In the State of New York, the worker’s compensation system is under the purview of the New York Worker’s Compensation Board. If you sustain an injury while on the job in New York and you get a denial for your worker’s compensation claim, you still have options. You can file a worker’s compensation appeal to get your case heard again and reevaluated.
When a Worker’s Compensation Claim is Denied
There are many reasons why your worker’s compensation claim could be denied. For instance, the insurance carrier for the worker’s compensation may deny your claim by disputing the validity of your injuries or that they were caused by activities at your place of work. They may also dispute that your injuries occurred while you were at work, or “on the clock.” If you are an independent contractor this could also be a reason that your claim is denied.
If the worker’s compensation insurance carrier for your employer decides to deny your claim, a notice of controversy will be filed by the insurance carrier with the Worker’s Compensation Board. The insurance carrier must file the notice within a certain amount of time per New York law – whichever is longer:
- Within 18 days after the disability begins, or
- Within 10 days of becoming aware of the incident
At that time the worker’s compensation claim will be referred to the Worker’s Compensation Board and a Worker’s Compensation law judge will make a determination.
Benefits if a Claim is Initially Denied
In the event that the worker’s compensation insurance agency for your employer decides to contest your worker’s compensation claim but you are unable to work you are not eligible for any worker’s comp benefits at that time. No benefits will be issued during the time that your case is pending but if you win at your hearing most carriers will pay the full weekly benefits, including any back payments and reimburse any medical expenses. This occurs even if the carrier is not pleased with the decision of the Worker’s Compensation Board and appeals it to the Appellate Division.
The Hearing Process
The worker’s compensation law judge will preside over your worker’s compensation appeal hearing. He or she may initiate a pre-hearing conference where it will be discussed whether or not your claim is covered and if you are eligible for benefits. The judge will review medical reports, take testimony, and use other evidence in order to make a determination. If the judge rules in your favor he or she will then set the amount of your worker’s comp benefits.
Appealing the Judge’s Decision
If the judge rules in favor of the insurance carrier (and your employer) you have the right to appeal the decision. Within 30 days of the day the judge made his or her decision, you can file an appeal. Likewise, the insurance carrier for your employer can also file an appeal under the same conditions.
When you appeal the worker’s compensation judge decision, the request must:
- Be in writing
- Clearly state the reasons why you feel that the judge’s decision was not correct
- Any supporting evidence for your case
Your request must be submitted to the worker’s compensation board where a three board member panel will review your request and supporting documents, then make a determination on whether or not they will grant your review request. If it is granted, the board members will review your case.
The panel will have three potential decisions:
- They can affirm the decision of the judge
- They can modify the decision of the judge
- They can reverse or rescind the decision of the judge
The panel could forego any decision and return the case to the judge who will view new evidence that may change his or her decision.
More Appeal Options
If you feel that the board’s decision was unfair, there is another appeal option. You can appeal your worker’s compensation decision to the Appellate Division at the Third Department of the Supreme Court of the State of New York. This type of appeal must be filed no later than 30 days after the board makes its decision. The New York Court of Appeals is the next step from Appellate Court in the appeals process, but that extremely rare.
Get Legal Help
At any point of your worker’s compensation claim you are entitled to legal representation. Under New York law, the attorney you choose cannot accept any payment directly from you. Instead, the Worker’s Compensation Law judge or the panel of three board members will determine what your attorney fee should be and if you win that amount will be deducted from your compensation award.
Legal representation is not mandatory, but it can prove to be very helpful as you navigate the system. An attorney can help ensure that you have a legal advocate who is experienced and is looking out for your best interest. If the benefits are substantial or you have a complex case, retaining an attorney is highly advisable. Contact us today for a free consultation.