Denied Claims or Reduced Benefits

If Your Workers’ Compensation Claim Is Denied

If your workers’ compensation claim is denied, don’t despair. Many workers’ compensation claims are denied, often because there was not sufficient medical information provided about the injury or the injured worker failed to give his or her employer proper notice of the injury.

At Erwin McCane & Daly, an Albany, New York, workers’ compensation law firm, we have extensive experience advocating on behalf of individuals who have had claims for disability denied. It’s important to have that kind of experience on your side, whether you are appealing a denied claim or filing a claim for the first time.

Why Workers’ Compensation Claims are Denied

When a claim is denied, a denial letter is sent to the injured worker. Inside the letter will be the reason as to why the case is not proceeding. It could be denied for not meeting the eligibility requirements, such as getting injured while fooling around at work, or while not actually on the job. If you believe the denial is an error, you may appeal.

Common reasons workers’ compensation claims are denied include (but are not limited to) the following:

  • The injury was not reported in time: You should submit the accident in writing to your employer as soon as possible but within 30 days

  • The injury was not submitted to the Board in time: you must report the injury to the Board within 10 days of notification of the accident

  • The employer disputes the claim: the employer may claim the accident happened outside of work, was the result of fooling around, or some other disqualifying reason

  • Injury is not compensable: For example, claims for stress-related injuries are difficult to prove

  • No medical treatment: A doctor must complete a preliminary medical report and mail it to the appropriate District office within 2 days of the accident

  • Insufficient evidence that the injury is workrelated: It’s not always clear whether an injury happened at work. In this case, another medical exam may be necessary.

  • The claim was filed after leaving the job: insurers typically deny claims that are filed after the employee is fired, laid off, or quits. If there is a good reason for the delay, the denial may be able to be contested. 

  • The injured worker refuses to give the insurance company a recorded statement: Workers’ Compensation insurers will often ask injured employees to give a recorded statement describing the accident and the injuries. Giving a recorded statement without proper legal advice and guidance typically does not help an injured employee. If the insurer asks for a statement, it is usually a sign that the insurer has a problem with the case. If the employee gives the statement, the insurer will probably not put that employee on workers’ compensation benefits. However, if the employee refuses to give the statement, then the adjuster can tell the employee that his/her failure to give the statement prevented the insurer from awarding compensation benefits.

  • The injured worker was intoxicated/under the influence of alcohol or drugs: If alcohol or drugs are involved in the accident, the injured employee is not entitled to make a claim. A manager has the right to request an alcohol and drug test be performed to rule out any possibility. If tests show that the injured employee was under the influence when the injury occurred, the claim will generally be denied.

  • The injury is from a pre-existing condition: If the injured worker has an injury or illness before starting the job, and the job does not make it worse, they are typically not eligible for Workers’ Compensation. The insurance company will fight incredibly hard to get a claim rejected using this argument.

We Tackle Denied Disability Claims and Reduced Benefits Head On

Doctors working for employers’ insurance carriers often minimize an injured person’s losses or claim that an injury was due to a pre-existing condition that is not covered under workers’ compensation.

In other instances, a recipient of workers’ compensation benefits can suddenly have his or her benefits reduced, often after having been asked by an employer’s insurance provider to receive an independent medical exam (IME).

Our workers’ compensation attorneys know how to challenge denials of workers’ compensation benefits or reduction in benefits. The first step to take when your workers’ compensation has been denied or reduced is to request a hearing before a Workers’ Compensation Board judge. In this situation, you want to have experienced, aggressive legal representation on your side fighting for benefits that are rightfully yours.

If you have questions for an Albany denied or reduced disability claims attorney, call 518-449-2245 or schedule a free initial consultation below.

If you choose to have us represent you on your workers’ compensation claim, we do so for no upfront cost. If we successfully recover your claim, a judge determines what our fee should be. This fee is deducted directly from the compensation, so you don’t have to come up with it yourself. If we are unsuccessful with your claim, you don’t owe any lawyer’s fees.