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Can my employer's workers' compensation insurer deny my claim?

Workers' compensation coverage in New York is close to universal. The law regarding this no-fault insurance requires that employers provide it. By virtue of the law, workers who get hurt on the job are supposed to have assurance that the immediate medical care they require is paid for. If you can't work temporarily or permanently, the coverage is meant to provide wage replacement and possible retraining.

The no-fault nature of the coverage is the trade off under the system. When coverage is delivered under a workers' compensation claim, the employer is largely shielded from further personal injury liability. This does not mean automatic approval if you do suffer a work injury. You have to file a claim, and because the insurance company wants to protect its profits, it will look for any legal way to deny the claim or minimize what it pays.

Common reasons for denying claims

Every state's laws establish a deadline by when an injured worker must file a claim. In New York, the statute of limitations requires a claim to be filed within two years of the date of the injury or date of last payment of compensation, whichever is later.

Other issues that could block or reduce a claim include:

  • Failing to properly inform your employer of your injury within 30 days of the event
  • Self-inflicted injury
  • Evidence the injury didn't result from employment activity
  • Failing to keep all claim-related doctor appointments
  • Claiming greater disability than evidence shows was actually suffered
  • Evidence you violated known employer safety rules
  • Independent medical examination fails to confirm it was a job injury

Employers and insurers have motive to keep claims and costs in check. You have a motive and a right, when you have a legitimate claim, to receive optimal benefits. Consulting your own attorney is an important way to protect those rights.

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    New City, New York 10956

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