Receiving a denial for your workers’ compensation claim can be disheartening and confusing. However, understanding the reasons behind the denial is crucial for figuring out your next steps. You need to ask three important questions if you receive a Notice of Controversy (NOC).
What specific reason did the insurer give for the denial?
New York law requires insurance companies to provide a reason why they denied a claim. They must include this in the NOC. Common reasons for denial include:
- Missing the deadline to report your injury (generally 30 days from the date of the accident)
- Disputes about whether the injury is work-related
- Lack of medical evidence supporting your claim
- Allegations of intoxication or horseplay at the time of injury
Take time to read the NOC carefully. If you’re unsure about any terms or concepts, don’t hesitate to ask for clarification from an attorney.
Was my claim denied within the required timeframe?
New York law requires insurance companies to file an NOC within 25 days after the Workers’ Compensation Board indexed the case if they decide to deny a claim. If an insurance company fails to do so, they lose the right to use certain defenses, such as:
- The person wasn’t actually an employee when the accident happened
- The injury wasn’t really an accident
- The injury didn’t occur because of work or during work activities
This means that if the insurance company misses the deadline, they must accept these basic facts about your claim as true. However, they may still dispute other aspects of your claim.
How can I appeal this decision?
You have the right to appeal a denied claim. The initial appeal is a hearing before a Workers’ Compensation Law Judge. Here, you’ll have the opportunity to present evidence and testimony supporting your claim.
If you disagree with the judge’s decision, you can appeal to the Workers’ Compensation Board Panel within 30 days. You can then appeal to the Appellate Division of the Supreme Court within 30 days of the Board Panel’s decision, if necessary.
A denied claim is not the end of the road
Appealing a denied workers’ comp claim can be a complex process, but you don’t have to face it alone. Reach out to an attorney who can assess your situation and advocate on your behalf.