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09 December 2014

Why Are Workers Comp Claims Denied?

As of December 7th, 2014, over 6,300 injured workers have filed claims for workers compensation in New York State this year. In total, workers have collected over $407 million. But the US Department of Labor reports a troubling finding: the majority of workers comp claims are denied, not approved.

Top 5 Reasons For A Claim Denial

Anywhere from 52% to 54% of all claims are turned away by New York State’s Workers Compensation Board. Unfortunately, many of these claims are perfectly justified, legitimate requests for compensation. So what went wrong?

1. You Filed Too Late

Most insurance companies will assume that if you didn’t file your claim immediately after the accident, you’re not really that hurt.

Here’s the bottom line: New York State gives you 30 days after you’re injured to file a claim. You have to notify your employer of the accident and fill out an accident report. File any later than 30 days and it’s an automatic denial.

2. Your Employer Is Disputing The Claim

Your employer has a direct incentive to argue against your claim: insurance premiums. The more employees get hurt on their watch, the more they have to pay the insurance company.

But if your employer or their insurer does deny your claim, they have to inform you in writing with a clear explanation of why. Usually, they try to argue things like:

  • Your injury isn’t serious enough for workers comp. This is especially common with soft tissue injuries, which are hard to objectively verify with x-rays and MRIs.
  • Your injury didn’t occur within the scope of employment.

These arguments can often be disproved with objective medical records and eye witness statements. You can fight the initial denial in an appeal before the state workers comp board.

3. No One Else Saw Your Accident

The vast majority of workers comp insurers will deny claims for accidents that have no independent witnesses. Unfortunately, there’s nothing you can do about who was around when you got hurt. The best defense in this instance is prompt reporting. Let your coworkers know about the injury, too.

4. Your Story Wasn’t Consistent

It’s usually an honest mistake. Memory is unreliable and a traumatic accident can really shake things up. But if you describe the accident one way in your initial report, another way to the doctor, and give a third story to someone else, you’re asking for the workers comp board to deny your claim.

5. You Failed The ER “Drug Test”

If you visit the emergency room after your workplace accident, there’s a good chance that they’ll run a standard drug test. If illegal substances are found, it’s almost a given that you will be denied workers comp. The insurance company could reasonably argue that you were impaired at the time of your accident.

Have You Considered All Your Options?

If your initial claim for workers comp was denied, consult the official letter. Most denial notices will detail how you can appeal.

Filing a personal injury lawsuit may be another solution. In New York, you can only sue your employer in limited circumstances. For example, state labor laws make employer’s strictly liable for many fall accidents, so long as they involved ladders, scaffolding, or other elevation-related equipment. If you were not adequately protected from a fall, you may have a case against your employer.

In many other cases, negligence is found elsewhere. Property owners, architects, engineers, contractors, and sub-contractors all have a duty to use reasonable care in performing their tasks. If they fail, and you get hurt, you may have a viable personal injury lawsuit.

Contact An NYC Construction Accident Lawyer

Lipsig, Shapey, Manus & Moverman, P.C. is a highly-esteemed team of personal injury lawyers, with over 80 years of combined experience. In that time, we’ve secured over $800 million in damages for our injured clients. A recent case, we recovered a jury verdict of over $20 million for a construction worker severely injured in the Bronx.

You deserve experienced, effective legal counsel. Our construction accident attorneys offer a free consultation to anyone interested in exploring their legal options. Call us toll-free, 24 / 7, at 1-800-954-7744 or complete our contact form today.