that the worker is not a “covered employee,” or
  • The employer argues that the worker intentionally injured himself or herself, or intended to injure someone else.

If a worker’s claim is denied, the Workers’ Compensation Board may decide to hold a hearing or series of hearings, which will be heard by a workers’ compensation law judge, who will review the facts of the case and decide whether the claimant should receive benefits.

If either side is dissatisfied with the judge’s decision, they have 30 days to file an appeal. At any point in the process, the claimant reserves the right to an attorney.

If your workers’ compensation claim was denied, we urge you to contact Katz Leidman Grossman Wolfe & Freund to request a free case evaluation!

Categories: Workers' Compensation