A New York worker legitimately injured on the job has a right to expect at least one benefit under the state's workers' compensation system: immediate medical treatment for the injury.
Further benefits, such as money benefits and rehabilitation treatments for a disability, may require a legal process and the filing of proper notifications with the employer and with the Workers' Compensation Board.
Missing a deadline can trigger a denied claim. It's also possible that the employer or its insurance company will challenge the claim. Reasons for denials might include:
- Disputing that the injury occurred
- Disputing that the injury happened at work or within the scope of employment
- The belief that the injury happened outside of when the policy was in force
Regardless of the reason, if the dispute can't be resolved, you are entitled to a hearing before a workers' compensation law judge. While exact processes might vary case to case, most follow a similar path.
A judge examines evidence
Once convened, the judge will hear evidence from both sides. This typically can include:
- Documentation and perhaps testimony about the injury
- Time sensitive documentation required to be filed by the parties
- Reports from your doctor and/or any doctor the insurer might have required you to see
- Direct testimony from you, your employer, and possibly your doctor
Upon review of all the evidence, the judge has authority to issue a decision. If the claim is established, the judge can make an award of monetary benefits. But that might not be the end of the story.
Within 30 days, either side can appeal. On appeal, the initial decision could be affirmed, modified, or reversed. In some cases, insurers are not obliged to cover lost wage benefits pending a final outcome of the appeal.
The other side has lawyers
Here is another thing to remember when fighting a denied claim: the insurance company will have experienced lawyers who understand workers' comp. The law entitles you to such representation, too, without having to pay fees upfront. Your lawyer will be paid out of money awarded to you.
When dealing with this very specific law and legal requiresments of workers' compensation, it is best to consult with an experienced workers' comp law firm.