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Steps to Take if Your Workers’ Compensation Claim Is Denied

If you’re injured in the workplace or developed a health condition due to the type of work you do, such as lung disease from toxic chemical exposure, a repetitive strain injury (RSI), or other cumulative trauma, you’re likely wondering if you qualify for workers’ compensation benefits. Workers’ compensation benefits cover the medical expenses of your illness or injury, along with lost earning capacity and lost wages. 

But, you have to meet specific requirements before you can begin receiving these benefits. Often, claims for workers’ compensation don’t meet these requirements or they’re not filed properly. This leads to the claim being denied. However, there are certain steps you can take if your claim was denied, and having an experienced New York workers’ compensation lawyer from Dalli & Marino, LLP on your side can also greatly help.

Steps to Take if Your Workers’ Compensation Claim is Denied

It’s only natural for you to feel vulnerable after you suffer a workplace illness or injury. You have the potential of facing lost wages or medical treatments you’ll have to undergo. Not to mention, it can feel extremely overwhelming having to fight a denied workers’ compensation claim by yourself. However, there are certain steps you can take after being denied workers’ compensation, including:

1. Don’t Communicate With the Insurance Company Yourself

After being denied workers’ compensation, you shouldn’t communicate with the insurance company before you consult with a lawyer. Insurance companies are well-known for their different tactics like requesting recorded statements from claimants without their lawyers present and using their words against them. Frequently, honest individuals hurt their claims because they talk with representatives who they believe are on their side, but aren’t. 

2. File an Appeal

You don’t have unlimited time to get your appeal submitted, therefore, it’s essential that you act quickly. When it comes to filing an appeal, you’ll want to work with a trusted New York workers’ compensation attorney. They’ll be able to assist you in compiling all the required evidence to help your case. 

3. File a Second Appeal if Your First Appeal is Denied

It’s not uncommon for the first appeal to also get denied. In New York, within 30 days of an appeal decision, you can still appeal to the Appellate Division. If needed, you can even take your appeal even further by going through the State Supreme Court if you desire. But, this can be a lengthy and taxing process that can cost you both money and time. It’s best to consult with a qualified attorney to go over your best options.

Reasons Your New York Workers’ Compensation Claim May Get Denied

In the state of New York, workers’ compensation claims are very common. However, even though most employees who sustain a workplace injury or illness may qualify for workers’ compensation benefits, this doesn’t mean the process of claiming those benefits and receiving them is going to be easy. Some reasons why your workers’ compensation claim may get denied include:

1. Pre-Existing Conditions or Injuries

It’s not uncommon for insurance companies to claim that a pre-existing injury or condition caused or partially caused an individual’s present condition. Even if you have a pre-existing condition, a skilled attorney may be able to collect evidence and build you a case that shows the workplace injury made your pre-existing condition worse.

2. The Doctor You Went to Wasn’t Approved

Under the workers’ compensation law in the state of New York, your employer can make it a requirement for you to only see an insurance-approved physician for your claim. You may be required to undergo an Independent Medical Exam (IME) and be treated by specific doctors. 

3. Incomplete Paperwork or Missed Deadlines

Typically, there is a two-year statute of limitations to file a claim from the date of your injury, though most individuals should begin the claims process within 30 days of the incident. A workers’ compensation lawyer can help you file your claim properly so you don’t make any mistakes or miss any deadlines.

4. The Injury Didn’t Occur at Work

The “coming and going” rule in the state of New York states that workers’ compensation isn’t available to employees that become injured while coming to and going home from work. But, there are gray areas and exceptions to this. For example, if you become injured in a motor vehicle accident while doing your job or if you’re injured in the workplace parking lot, you may qualify for benefits.

Should You Hire a Workers’ Compensation Attorney to File an Appeal?

Unless a simple error caused your claim to be denied and it was cleared up immediately, it’s always a good idea to talk with an experienced workers’ compensation attorney as soon as possible. A lawyer can help you decide if an appeal is even the best course of action. workers’ compensation appeals timelines are strict and short, and you can easily lose your rights to workers’ comp benefits if you miss a deadline.

You definitely want to speak with a qualified lawyer before you attempt to file an appeal yourself. Appeals are complex legal processes and involve rules of civil procedure and evidence that a judge expects you to know.

Contact a Highly-Skilled New York Workers’ Compensation Attorney at Dalli & Marino, LLP Today

If you were involved in a workplace accident or injury, our experienced and Spanish-speaking workers’ compensation lawyers here at Dalli & Marino, LLP may be able to assist you. We offer all of our clients a high level of legal representation that may possibly secure you the compensation you may be entitled to. 

Our team at Dalli & Marino, LLP is highly experienced in workers’ compensation law and can help you file your claim. Give us a call at (888) 465-8790 or fill out our contact form to schedule a free consultation with one of our experienced workers’ compensation attorneys today.

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