Long Island Workers’ Compensation Denied Claim Lawyer

Getting a workers’ compensation denial while you’re still hurting, out of work, and facing medical bills can feel like the case is finished before it started.

When a workers’ compensation claim is denied, however, it isn’t necessarily the end of the road. The dispute can be addressed through the New York Workers’ Compensation Board, where a judge reviews evidence from both sides before deciding whether the claim should be established and benefits awarded.

At The Odierno Law Firm, our workers’ compensation attorneys represent injured workers throughout Nassau and Suffolk County and have more than 150 years of combined legal experience. If your claim was denied after suffering a workplace injury, we offer a free consultation so you can understand your options before deciding how to move forward.

Take the first step in your recovery by calling (631) 752-8580 or using our contact form to connect with us.

Common Reasons Why Long Island Workers’ Comp Claims Get Denied

The specific reason an insurer gives for disputing your claim matters because it tells you what evidence you need to challenge it. A carrier that says your injury isn’t work-related requires a different response than one that says you missed a filing deadline.

Some of the most common grounds for denial include:

• The accident was not work-related. The employer or carrier may argue that the accident did not arise out of or occur in the course of your employment.
• The deadline for reporting or filing has passed. You must notify your employer of your work injury within 30 days and file your workers’ comp claim within two years of the accident (or within two years after you knew, or should have known, your condition was work-related). Exceptions can apply, so a missed deadline shouldn’t automatically be treated as the end of the case.
• The insurer says your injury was not caused by the work accident. The insurer may acknowledge that an accident occurred at work but argue that the medical condition you are claiming was not caused by it. For example, it may point to a preexisting condition and argue that the workplace accident did not cause a new injury or aggravate the existing one.

How to Appeal a Denied Workers’ Compensation Claim in New York

If your workers’ compensation claim is denied in New York, challenging that decision generally begins with a hearing before a Workers’ Compensation Law Judge. If the judge also rules against you, you can then ask the Workers’ Compensation Board to review that decision.

1. Challenging the Insurance Carrier’s Denial

When the insurer formally denies, or controverts, the claim, the Workers’ Compensation Board schedules a hearing before a Workers’ Compensation Law Judge. This gives you the opportunity to present evidence addressing the carrier’s reason for denial.

What that evidence looks like depends on the issue. A dispute over whether your injury was caused by work may require medical evidence connecting the condition to your job, while a dispute over notice may focus on when and how you reported the injury. The insurer can present its own evidence as well.

The judge reviews the evidence, may hear testimony from the parties and witnesses, and decides whether the claim should be established and benefits awarded.

2. Appealing an Unfavorable Judge’s Decision

If the Workers’ Compensation Law Judge rules against you, you generally have 30 days from the filing date of the decision to request administrative review.

The appeal must identify what part of the decision you are challenging and why you believe it should be changed. A three-member Workers’ Compensation Board panel then reviews the decision and may affirm it, modify it, reverse it, or send the case back for further proceedings.

Further review may be available in some cases if the Board panel also rules against you.

3. Seeking Further Review

If the Board panel also rules against you, additional review may still be available. You can request reconsideration or review by the Full Board within 30 days of the panel’s decision. Depending on the circumstances, you may also appeal a Board panel decision to the New York Supreme Court, Appellate Division, Third Department, generally within 30 days after the decision is served. These are separate avenues of review, so an attorney can determine which option is appropriate and make sure the applicable deadline is preserved.

How The Odierno Law Firm Can Help

The Odierno Law Firm has represented injured Long Islanders since 1978, including workers dealing with denied workers’ compensation claims. We understand the New York workers’ compensation process and what it takes to challenge an insurer that refuses to accept a claim.

Our attorneys can help by:

• Getting to the heart of the denial. We review the carrier’s position, the medical record, notice history, and other available evidence to determine exactly what needs to be addressed.
• Building stronger evidence. Depending on the reason for denial, we may gather additional medical support, employment records, witness testimony, accident documentation, or other evidence needed to establish the claim.
• Preparing you for the hearing process. We explain what to expect, prepare you for testimony, organize the evidence, and represent you before the Workers’ Compensation Law Judge.
• Handling an appeal when necessary. If the judge issues an unfavorable decision, we can evaluate the ruling and pursue Board review when there is a basis to challenge it.
• Looking beyond workers’ compensation when appropriate. Because we also handle personal injury cases, we can evaluate whether a negligent third party may also be responsible for your injuries.

What Should You Do Immediately After a Workers’ Comp Denial?

A denial does not mean you should stop everything and wait. The next steps should focus on understanding why the carrier denied the claim, protecting your medical record, and preserving the evidence you may need to challenge that decision.

• Review the denial carefully. Identify exactly what the carrier is contesting and why. The reason for the denial will determine what evidence or argument is needed in response.
• Keep getting appropriate medical care. You may be concerned about continuing treatment if the insurer is refusing to pay, but stopping care can affect both your recovery and the medical record documenting your condition. Let your providers know the claim has been denied so you can discuss how treatment and billing should be handled while the dispute is pending.
• Gather evidence related to the reason for denial. Depending on the issue, that may include medical records, accident reports, written notice to your employer, witness information, photos or video, or records showing your job duties.
• Keep every notice from the insurer and Workers’ Compensation Board. These documents can explain what happens next and may contain important deadlines or hearing information.
• Talk with a workers’ compensation lawyer if you plan to challenge the denial. Once the carrier has formally disputed the claim, the issue becomes more than simply filing paperwork. An attorney can identify what must be proven, help develop the evidence, and represent you through the Board process.

Can You Still Get Medical Treatment or Benefits While You Appeal?

If your workers’ compensation claim has been denied, the insurer generally does not have to pay medical expenses or lost-wage benefits while the Workers’ Compensation Board determines whether the claim is compensable. That can leave you without weekly benefits while the case is being decided.

As mentioned above, however, you should not assume that you need to stop medical treatment or immediately start paying those bills yourself. Health care providers are required to continue treating you while the claim is unresolved, and the Workers’ Compensation Board advises injured workers not to pay their providers for work-related treatment unless the Board ultimately determines that the claim is invalid.

Your provider may ask you to sign Form A-9, Notice that You May Be Responsible for Medical Costs. This form acknowledges that you may become responsible for the bills if the Board ultimately disallows the claim or if you stop pursuing it. It does not mean you must pay those bills simply because the insurance carrier initially denied the claim.

If the Board later establishes the claim, responsibility for covered workers’ compensation medical expenses shifts back to the carrier, along with any wage benefits the judge determines are owed.

FAQ About Denied Workers’ Compensation Claims

Speak With a Long Island Workers’ Compensation Denied Claim Lawyer Today

A denial notice means the insurance carrier is disputing your claim, not that your case is over. What happens next depends heavily on why the carrier denied your benefits and whether your case is still at the early dispute stage or has already reached a judge’s ruling.

The Odierno Law Firm can review your denial notice, identify evidence that’s missing or needs strengthening, and represent you before the Workers’ Compensation Board at every stage, including further review if a judge rules against you.

If your workers’ compensation claim has been denied, contact us today for a free consultation to talk through what the denial means for your case and what steps make sense next.