Many workers, even in dangerous jobs, rest easy knowing that if they’re injured at work they’ll be covered by workers compensation insurance. While that’s true in most cases, it’s not unheard of for workers comp claims to be denied, leaving an injured worker with no assistance after a serious or even crippling injury.
Some of the reasons claims are denied are simple and avoidable—and some are correctable—and it’s helpful to know about them. We’ve put together a list of some of the most common reasons behind claim denials to help workers and their families avoid them.
Common Reasons for Denial
Most workers compensation claims are denied for one of these reasons:
- Delay in Filing – An injury can change your life forever, but you don’t have forever to file a claim. In New York State, a claim must be filed within thirty days of an injury. The NYS Workers’ Compensation Board provides a timeline with recommendations of when you should take different steps in the claim process, from being examined by a doctor to filing follow-up paperwork, and their recommendation for reporting an injury is simple: immediately.
- Off-Site Injury – Workers comp only covers things that happen on the job. If an injury happened somewhere else—in most cases while travelling to and from work—it’s not covered.
- Not Treated by an Approved Provider – In New York, you should be treated only by a provider authorized by the NYS Workers’ Compensation Board. Your doctor might already be on this list, but it’s important to check. An insurer can require that you use facilities of its choice for tests, and it can also require you to see a doctor of its choosing for an independent medical exam (IME).
- Minor or Fully-Healed Injury – It’s disheartening to hear that an injury isn’t serious enough to qualify for work comp. But if it doesn’t cause harm sufficient to keep you out of work, or if it heals before you see a doctor, this can be an issue. That’s why it’s important to see a doctor immediately.
- Pre-Existing Injury – If you already have a condition and a work injury makes it worse, or if a work injury involves a previously injured body part, the insurer may try to deny the claim. Again, this is part of why it’s important to see a doctor immediately.
- Misconduct – This is a broad category that can include injuries caused by fooling around on the job as well as injuries caused because you were under the influence of drugs or alcohol. It also includes injuries caused by starting a fight at work and getting injured in it.
- Never Received Medical Treatment – Injuries must be verified before a claim can be accepted. If you are injured, you’ll need proof of the injury from a doctor or other provider. Without it, you can expect a denial.
- An Employer Disputes the Claim – Many employers try to avoid paying claims in order to keep their insurance rates down. Some will dispute all claims, no matter how small or how solid the evidence is on the worker’s side.
New York Workers Compensation Lawyer
No one goes to work hoping to get seriously injured, but unfortunately, many workers are injured on the job every year. In fact, nearly 2.9 million Americans were injured or fell ill while on the job in 2015 (the most recent year with available data). In New York, close to 2.5 percent of all workers missed at least one day of work because of an injury or a work-related illness.
If you’ve been hurt on the job, it’s important to get in touch with an experienced New York workers compensation and Social Security Disability law firm to protect your rights and help you through the often difficult and complicated claims process. The attorneys at Finkelstein, Meirowitz & Eidlisz, LLP have handled many workers comp cases, and we’re ready to discuss your case, free of charge. Give us a call today at 212-385-9190 or contact us online through the form below to schedule a free consultation.