While New York construction and warehouse workers experience more injuries than other professions, workplace accidents can occur virtually anywhere. At the Law Office of Frank A. Cetero, we often help clients navigate the complex workers’ compensation process. 

PayScale reports that you must meet several requirements for workers’ compensation claim approval. Depending on the circumstances, you may receive denial notification, even if your injuries qualify. Understanding the reasons behind the denial can help you file an appeal appropriately. Here are the top reasons for claim denial. 

  • Delayed reporting – You must notify your employer of the injury in writing immediately. The longer you wait, the harder it is to prove the accident is work-related. 
  • Unrelated to job duties – Even if you got hurt while at work, you may receive a denial notification if it occurred outside your job duties. For example, during the last seconds of break-room basketball, your co-worker goes up to score and lands awkwardly, resulting in a broken ankle. The injury may not qualify for workers’ compensation. 
  • Out-of-network doctor visits – To have your bills covered by workers’ compensation, the doctor you see must be in your employer’s insurance network. You may be responsible for the fees if you see your personal physician and he/she is not in that network. 
  • Pre-existing conditions – If you have an existing condition exacerbated by your current job requirements, you may not qualify for workers’ compensation. 

The claims process is extensive. If at any time you miss deadlines or omit documentation, you may have to begin again. An experienced workers’ compensation attorney can help you understand the requirements and maximize the benefits. Visit our webpage for more information on this topic.