New York City Workers’ Compensation Appeals Attorneys

Helping Clients Appeal a Denied Workers’ Compensation Claim in New York

It is not uncommon for the Workers’ Compensation Board to disallow a claim or otherwise rule in a way that severely harms an injured worker. These decisions can seem devastating, but they may be challenged outside of the Workers’ Compensation Board.

New York State law gives victims the chance to appeal a denied or disallowed workers’ compensation claim. An appeal can be requested by the worker who was injured, the employer, or the insurance provider. It is important to note that an appeal must be requested within 30 days of the Board’s unfavorable decision. 

If your workers’ compensation claim has been denied, or if the Workers’ Compensation Board has made an unfavorable decision in your case, reach out to our team at Schotter Millican, LLP. Navigating the workers’ compensation appeals process can seem daunting—but it doesn’t have to be. Our New York City workers’ compensation appeals attorneys can guide you through the process, represent your best interests, and protect your rights every step of the way.

Contact us online or call (718) 550-0610 to request a free case review with a member of our New York City workers' compensation appeals lawyer. Hablamos español; mowimy po polsku. 

Why Are Workers’ Compensation Claims Denied?

Workers’ compensation claims are denied or disallowed for a variety of reasons. Some of the most common reasons the Workers’ Compensation Board denies or disallows claims include:

• Disputes regarding whether the injury/illness was work-related
• Allegations of preexisting injuries or medical conditions
• Ineligible workers, including those classified as independent contractors
• Failure to notify the employer of the injury/illness within the applicable timeframe
• Failure to seek/receive medical treatment
• Mistakes in filing paperwork or failure to file on time
• Violation of company policies, leading to injuries (i.e., intoxication, roughhousing, etc.)

While some workers’ compensation claims are denied for legitimate reasons, employers and their insurance companies often dispute valid claims. In any case, you have the right to appeal a denied claim, regardless of the reasons for the denial.

It is very important that you work with a knowledgeable workers’ compensation attorney, as the appeals process can be challenging without the help of a skilled legal professional. At Schotter Millican, LLP, we have a long history of appellate wins. Our New York City workers’ compensation appeals lawyers know how the process works and what it takes to successfully represent you at workers’ compensation appeals hearings and proceedings.

What are the Requirements For a New York Workers’ Compensation Appeals?

If you wish to appeal a denied workers’ compensation claim or any unfavorable decision by the New York Workers’ Compensation Board, there are several things you should know:

• You must file your appeal within 30 days of the Board’s unfavorable decision
• If you wish to appeal an administrative law judge’s review of your claim, you must also do so within 30 days of the judge’s unfavorable decision
• An injured worker, an employer, or an employer’s insurance provider may file an appeal; medical service providers may not file a workers’ compensation appeal
• Injured workers are permitted to file an appeal regarding a self-insured employer or employer’s insurance provider’s payment of medical bills to a medical provider

Furthermore, if you work with an attorney (as is recommended), you must use the current Application for Board Review (Form RB-89) when filing your appeal. This form must be fully and correctly filled out with information such as the WCB case number, the claim administrator’s claim number, the insurer’s name, the date of injury, the type of application being made, issues for review, the basis for review, and more.

We strongly encourage you to reach out to a workers’ compensation appeals attorney, like those at Schotter Millican, LLP, who can aid you in this process. Our team offers complimentary case evaluations and can assist you in English, Spanish, and Polish.

What is the New York Workers’ Compensation Appeals Process?

Every workers’ compensation case is different, and the exact processes involved in appealing a denied claim may vary from case to case.

Below, we have provided a general overview of the New York workers’ compensation appeals process so that you can know what to reasonably expect:

• If you are injured at work or suffer a job-related medical condition, you should notify your employer right away, but no more than 30 days after the incident. Next, you should file a New York Employee Claim Form (Form C-3). This is your official workers’ compensation claim, and ideally, should initiate prompt payments of your benefits.
• If you do not begin receiving workers’ compensation benefits, or if your claim is denied or disallowed by the Workers’ Compensation Board, you may need to file an appeal. The first step in the appeals process is requesting a “Board panel hearing” before three administrative law judges. At this hearing, the panel will hear information about your claim and decide on your case.
• If you disagree with the panel’s decision after the Board panel hearing, you may escalate your appeal by requesting a full Board review of your case. The Board may not grant you a full review, as it has the discretion to approve or deny requests for full Board reviews.
• If the Board denied your request for a review, or if you disagree with the Board’s ruling following a full Board review, you may be able to take your case to court. Our attorneys at Schotter Millican, LLP, can assist you in bringing your claim to the Appellate Division if necessary. This is a rare step, but one that occasionally must be taken in the pursuit of an injured worker’s full and fair benefits.

