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What are the reasons for a workers' compensation denial?

Insurers deny workers' compensation claims for numerous reasons. In some situations, the denial of benefits is legitimate and there's nothing a worker can do. In other situations, workers can appeal the denial to get the benefits they have a legal right to receive.

Here are some of the most common reasons why insurers reject a workers' compensation claim:

  • The employer claims that no accident ever happened and there aren't any witnesses to the accident.
  • The employee was not working at the time the injury occurred.
  • The injury wasn't serious enough to award compensation.
  • The type or nature of the injury or illness isn't covered under workers' compensation insurance.
  • A preexisting condition was the actual cause of the injury/illness.
  • The worker didn't require any medical treatment.
  • The worker didn't submit an injury report within the time limitation guidelines.
  • The employee was drunk or impaired by drugs when the accident happened.
  • The worker was not actually an employee when the accident happened.

Just because the insurer sights one of the above reasons in its rejection of your application -- even if it seems that the insurer's reasoning makes sense -- don't be so quick to believe the insurer's opinion. At Rosado Apat & Dudley LLP, we have seen numerous instances in which a claim was denied, appealed and later the claimant received the benefits that he or she deserved. There are numerous ways that an injured or ill employee can respond to a denial of benefits claim, so never give up -- even if your situation appears hopeless. There's always the chance that a potential angle or strategy to get benefits was overlooked.

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  • American Association for Justice
  • NYCOSH-New York Committee for occupational Safety & Health
  • NYSTLA
  • Queens County Bar Association
  • Society of New York Workers’ Compensation Bar Association, Inc | 1945
  • National Organization of social security claimants Representatives
  • NYSBA
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