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More than 6,300 injured workers in New York State have filed workers’ compensation claims, collecting over $407 million in benefits. However, the U.S. Department of Labor reports that most claims are denied rather than approved. If you’ve experienced a denial, our personal injury lawyers can help you appeal and pursue the benefits you deserve.
Top 5 Reasons for a Claim Denial
Anywhere from 52% to 54% of all claims are turned away by New York State’s Workers’ Compensation Board. Unfortunately, many of these claims are perfectly justified, legitimate requests for compensation. So what went wrong?
1. You Filed Too Late
Most insurance companies will assume that if you didn’t file your claim immediately after the accident, you’re not really that hurt.
Here’s the bottom line: New York State gives you 30 days after you’re injured to file a claim. You have to notify your employer of the accident and fill out an accident report. File any later than 30 days, and it’s an automatic denial.
2. Your Employer is Disputing the Claim
Your employer has a direct incentive to argue against your claim: insurance premiums. The more employees get hurt on their watch, the more they have to pay the insurance company.
But if your employer or their insurer does deny your claim, they have to inform you in writing with a clear explanation of why. Usually, they try to argue things like:
- Your injury isn’t serious enough for workers’ comp. This is especially common with soft-tissue injuries, which are hard to verify with X-rays and MRIs objectively.
- The injury didn’t occur within the scope of employment.
These arguments can often be disproved with objective medical records and eyewitness statements. You can fight the initial denial in an appeal before the state workers’ comp board.
3. No One Else Saw Your Accident
The vast majority of workers’ comp insurers will deny claims for accidents without independent witnesses. Unfortunately, there’s nothing you can do about who was around when you got hurt. The best defense in this instance is prompt reporting. Let your coworkers know about the injury, too.
4. Your Story Wasn’t Consistent
It’s usually an honest mistake. Memory is unreliable, and a traumatic accident can really shake things up. But if you describe the accident one way in your initial report, another way to the doctor, and give a third story to someone else, you’re asking for the workers’ comp board to deny your claim.
5. You Failed the ER “Drug Test”
If you visit the emergency room after your workplace accident, there’s a good chance that they’ll run a standard drug test. If illegal substances are found, it’s almost a given that you will be denied workers’ comp. The insurance company could reasonably argue that you were impaired at the time of your accident.
Have You Considered All Your Options?
If your initial workers’ comp claim was denied, consult the official letter. Most denial notices will detail how you can appeal.
Filing a personal injury lawsuit may be another solution. In New York, you can only sue your employer in limited circumstances. For example, state labor laws make employers strictly liable for many fall accidents involving ladders, scaffolding, or other elevation-related equipment. If you were not adequately protected from a fall, you may have a case against your employer.
In many other cases, negligence is found elsewhere. Property owners, architects, engineers, contractors, and subcontractors all have a duty to use reasonable care in performing their tasks. If they fail, and you get hurt, you may have a viable personal injury lawsuit.
Contact an NYC Construction Accident Lawyer
Lipsig, Shapey, Moverman, Freund & Wisell, PLLC is a highly esteemed team of personal injury lawyers with over 80 years of combined experience. In that time, we’ve secured over $800 million in damages for our injured clients. In a recent case, we recovered a jury verdict of over $20 million for a construction worker severely injured in the Bronx.
You deserve experienced, effective legal counsel. Our construction accident attorneys offer a free consultation to anyone interested in exploring their legal options. Call us toll-free, 24/7, at 1-800-954-7744 or complete our contact form today.