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5 Reasons Workers’ Comp Claims Get Denied in New York

by | Jul 8, 2023 | Denials

When your workers’ compensation claim is denied, your life can be thrown into chaos. You can’t work, but you need to pay bills. You still need medical care, and you’re left with no way to pay for it. 

Thus, it’s important to understand the reasons claims get denied, both so you can try to prevent a denial and address a denial if it arises despite your best efforts.

Here’s what you need to know. 

#1) The Workers’ Compensation Board Believes Your Injury Is Not Work Related 

You must clearly establish the link between your job and your injury before workers’ compensation will pay for it. 

  • Report your injury as soon as it happens
  • Gather the names and numbers of any witnesses
  • Note any security cameras in the area and ask that the footage be preserved
  • Take pictures at the scene of the accident

Some claims are more ambiguous despite your best efforts. For example, it may be tougher to prove your injury happened at work if you had a pre-existing or chronic condition like a repetitive stress disorder. A New York workers’ compensation attorney can help with these issues. 

#2) Medical Attention Issues

Some people have a denied workers’ compensation claim because they failed to seek medical attention directly after the accident.

Others initially receive workers’ compensation but lose it because they fail to follow their doctor’s orders. This could mean working a second job when you’re supposed to be resting, engaging in recreational activities that go against your doctor’s orders, or even engaging in day-to-day activities that go against doctor’s orders, like lifting heavy boxes or bags.

If your doctor’s orders create problems with your day-to-day life, be sure to get an exception. For example, if you live on the second floor and need to get to and from your apartment, you can ask your doctor to add an exception to your orders that says you can travel up and down stairs to enter or leave your apartment. 

#3) Employee Conduct

Workers’ compensation doesn’t cover injuries when employees goof off, rough house, or intentionally ignore safety protocols. It also won’t cover injuries resulting from working under the influence of alcohol or drugs

Be sure your conduct at work is above reproach and that you can prove it if necessary. 

#4) Failure to File Paperwork

All workers’ compensation paperwork comes with deadlines that must be observed. 

We recommend filing your Form C-3 on the same day you are injured if possible. If you have a pre-existing condition, you must also file a Limited Release of Health Information (Form C-3.3) form. 

While you technically have ten days to inform your employer, we recommend informing them immediately. You must notify them in writing. Telling your supervisor verbally is not enough.

#5) Employer Conduct

Sometimes employers aren’t on the up and up, and they dispute claims because it’s better for their bottom line. They attack your claim simply to save a few dollars on their premiums. It’s not fair, and it’s not nice, but it happens. This is especially true when their negligence contributed to your injuries. 

When that happens, you’ll need help from a qualified workers’ compensation attorney. We can help you dispute bogus employer claims to get your deserved compensation.

Get Help Today

If you’re struggling with your workers’ compensation claim, we can help. We’ve helped thousands of New Yorkers obtain their benefits.

Call (332) 378-1249 to schedule a consultation today.

See also:

Claiming Workers’ Compensation for an Occupational Disease 

Steps to Take After Getting Injured on the Job in New York

Can I Use My Own Doctor in a New York Workers’ Compensation Case?