Appealing a New York Workers' Compensation Denial
Understand what steps should be taken when appealing a workers compensation denial in the state of New York.
The New York Workers' Compensation Board administers the workers' compensation system in New York. If you are injured on the job in New York, and your workers’ compensation claim is denied for any reason, you may appeal to the Workers' Compensation Board. (To learn more about the claim application process, see our article on New York Workers Comp Claims.)
What If Your Claim Is Denied?
Your claim may be denied by your employer's workers' compensation insurance carrier for a variety of reasons. The insurance carrier may dispute that your injuries were caused by your workplace activities, or may dispute that your injury occurred during work. Or the insurance company may deny your claim because the employer says you are an independent contractor.
If your employer’s workers’ compensation insurance carrier wishes to deny your claim, the insurance carrier will file a “notice of controversy” with the Workers’ Compensation Board. This notice of controversy must be filed within 18 days following the beginning of disability, or 10 days of being made aware of the work-related incident, whichever is longer.
Your claim will then be referred to a Workers’ Compensation law judge at the Workers’ Compensation Board.
What Benefits Will You Receive if Your Claim Is Initially Denied?
If your employer’s workers’ compensation company contests your workers’ compensation claim, but you are off work, you will not receive weekly temporary disability benefits while your case is pending at the Workers’ Compensation Board. The insurance carrier will, however, pay you the full amount of weekly benefits (including back payments) and will reimburse you for medical bills if you win at hearing at the Workers’ Compensation Board. This is true even if the insurance carrier appeals the Workers’ Compensation Board’s decision to the Appellate Division. (See below for more information about the different levels of appeals.)
The Initial Hearing Process
First, the workers’ compensation law judge will hold hearings. This may include a pre-hearing conference to discuss the compensability of your workers’ compensation claim (whether your claim should be covered and you should receive worker's comp benefits). The judge will likely take testimony and review medical and other evidence.
The judge will then issue a decision determining whether you have a valid workers’ compensation claim. If so, the judge will also determine the amount of your compensation benefits.
Appealing the Workers’ Compensation Law Judge’s Decision
If the workers’ compensation law judge rules in favor of your employer and their insurance carrier, you may appeal that decision within 30 days of the judge’s ruling. Your employer’s workers’ compensation insurance carrier may also appeal a decision of the workers’ compensation law judge within 30 days.
An appeal of the workers' comp judge is made by submitting a request, in writing, to the workers’ compensation board for review. In the request, state why you believe the judge’s decision was incorrect, and the evidence that supports your case. A panel of three board members will review your written request, and determine whether to grant your request for review. If your request is granted, the three board members will review your case.
The three-member board panel will take one of three actions:
- affirm the judge’s decision
- modify the judge’s decision, or
- rescind (reverse) the judge’s decision.
Alternatively, the board panel may send the case back to the workers’ compensation law judge to consider further evidence.
Further Options for Appeal
If you are unsatisfied with the board’s decision, you may appeal the decision to the Appellate Division, Third Department, of the Supreme Court of the State of New York. Such appeals must be filed within 30 days of the board’s decision. Although very rare, you have the right to seek review from the New York Court of Appeals from an Appellate Division decision.
You Should Talk to an Attorney
You are entitled to legal representation at any point during your workers’ compensation claim. In New York, your attorney may not accept money from you. Rather, the Workers’ Compensation Law Judge or the three-member board panel will determine the attorney’s fee. The fee will then be deducted from your award of compensation, if you win.
You are not required to have legal counsel, but an attorney can assist you to ensure you have an experienced, legal advocate on your behalf. If your case is complex, or there are significant benefits at stake, you should strongly consider retaining an attorney.