Appealing the Denial of a Workers' Compensation Claim

In order to initiate a claim for workers’ compensation in New York, an injured employee is required to file an Employee Claim Form (also known as a C-3) and give his or her employer written notice of how, when, and where the injury or illness occurred. If the employer or its insurance company contests the employee’s claim, the employee has certain legal rights, including the right to retain an attorney to assist him or her with the case. Rockland County workers’ compensation lawyer Valerie J. Crown regularly assists injured people throughout Greater New York whose claims have been denied by employers or insurance companies.

People who have been hurt on the job deserve access to compassionate treatment and vigorous representation. At our boutique firm, all of our staff take pride in offering personal attention to each of our clients during their times of need. We are available to the people whom we serve whenever they need us. You can reach Valerie’s cell phone at any time of day or night by calling 845.598.8253.

An employer or insurance carrier that wishes to contest an employee’s claim must file a notice of controversy with the New York Workers’ Compensation Board. This should occur within 18 days of the date the employee was injured or within 10 days of the date that the carrier learned of the accident, whichever is later. In the notice of controversy, the employer or insurance carrier must explain the reason why it is not paying the employee’s claim. The matter is then scheduled for a prehearing conference or a hearing, at which a workers’ compensation law judge will hear the parties’ respective arguments. At the hearing, the judge can consider evidence such as the parties’ testimony, medical reports, wage statements, and more.

In some instances, an insurance carrier may be able to suspend or modify cash benefits pending the resolution of the dispute. Once the workers’ compensation law judge has ruled with regard to the compensability of the injury, the employee may file a written application for review if he or she is not satisfied with the judge’s decision. This application should be filed within 30 days of the filing of the notice of the judge’s decision, and it should explain the reasons why the employee disagrees with the judge’s ruling. A panel of three members of the Workers’ Compensation Board will then make a decision on the matter. This board’s decision may affirm, rescind, or modify the law judge’s ruling.

If the board’s decision is unfavorable to the employee, he or she has the right to appeal the matter further. That appeal would be directed to the Appellate Division, Third Department, of the Supreme Court of New York and should occur within 30 days after the decision is served upon the employee. There is also the possibility of a further appeal from the appellate division to the Court of Appeals of New York.

Although each case is unique, some of the more common reasons why a claim may be denied by the insurance carrier are because of a disagreement as to whether the victim was a covered employee or an independent contractor, whether the injury was incurred in the course and scope of the victim’s employment, and whether the injury was serious enough to prevent the worker from returning to his or her job within a few days of the accident.

If you have been hurt at work, you have the right to retain an attorney to assist you with your case. You do not have to pay any legal fees upfront. The attorney’s fee is submitted to the Board and deducted from the award that is paid by the insurance carrier. To schedule a free appointment with Rockland County workers’ compensation attorney Valerie J. Crown, call our office at 845.708.5900, call Valerie’s cell phone at 845.598.8253, or contact us online. We represent injured workers throughout Rockland, Westchester, Dutchess, Ulster, and Orange Counties. Valerie J. Crown also is available to assist residents of Greater New York who need an injury attorney or representation in a medical or dental malpractice, wrongful death, nursing home abuse, or Social Security Disability matter.