Not every unfavorable decision by the Board is so wrongly decided that it is worth the time and expense of appealing to a higher court. Our firm, however, has appealed dozens of unfavorable Board decisions and has won many of these appeals, helping not only the individual clients whose cases we appealed but injured workers throughout the state who now benefit from the precedents our victories set.

How Our Workers’ Compensation Appeals Lawyer Can Help You

We can assist you by:

• Comprehensive Case Evaluation: The first step in any appeal is to assess the specifics of your denied claim. We thoroughly evaluate your case, reviewing all documentation, medical records, and previous correspondence with the insurance company or employer.
• Strategic Appeal Preparation: Once we understand the nuances of your case, we will develop a strategic plan to address the reasons for the denial. This includes gathering additional evidence, obtaining expert opinions, and preparing a detailed written appeal.
• Experienced Legal Representation: We have extensive experience in representing clients in workers’ compensation appeals. We advocate in hearings and negotiations, presenting your case with clarity and conviction.
• Navigating Complex Procedures: The appeals process can involve numerous legal procedures and deadlines. We handle all procedural aspects, including filing necessary documents, meeting deadlines, and ensuring all legal requirements are met.
• Effective Negotiations and Settlements: In many cases, appeals can be resolved through negotiation rather than a lengthy hearing. We are skilled negotiators who work to reach a fair settlement that meets your needs.
• Appeals Hearings and Representation: We will be with you every step of the way if your case proceeds to a formal appeals hearing. We prepare you for the hearing, develop arguments based on legal precedents and factual evidence, and present your case before the judge.
• Post-Appeal Support: We continue to provide support after the appeals process, whether successful or not. If your appeal is successful, we assist in ensuring that the benefits are properly administered and that any additional paperwork or follow-up actions are handled.

Frequently Asked Questions (FAQ)

1. What is a workers’ compensation appeal?

A workers’ compensation appeal is a legal process through which an injured worker challenges a denial or unfavorable decision made by the New York Workers’ Compensation Board regarding their claim for benefits. This process allows the worker to seek a review and potentially overturn the decision.

2. Why might my workers’ compensation claim be denied?

Claims can be denied for several reasons, including:

• Disputes about whether the injury was work-related.
• Allegations of preexisting conditions.
• Classification of the worker as an independent contractor.
• Failure to report the injury within the required timeframe.
• Not seeking or receiving medical treatment.
• Mistakes in filing paperwork.
• Violations of company policies.

Even valid claims can be disputed, which is why it’s important to have legal representation.

3. How long do I have to file an appeal?

You must file your appeal within 30 days of the Workers’ Compensation Board’s unfavorable decision. If you are appealing a decision from an administrative law judge, the same 30-day timeline applies.

4. Who can file an appeal?

An appeal can be filed by:

• The injured worker
• The employer
• The employer’s insurance provider

Medical service providers do not have the right to file appeals under workers’ compensation law.

5. What is the process for appealing a denied workers’ compensation claim?

The appeal process typically involves the following steps:

1. Notification: Notify your employer and file a claim if you haven’t already.
2. Request a Board Panel Hearing: If your claim is denied, you’ll need to request a hearing before a panel of administrative law judges.
3. Panel Decision: If you disagree with the panel's decision, you can request a full Board review.
4. Further Appeals: If the Board denies your request or if you disagree with its ruling, you may escalate your case to the Appellate Division.

6. Do I need a lawyer for the appeals process?

While you can represent yourself, having an experienced attorney can significantly enhance your chances of a successful appeal. Legal professionals understand the intricacies of workers’ compensation law and can navigate the process on your behalf.

7. What should I do if my appeal is denied?

If your appeal is denied, consult with your attorney about your options for further action, including whether it is worth pursuing a court appeal. Our team at Schotter Millican, LLP can guide you through this process.

Contact us online or call (718) 550-0610 to request a free case review with a member of our New York City workers' compensation appeals lawyer. Hablamos español; mowimy po polsku.