Queens Workers’ Compensation Appeals Attorney

Workers’ compensation is meant to be a safety net that provides you with medical coverage and wage benefits when you’ve been injured on the job. Unfortunately, there are times when workers’ compensation claims, even when they’re filed by workers with valid cases for compensation, are denied.

Claim denials can be distressing situations for injured workers, which is why it’s important for any claimant who’s been denied benefits to work with legal representation that can help them understand the underlying reason for a denial and how to best navigate the appeals process.

At the Harris Firm, LLC, our award-winning attorneys are devoted solely to fighting for workers who’ve suffered losses due to work-related injuries and occupational illnesses. We’re backed by decades of experience and know the ins and outs of the New York workers’ compensation appeals process.

If you’ve been denied workers’ compensation, the time to act is now. Our Queens workers’ compensation appeals lawyers at the Harris Firm, LLC proudly serve workers across New York City and offer FREE consultations during which we can review your case and how we can help you challenge your denial. Call (718) 487-8669 or contact us online to get started.

Why Workers' Compensation Claims Get Denied

Claims for workers' compensation can be denied for a variety of reasons, but common issues include:

• Disputes Over the Injury Being Work-Related: Workers’ compensation insurers may deny claims if there is uncertainty as to whether an injury occurred on the job or was caused by work-related activities. Insurance companies that challenge causation commonly argue that injuries were pre-existing, occurred outside of work, or were otherwise not caused by work-related activities.
• Insufficient Documentation: Lack of proper medical records, accident reports, or witness statements can lead to a denial, as can claim forms that lack necessary information or accuracy.
• Missed Deadlines: In New York, workers injured on the job must report their injuries to their employer within 30 days of an accident or as soon as possible. Failing to report the injury in a timely manner or to file a claim by the statutory deadline can result in a denial.
• Employer Disputes: Employers might contest claims, alleging that the injury did not take place at work or that the worker has misreported their injury. Employers may also rase allegations of misconduct, arguing that workers are not entitled to workers’ compensation because they were violating laws or safety regulations.
• Employment Status Disputes: Workers’ compensation insurers and employers may argue that injured workers were acting as independent contractors, rather than employees, at the time they were injured. In New York, independent contractors are generally not entitled to workers’ compensation benefits.

Understanding the specific reason for your claim's denial is the first step in preparing for the appeals process, which is why it’s important to have an experienced advocate by your side as soon as possible after you’ve been notified of a claim denial.

At the Harris Firm, LLC, our Queens workers’ comp appeal attorneys help workers decipher Notices of Controversy and administrative decisions to identify the underlying reason for their claim denial. We also assist workers who, while not facing a denial of their claim entirely, face disputes involving the reasonability and necessity of specific treatments or their ability to return to work, which can greatly affect their benefits.

How Does the New York Workers’ Compensation Appeals Process Work?

When your workers’ compensation claim gets denied, you have the right to appeal the decision. Here's an outline of how the workers’ compensation appeals process works in New York:

1. Initial Review / Full Review by the Workers' Compensation Board.

The first level of appeal is to request a review by the Workers' Compensation Board. This administrative appeal requires you to file an application within 30 days of the decision filing date. Your application will state your case and why the initial decision was incorrect. This process involves:

• Application for Board Review: Submitting the appeal form with detailed reasons for your appeal.
• Hearing: Sometimes, a hearing is scheduled where both you and your employer can present evidence.
• Board Panel Decision: A three-member Board panel will review your application and make a determination as to whether the decision reached by the administrative judge should be affirmed, modified, or rescinded. The panel may also send the claim back to the judge for additional consideration.

If the panel’s decision is not in your favor, you can request a Full Board review of the panel’s decision. The full Board must review decisions upon request when decisions reached by the three-member panel are not unanimous. However, when the panel’s decision was unanimous, the full Board has discretion to review the Board Panel Decision or let it stand.

