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Reasons why workers' compensation claims are denied

Workers in New York and elsewhere understand that accidents and injuries are possible in the workplace. For the most part, individuals think that workplace injuries are minor incidents that might require a few days off of work to recover. Additionally, they often think of these injuries of being covered by his or her employer's worker compensation insurance. However, there are many instances where workplace injuries are not covered by workers' compensation, or the accident in question falls in a gray area. In these circumstances it is critical to acquire legal assistance to ensure that the right evidence is presented to protect a claim.

Filing a claim after a workplace injury is necessary for those seeking workers' compensation. However, just because an employee files a claim does not mean that he or she will automatically be approved and receive these benefits. It is very possible that the employee could be denied. By knowing the common reasons for denial, a claimant can better prepare the legal arguments that are necessary to support his or her position.

There are many reasons one could have a denied workers' compensation claim. When a denial letter is received, this should outline why the claim was denied. In some cases, a denial could result because the employee did not meet the eligibility requirements. For example, if he or she was injured while engaging in horseplay or while he or she was away from work, then he or she won't be able to recover benefits. Other reasons for denial include not reporting the injury in time, not filing the claim in time, an employer's successful dispute of a claim, an injury that is not compensable, no medical treatment was sought in the mater, and insufficient evidence that the injury was work-related.

If a worker was denied after filing for workers' compensation benefits, then he or she has the ability to file an appeal within 30 days. However, prior to filing an appeal, it is possible to meet with an employer to determine if a resolution can be reached. The appeals process can get complicated, making it important to understand the steps of the process and what is required. This can help an injured employee make well-informed choices to protect his or her rights.

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