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Why do some workers’ compensation claims face rejection?

On Behalf of | Jul 24, 2020 | Workplace injuries

Sustaining an injury at work can cost you both time and money. Your pain may prevent you from performing your job. And the time you spend recuperating will impact your earnings. You may have applied for workers’ compensation benefits to cover your medical expenses and recover a part of your lost wages. Yet, your claim might have faced rejection. If it did, it’s important to understand why.

Reasons for rejection

To receive workers’ compensation benefits in New York, you must have reported your injury and filed your claim within the state’s statute of limitations. You must have reported your injury to your employer within 30 days of sustaining it. And you must have filed your workers’ compensation claim no more than two years after your date of injury – or two years after discovering your injury was work-related. Reporting your injury or filing your claim outside these periods will lead to its rejection.

You may have reported your injury and filed your claim within New York’s statute of limitations. Yet, your employer’s insurance provider may have rejected it if your employer disputed that you sustained your injury while working. This rejection could stem from your employer claiming:

  • Your injury arose from horseplay with your coworkers
  • Your injury happened outside of work
  • Your injury happened while you were on break
  • Your injury stemmed from a pre-existing condition
  • Your injury was not work-related

Filing an appeal

No matter the reason your workers’ compensation claim faced rejection, you will want to appeal its denial. New York’s statute of limitations gives you 30 days to do so after the insurance provider controverts your claim. Before your hearing, you will attend a pre-hearing conference where a judge will review your case and schedule your hearing date. At your hearing, a three-judge panel from the state’s Workers’ Compensation Board will review your case. Based on their findings, they will either uphold, modify or reverse the initial decision.

A denied workers’ compensation claim does not mean you must forego the benefits you deserve. An attorney can help you understand your options for receiving recourse for your injury.