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What happens if my workers' compensation claim is denied?

In New York, many workers in a variety of industries file workers' compensation claims, only to encounter a rejection. With so much depending on these benefits, it is important to know what to do next.

Reasons for denial may include late or incomplete paperwork, insufficient medical documentation and other issues. You may also face a situation where you do get compensation, but it does not suffice because the insurer and its doctor dispute the extent of your disability.

When an insurer wants to deny a claim

In the case of a denial, the insurer will let you and the Workers' Compensation Board know that it intends to dispute your claim. A workers' compensation law judge will conduct a hearing on the case. The judge will hear testimony and examine evidence such as medical records and witness statements.

Appealing to the Workers' Compensation Board panel

Either you or the insurer can appeal the judge's decision and request review by a panel of three Workers' Compensation Board members. The panel may refuse to review your case, in which case the judge's decision will stand. If the panel does examine your case, it may affirm the decision or reverse it. The Board may also change the decision or send it back to the judge. The last option typically occurs when the Board believes the judge did not fully consider all currently available evidence.

Further steps

You may appeal the Board's decision to the Appellate Division, Third Department. The court does not accept all cases for review. You may also be unable to submit additional evidence, as the Court will generally refuse to examine questions of fact, focusing only on whether the Board interpreted applicable laws correctly.

The workers' compensation process can be difficult to navigate, and even a seemingly straightforward case can encounter roadblocks. An experienced lawyer can navigate the complex procedural requirements, help you ensure a full medical record and do anything else necessary to assist you in filing a strong claim to get you the compensation you need.

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