2. Appeal to State Court Appellate Division.

If the Workers' Compensation Board denies your appeal, you have the right to further appeal to the Appellate Division of the New York State Supreme Court. Unlike the previous administrative appeal proceedings, this level of appeal is judicial, meaning that it takes place in court and will consist of a five-judge panel that reviews the case.

The appellate process is as follows:

• Notice of Appeal: File a notice of appeal with the Board and the appellate court within 30 days of the Board decision. The court may then set a schedule with various deadlines and submission requirements, depending on the circumstances.
• Brief Submission: Your attorney will submit legal briefs outlining the argument, evidence for your claim, and precedents supporting your appeal.
• Oral Arguments: Both sides may be asked to present their case in oral arguments before the court judges.
• Court Decision: After review, the Appellate Division will issue its decision to affirm, reverse, or modify the Board’s decision.

3. Appeal to the State's Highest Court

The final step in the appeals process, if necessary, is to take your case to the New York Court of Appeals, which is the state's highest court. This appeal must be filed within 30 days of the decision issued by the Superior Court’s Appellate Division.

As with the previous steps, your attorney will submit briefs and possibly present oral arguments before the Court issues a final determination on your case. Typically, the Court of Appeals considers only cases that involve unique issues or questions with the potential to impact other cases or the law.

How a Workers’ Compensation Appeals Attorney Can Help

Navigating the workers' compensation appeals process can feel overwhelming, especially when recovering from an injury. It is important to understand your rights and the proper procedures to challenge a denial effectively.

Given the complexities of the legal system, it is also beneficial to seek the assistance of an attorney specializing in workers' compensation claims. Experienced attorneys like those at the Harris Firm, LLC can provide the step-by-step guidance you need to evaluate your options, ensure all proper paperwork is filed, meet all applicable deadlines, and present the strongest possible case on your behalf.

FAQs About Workers' Comp Appeals

What decisions can be appealed?

You can appeal any decision made by the Workers' Compensation Board that you believe is incorrect or unfair, such as denial of benefits, reduction of benefits, or termination of benefits.

How do I file an appeal?

To file an appeal, you need to complete a Form C-108, "Notice of Controversy," and submit it to the Workers' Compensation Board. You must also provide a written statement explaining the reasons for your appeal.

What happens after I file an appeal?

After you file an appeal, your case will be assigned to a workers' compensation law judge who will schedule a hearing. During the hearing, both parties will have the opportunity to present evidence and arguments supporting their positions.

Can I represent myself at the appeal hearing?

Yes, you have the right to represent yourself at the appeal hearing. However, it's often beneficial to seek assistance from an experienced workers' compensation attorney who can help you navigate the legal process and present a strong case on your behalf.

What evidence do I need to support my appeal?

You should gather any relevant medical records, witness statements, and other documentation that supports your claim. This evidence will be crucial in proving that you are entitled to workers' compensation benefits.

How long does the appeal process take?

The length of the appeal process can vary depending on various factors, such as the complexity of your case and the availability of the workers' compensation law judge. In general, it can take several months to resolve an appeal.

What if I disagree with the decision made at the appeal hearing?

If you disagree with the decision made at the appeal hearing, you have the right to further appeal to the Workers' Compensation Board's Appeal Board. This involves submitting a written appeal within 30 days of the decision.

Do I have to pay any fees to file an appeal?

No, there are no fees required to file an appeal with the Workers' Compensation Board. However, if you choose to hire an attorney to represent you, you will be responsible for their legal fees.

Speak With a Workers’ Comp Appeal Lawyer in Queens Today: (718) 487-8669

Workers give a lot to their employers and deserve to be treated fairly when they’ve suffered a work-related injury or illness. Unfortunately, workers’ compensation insurance carriers are far more concerned with profits than doing right by injured people and will go to great lengths to deny and dispute claims.

If you’re facing challenges with your workers’ compensation claim or have already received a denial, don’t delay in reaching out for the help you need. The Harris Firm, LLC proudly serves workers from all five NYC boroughs from our office in Queens and can help immediately when you’re in need.

Request a FREE evaluation of your appeal with an attorney from our firm. Call (718) 487-8669 or contact us online today.