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Reasons why workers' compensation claims are denied

Being injured at work is bad enough - being denied workers compensation benefits makes it even worse. 

Many workers' comp claims are denied on the first application. Often, the denial has nothing to do with the legitimacy of the claim, and a significant percentage of individuals receive benefits after being denied on the first application.

Why are claims denied?

So what can go wrong with a workers' comp application? Here is a list of some of the common reasons why applications are denied.

  • The injury was not reported to the employer in a timely manner. Many states, including New York, have deadlines for reporting work-related injuries. The New York Workers' Compensation Board says employees should report injuries to a supervisor immediately. Then, within 30 days of the accident, employees must inform employers of the accident, in writing.
  • The application was not filed in time. Applications in New York must be filed within two years of the accident.
  • Your employer is disputing the claim. Employers dispute claims for many reasons, but here's one example: there were no witnesses and the employer does not believe the injury occurred at work.
  • Your injuries are not eligible for benefits.
  • You have not sought medical treatment yet for your injuries.
  • The insurance company determines that you were working as a contractor and you were not an employee.

Sometimes the denial could be the result of clerical error or a simple misunderstanding of the facts of your case.

What is the next step?

If or when you are denied benefits, it is crucial to think logically and make good decisions regarding how to proceed.

The denial letter will tell you why your claim was refused. After an application is denied, the next step is to appeal. At this point, it is very important to not make any mistakes - your financial and physical health could hinge on making a well-reasoned objection to the benefits denial. Hiring an experienced workers' compensation attorney who will fight for your interests typically is a wise move.

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