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QUESTION: What do I do if the carrier denies my workers’ compensation benefits claim in New York?
ANSWER: If your workers’ compensation claim is denied for any reason, it is prudent to immediately contact an experienced workers’ compensation lawyer in NYC. There are many different reasons why a WC claim may have been denied. Some of these mistakes could be fixed quickly, while other mistakes might be permanent. In either event, there is a limited amount of time to challenge a determination denying your workers’ compensation claim. If you fail to take the appropriate actions within that time, your claim may be forever barred from appealing the decision or otherwise obtaining compensation for your work-related injury or work-related illness.
For instance, if your claim was denied for a filing mistake, you may have time to revise your application papers if the initial time period is still valid (i.e., within two years from giving notice to your employer). To that same extent, however, if you failed to timely give notice to your employer or if you are outside the two-year time period, you will likely be barred even on an appeal as being untimely to file your claim.
However, if your claim was denied for any reason, you still have the right to appeal your claim. This includes if your benefits are greatly below what you would normally expect for your type of injury and wages (i.e., the Board found that your injuries were preexisting and lowered your recovery when there was no preexisting injury). Thus, the first thing you should do whenever your claim is denied is to contact an experienced workers’ compensation lawyer in NYC.
Before your claim is denied, you will get a notice of controversy which sets up a pre-hearing conference. During this conference, your claim will have been assigned to an administrative law judge (ALJ) who will review the contentions of the parties. The ALJ will attempt to narrow the issues in controversy for the hearing, as well as attempting to settle the dispute. If the ALJ cannot settle the matter, the case will proceed to a hearing. The hearing will allow each side of present evidence and offer testimony, including through witnesses and experts. After the hearing, the ALJ will consider the evidence and subsequently issue a decision resolving the matter.
If your initial workers’ compensation claim was denied by the ALJ, you have 30 days from the date of the ruling to file an appeal with the Workers’ Compensation Board. This appeal requests a review from a panel of three board members. In this appeal, you will need to provide the record and submit legal briefs arguing why the ALJ erred in denying your appeal. This stage is more focused on the legal arguments and the facts that were generated during the hearing with the ALJ.
If the Board denies your appeal, you will be entitled to file an appeal to the Appellate Division, Third Department. This appeal must be filed within 30 days of the Board denial. This is a state court which can review the determination and decide whether the law and the evidence from the ALJ and Board’s determination supports your denial. A denial here is usually final, as it is very rare for the Court of Appeals to accept an appeal.
If your WC claim was denied in New York, do not delay. Contact an experienced workers’ compensation lawyer for help right away. There is a limited amount of time to file an appeal and challenge an adverse decision.
We hope this FAQ was helpful. We have more FAQ questions and answers available here [[ADD LINK WHEN FINAL]].
But if you still have questions about what is workers’ compensation in New York, call to schedule a FREE consultation with our experienced workers’ compensation lawyers in NYC to learn more about how we can help you. You can reach us by dialing (844) 692-6671 or by sending us a private message through our “Contact Us” box available here.
