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When Do You Need a Lawyer for a Denied Workers’ Comp Claim

by | Sep 12, 2023 | Denials

It’s frustrating and stressful to learn that your workers’ compensation claim has been denied. After all, you need that money and medical care to recover, feed your family in a crisis, and then return to work.

Here are some of the most common reasons why claims get denied, along with some guidance about whether or not a workers’ compensation lawyer will be able to help you with that particular issue. 

Reporting and Medical Attention Issues

You must seek medical attention immediately from an appropriate doctor. You should also report your injury immediately. The official deadline is within 30 days, but the sooner you report, the better.

If you need emergency care, you can go to the ER. If the situation is not an emergency, you must check whether your employer uses a workers’ compensation insurance company with a PPO. If they do, you must see one of their doctors for at least 30 days.

If you don’t or are looking for a new doctor within 30 days, you must ensure they are approved by the New York Workers’ Compensation Board. You can use this link to search their database. 

Finally, once you have a doctor, it is vital for you to follow that doctor’s advice. If you fail to follow doctor’s orders, workers’ compensation insurance will have grounds to deny your claim. 

A lawyer can’t necessarily help if you’ve failed in your reporting requirements or did not receive medical attention. 

Refusing Light Duty or Part-Time Work

You must take it if you’re offered work that meets your medical restrictions, such as part-time or light-duty work. If you don’t, your employer can stop your benefits. 

Returning to work only to find that your employer is ignoring your doctor’s restrictions and demanding work you cannot do is different. If your employer is engaged in that behavior, you should reach out to a New York workers’ compensation law firm like ours immediately. 

Employer Disputes

Sometimes, employers dispute that workers’ compensation should cover the claim. Common disputes include:

  • Accusations that drugs or alcohol were in your system at the time of the accident.
  • Accusations that you ignored safety protocols or were engaged in horseplay on the job. 
  • Claims that you were not on the job at the time of the injury.
  • Claims the problem represents a pre-existing condition.

If any employer dispute exists, you will need a workers’ compensation lawyer to handle your case. At this point, you will need an advocate who knows the laws backward and forward and can help you prove you have a bona fide work-related injury that should be covered.

Get Help Today 

Call our office to schedule a free consultation today if your claim has been denied. We’ll look at the facts of your workers’ compensation case and help determine the best way to proceed with your claim.

See also: 

How to Maximize Your New York Workers’ Compensation Settlement

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

What Are Your Rights When You Return to Work After a NY WC Claim