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Why Your Workers’ Compensation Claim Was Denied

July 17, 2013 By Paul Giannetti

After suffering an injury at work, it can be both shocking and frustrating to receive a letter from your employer’s insurance carrier stating that your workers’ compensation claim was denied. Unfortunately, this is a common occurrence.

Insurance companies often look for any excuse to deny a workers’ compensation claim.  The denial letter may offer any one of a number reasons why your claim was rejected.

Reasons Workers Compensation Claim Was Denied

  • Your employer doesn’t believe that there was an accident (no witnesses)
  • You were not working at the time of the accident
  • You didn’t suffer a serious injury
  • Your injury is not covered by workers’ compensation
  • You had a preexisting condition similar to the injury arising from the accident
  • You don’t need medical treatment for your injury
  • Your injury wasn’t work-related
  • You did not report your injury properly or in a timely manner
  • You were under the influence of alcohol or drugs at the time of the accident
  • You were not an employee at the time of the accident

While there might be truth to these claims in some cases, insurance companies often interpret events as aggressively as possible to deny a valid claim.  Why?  To save money.

Some injured workers, intimidated by the denial letter or unaware of their right to fight it, fail to appeal the claim, thus allowing the insurance company to get away with paying nothing.  In other cases, the insurance company may allow the case to drag on for awhile, then offer a settlement figure far below the amount the injured worker deserves. The injured worker may be so desperate for financial help that he or she accepts the offer. Either way, the insurance company wins.

How to Avoid Workers Compensation Denial

If an insurance company is determined to deny your claim, they’ll probably find someone excuse to do so. But that doesn’t mean you can’t make it tough for them.   If you are injured on the job, remember to do these two things:

Notify Employer in Writing Immediately

You have 30 days to notify your employer in writing about the injury, but don’t delay – do it as soon as possible. Even if your employer is on vacation, away on a business trip, or if you were about to go home for the weekend, send an email to put the employer on notice. Be sure to state the time and place of the injury and how it occurred.  If you have developed a work-related illness, notify your employer as soon as you realize that you have a work-related illness, take time off work for the illness, or see a doctor for treatment of the illness.

Record All Details About the Accident and Injury

Even if you’ve notified your employer, write down all details of the events leading up to the incident, including the date and time of the incident, the names of any witnesses, how the injury occurred, and your doctor’s comments and prescribed treatment (especially if it was an injury that needed immediate medical attention and you didn’t see a Workers’ Comp doctor).  You may need to remember these details later in a workers’ compensation hearing.

File Your Workers’ Compensation Claim Quickly

Although you have two years to file a workers’ compensation claim, it’s best to submit a Form C-3 with the New York Workers’ Compensation Board as soon after the injury as possible.  Once the two-year statute of limitation lapses, you’re very likely to have forfeited your right to workers’ compensation.

If the worst happens and your claim is denied, remember that you have 30 days to appeal the decision.  Be sure to review the Most Common Workers Compensation Questions. For the best chance of success, contact an experienced New York Workers’ Compensation attorney for a free consultation to help you through the appeal process and fight for the compensation that you deserve.

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