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Workers' Compensation Claim Denied?

a fallen warehouse worker

If you've been injured on the job, the New York workers' compensation system ensures that you receive the necessary compensation to cover medical expenses, lost wages, and other related costs. In most cases, filing a workers' compensation claim is straightforward and uncomplicated. However, if your claim has been denied, it can be a confusing and intimidating situation.

Understanding the Appeals Process

If your workers' compensation claim has been disallowed, your first course of action should be to appeal the decision. This process may seem daunting at first, but it's important to remember that it exists to protect your rights as an injured worker. In New York, the appeals process involves several steps:

1. Contact an Attorney

Before you begin the appeals process, it's essential to understand your legal rights and options. This is where an experienced New York attorney can help. Your attorney can explain the appeals process and provide guidance and support throughout each step.

2. Apply for Board Review

After a workers' compensation claim has been disallowed, you have the right to apply for Board review of the unfavorable decision within 30 days of its filing date. Board review is an administrative appeal that takes place in front of three workers’ compensation Commissioners who will hear both sides of the case and make a final decision. Your attorney will prepare the appeal and submit it without you having to do anything.

3. Apply for Full Board Review and/or Appeal to the Appellate Division, Third Department

If you're unhappy with the Board Panel’s decision, you have the right to apply for Full Board review, again within 30 days of the Board Panel’s decision. Full Board review involves all of the Commissioners. However, the Board does not have to even look at this second administrative appeal unless one of the Board Panel commissioners dissented.

Fortunately, you can also, at the same time, appeal to the Supreme Court, Appellate Division, Third Department, which is an actual appeals court outside of the Workers’ Compensation Board. These appeals are limited to questions of law, and the Third Department cannot second guess the Board’s findings of fact if the evidence supports those findings. But if the Board was wrong purely on the law, the Third Department will reverse it and send the case back.

Appeals Based on the Existing Evidence at the Time of the Decision

With very rare exceptions, you cannot add new evidence to applications for Board review or Full Board Review. These administrative appeals will be decided on the evidence that was in the record at the time your case was disallowed. You will never be able to add new evidence to a Third Department appeal, because the Third Department does not make fact determinations.

If your workers' compensation claim has been denied in New York, it's essential to take immediate action. By understanding the appeals process and gathering additional evidence, you may be able to overturn the decision and receive the compensation you deserve. With the help of an experienced attorney at Schotter Millican, LLP, you can navigate the appeals process and take steps to protect your rights as an injured worker.

Contact us today at (718) 550-0610 for a free consultation.

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