A disputed workers’ compensation claim can make an already difficult workplace injury more stressful. In New York, an employer may ask its insurance carrier to challenge a claim, while the insurer may dispute whether an injury is work-related, the extent of the injury, or other aspects of eligibility.
Why a Workers’ Compensation Claim May Be Disputed
A claim may be contested for several reasons. The insurance carrier may argue that the injury did not happen because of the job, question the extent of the claimed disability, or raise other issues concerning eligibility. The employer can also request that its insurance carrier dispute a claim.
What Happens After a Claim Is Disputed
When a claim is controverted, the New York Workers’ Compensation Board may become involved in resolving the disagreement. Board staff may first attempt to address certain issues through administrative processes or conciliation. More complicated disputes can proceed to a hearing before a Workers’ Compensation Law Judge.
During a hearing, the judge may review medical records, wage information, other evidence, and testimony from the parties. The judge then determines whether the claim is compensable and, when appropriate, the amount and duration of benefits.
Gather Important Documentation
If your claim is disputed, keep copies of relevant documents. These may include medical records, accident reports, work schedules, wage information, communications with your employer or insurer, and information from witnesses.
Your medical records can be particularly important because they may provide information about your diagnosis, treatment, work restrictions, and the relationship between your condition and employment.
Attend Workers’ Compensation Hearings
If the Board schedules a hearing, carefully review the notice and follow the instructions provided. New York Workers’ Compensation Board hearings are generally conducted virtually, and testimony may require participants to appear by video.
Failing to respond to notices or attend required proceedings can create additional complications. Keep your contact information current and retain copies of correspondence related to your case.
Consider Legal Guidance
A workers comp injury lawyer in New York can help you understand the disputed claim process, organize relevant evidence, and explain your legal options. Injured workers have the right to an attorney or licensed representative, although legal representation is not required.
If a claim is disputed, the insurer generally does not have to pay indemnity or medical benefits until the controversy is resolved, although healthcare providers must continue treatment during the dispute.
Moving Forward With a Disputed Claim
A disputed workers’ compensation claim does not necessarily end the process. The New York Workers’ Compensation Board provides procedures for resolving disagreements through administrative review, conciliation, hearings, and appeals when applicable.
Keeping accurate records, following medical advice, responding to Board notices, and understanding your rights can help you navigate the process more effectively.
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