Denied Workers’ Comp Claim in Queens
Appealing a Denied Workers’ Compensation Claim in NYC
Nearly all employees in the state of New York are covered by workers’ compensation. This is a type of no-fault insurance provided by your employer that is meant to compensate you for medical expenses and lost wages when you sustain an on-the-job injury or work-related illness.
However, many people have their workers’ compensation claims denied, and they’re not sure what comes next. What are your options if your New York workers’ comp claim was denied? Can you appeal the decision and still recover benefits?
Appealing the insurance company’s denial is challenging; it’s important that you have a skilled legal team on your side that can aggressively advocate for you and your rights. Our Queens workers’ compensation attorneys have over 30 years of experience and a proven record of success in even the most complex of claims. We are ready to fight for you.
What to Expect If Your Claim Was Denied
If your workers’ compensation claim was denied, you may be wondering if it’s even worth it to file an appeal. The short answer: yes! If your claim was denied, you not only have the right to appeal this decision but appealing is likely to be the fastest and most effective method of recovering benefits for your work-related injury or illness.
Here’s what you can expect if your workers’ compensation claim was denied:
- You will not receive any workers’ compensation benefits unless/until your claim is resolved
- You will not receive any benefits while your case is pending (during the appeals process)
Because of this, it is important that you act quickly. If your initial workers’ compensation claim was denied, or if your benefits have been terminated early, get in touch with our firm to learn how we can help.
The Workers’ Compensation Appeals Process
The first step in appealing a workers’ compensation claim denial is submitting an Application for Board Review. This begins the initial hearing process.
Your workers’ compensation hearing is where you (or your attorney) have a chance to share your side of the case and present evidence in support of your claim. The initial hearing process may include a pre-hearing conference to discuss the validity of your case.
During the pre-hearing conference or the hearing, the administrative law judge will hear evidence from both sides—you/your attorney and your employer/the insurance company. During a typical workers’ compensation hearing, the administrative law judge will listen to testimony and examine various evidence, including medical reports.
If the administrative law judge rules in your favor, you will begin receiving workers’ compensation benefits. This may include back-payments for lost wages and medical expenses during the period in which your case was pending and you were not receiving benefits.
If, however, the administrative law judge rules in favor of your employer/the insurance company, your next step will be to appeal the administrative law judge’s decision.
The Cassisi Law Firm Is Ready to Fight for You
If your workers’ compensation claim has been denied, reach out to our firm right away. It is incredibly important that you have an experienced attorney on your side throughout the appeals process, as this greatly enhances your chance of a successful outcome.
Since 1985, our firm has been advocating tirelessly for injured workers right here in our community. We are proud to serve clients throughout New York City, including in Queens, Brooklyn, the Bronx, and throughout Nassau and Suffolk Counties. We understand the challenges you are facing, which is why we leave no stone unturned in our pursuit of the fair, rightful benefits you are owed.
We do not charge any attorneys’ fees unless we recover compensation for you. Our firm offers services in English, Spanish, and Italian, as well as same-day appointments and 24/7 accessibility.
Why Workers’ Compensation Claims Are Denied
The process of filing for workers’ compensation is complicated; you must make sure that you meet all applicable deadlines and avoid making any mistakes on your initial claim that could jeopardize your benefits. However, even when you do everything correctly, your employer or their insurance company may still deny your claim.
Workers’ compensation claims are denied for many reasons. Common ones include:
- Missing the deadline to notify your employer of your injury/illness: In New York, you must notify your employer in writing of your work-related injury or illness within 30 days. Failure to do so could result in the denial of your claim.
- Failing to file your workers’ compensation claim on time: You only have two years from the date of the injury or the date on which you learned or reasonably should have learned that your injury/illness was work-related to file a workers’ compensation claim.
- Disputes regarding your eligibility to receive benefits: Your employer and/or their insurance company may try to argue that you are not eligible for benefits. They may try to say that your injury was not work-related or that it was a pre-existing condition. They may argue that you were not covered by workers’ compensation or that you were responsible for your injuries because you were being negligent or violating workplace conduct rules.
Regardless of the reason for the denial, our Queens workers’ compensation lawyers can help you determine if you have grounds to appeal. If you believe your employer or their insurance company is trying to wrongfully argue that you are not eligible for benefits, or if you are having any difficulty with your workers’ compensation claim whatsoever, do not wait to contact The Cassisi Law Firm for a free consultation.
Appealing the Administrative Law Judge’s Decision
If the administrative law judge ruled in the initial hearing that your claim is not compensable, you have the option of appealing this decision. You must file your appeal within 30 days of the ruling. Note that your employer/employer’s insurance company may also appeal an administrative law judge’s decision within 30 days, as well.
To appeal an administrative law judge’s decision, you must do the following:
- Submit a written request for review to the Workers’ Compensation Board
- Provide reasons as to why you believe the administrative law judge’s decision was incorrect
- Present evidence in support of your claim/request for review
Your request will be provided to a panel of three Workers’ Compensation Board members. This panel will decide whether to accept your request for review and, if so, will either affirm, modify, or reverse the administrative law judge’s decision. In some cases, the panel may return your case to the administrative law judge for further review, but this is relatively rare.
Can You Appeal the Workers’ Compensation Board’s Decision?
If you disagree with the panel’s decision regarding your case, you have the option of filing additional appeals. These can be made to the Appellate Division, Third Department, of the Supreme Court of the State of New York. This is only possible in very rare circumstances. We strongly advise that you work with an attorney throughout the appeals process to learn more about your rights and legal options.
Our firm handles all aspects of personal injury, and we encourage you to explore the ways in which we can help protect your rights and get you the compensation you deserve.