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Can You Appeal a Workers’ Comp Denial?

December 13 2019

Yes. Those who have been injured on the job will be pleased to know that their initial denial is not the end of the matter. New York law affords injured workers a chance to bring an appeal and show that they are entitled to benefits. There are many unique issues that crop up in workers’ compensation claims, so appeals are sometimes successful.

We encourage injured workers to hire an attorney to help them with any appeals. The process is complicated, and you don’t want to leave anything up to chance. Contact one of our NYC workers’ comp lawyers for a free consultation.

Identify the Reason for the Denial

In your appeal, you need to directly address why you were denied workers’ compensation benefits. Read your Notice of Decision and identify the reason given. Some common ones include:

If you are unsure why you were denied, contact an attorney immediately. You need to move quickly to protect your rights.

Request a Hearing

This is your first level appeal. You must make your request for a hearing before an administrative law judge. At the hearing, you can present evidence that shows you are qualified for benefits. This evidence might include witness testimony or documents.

An attorney will be a big help pulling together all the evidence you need to make a solid case. For example, you might need to go to different doctors to fully document the seriousness of your injuries. Or you will need to present witnesses who saw you injured at work. After hearing all the evidence, the judge will make a decision about whether you qualify for benefits.

Appeal the Judge’s Decision

If you are successful at the hearing, you should receive benefits. However, even if the judge decides against you, you can still bring an appeal to the Workers’ Compensation Board. You must request an appeal within 30 days of receiving the administrative law judge’s decision. Three members sit on the Board, and they will review the judge’s decision. They can reverse it, uphold it, or modify it.

Bring Additional Appeals

The Workers’ Compensation Board’s decision is not final, either. Instead, a claimant can continue to appeal through the court system. Speak with an attorney about whether you should continue to appeal.

Building a proper evidentiary foundation is critical before you even request your first hearing. The chance of introducing helpful evidence closes considerably once you start the appeals process, so working with an attorney is vital.

Contact an NYC Workers' Compensation Attorney Today

Injured workers deserve benefits, and insurers should approve valid claims. At Lipsig, Shapey, Manus & Moverman, we have seen many workers be unfairly denied the medical care and wage loss benefits they deserve. For help with your case, contact us today by calling or filling out our contact form.