New York Workers’ Compensation claims can be denied by the insurance company for a variety of reasons. One of the common denial reasons we see is when the insurance carrier is still investigating a claim. They may file a denial to buy some time to complete their investigation. Once their investigation is complete, if they are satisfied the requirements of the law have been met, they may change their position and accept a claim.
Other common denial reasons include: lack of medical evidence connecting employment to the injury, lack of a completed C-3, lack of timely notice to the employer of the injury, conflicting versions of the events that led to the injury from co-workers or other witnesses, a pre-existing condition, or Statute of Limitations.
A denied claim is referred to as a controverted claim, and the Board has a specific process for handling these claims that starts with a Pre-Hearing conference. There are also different documents that are required in controverted claims. Litigation of controverted claims usually involve testimony of the injured worker, as well as employer witnesses, an Independent Medical Exam, depositions of any doctors, and a written or oral argument to the judge. An appeal may also be likely in a controverted case if either side is unhappy with the outcome.
Controverted claims require a more heightened level of knowledge and experience than an accepted claim. The timelines are shorter in controverted claims, so it is imperative to be sure you have all your evidence ready before you pursue your claim. It is crucial to make sure you have a seasoned Workers’ Compensation attorney pursuing your controverted claim. Call MCV Law today to ensure your claim is protected.