Seeking benefits through a workers’ compensation claim following a workplace accident shouldn’t be difficult. However, some employers and insurance providers make the process of receiving these benefits harder than it needs to be for injured employees by contesting and denying their claims.
If you have had a claim contested or denied in Monroe County, NY, contact Fessenden Laumer & DeAngelo, PLLC, to speak with an experienced workers’ compensation attorney about your case. One of our law firm’s lawyers will review the denial letter you received from the insurer and help you understand your options for seeking the compensation you need.
Workers’ compensation insurance companies may dispute or deny claims for many reasons. Some of the most common reasons our lawyers see include:
When an insurance provider contests or denies a claim, they must send a letter explaining the reason for the contest or denial to you. The information contained in this letter is crucial for your ability to make a successful appeal with the Workers’ Compensation Board.
If the insurer doesn’t accept your initial claim, they may contest parts of it, leading to a contested hearing before a Workers’ Compensation Law Judge. The first step in this process is to schedule your hearing before the judge, the timing of which depends on how busy the court is.
Once the date of your hearing comes around, you and your attorney will have an opportunity to present various types of evidence that support your claim. This may include your testimony, testimony from coworkers who witnessed the incident that harmed you, and testimony from medical or vocational experts. It also includes critical documents, including your medical records, employment history at the company, wage records, and accident reports.
Photographs of the hazardous work conditions that caused your injury and security camera footage of the incident occurring are also strong pieces of evidence you may be able to present.
Your employer and their insurer will also have the opportunity to present evidence, including calling their own witnesses to testify. At the end of the hearing, the judge will issue a written decision granting or denying the benefits in question.
Following a workers’ comp claim denial, you should take these steps to strengthen your case upon appeal:
If the Workers’ Compensation Law Judge upholds the insurer’s denial of your benefits, you have 30 days from their decision to file an appeal. Your appeal should include various information about your case, including the basis for your appeal, documents relevant to the appeal, and whether new evidence is being brought.
Appealing a workers’ comp claim denial can be overwhelming, especially if you are still recovering from your injuries. For this reason, it’s in your best interest to have a lawyer handle your appeal on your behalf.
The workers’ compensation attorneys from our law firm have extensive experience with filing appeals and representing clients during hearings. We’ll gather the evidence needed for your appeal based on the notice of claim denial sent by the insurer and the findings of our own investigation into the accident.
Injured employees in Monroe County, NY, face a wide array of challenges when seeking the workers’ compensation benefits they need following an on-the-job injury. Some of the biggest challenges include:
When you hire our workers’ compensation lawyers to handle your Monroe County case, we’ll conduct a thorough investigation into the incident that caused your workplace injury. This investigation will include speaking to coworkers who witnessed the incident, requesting records from your employer, and working with your doctor to understand the extent of your injuries.
We’ll also calculate the value of your case so we know how much to seek through your claim. And we’ll handle filing your claim, as well as any appeals or follow-up lawsuits that may be necessary.
By working with our lawyers, you also won’t have to deal with the insurance company alone. We’ll handle all correspondence with your employer’s insurer, negotiate with the insurer on your behalf, and represent you in court hearings.
Just because the insurance company is contesting your claim or has issued a denial, that doesn’t mean you should give up. Claim contests and denials are a regular part of New York’s workers’ compensation system and don’t necessarily mean your claim is without merit.
In some cases, a denial is the insurance company trying to intimidate you into dropping your claim. And in others, it simply means you need to provide additional evidence during your appeal.
The workers’ compensation lawyers of Fessenden Laumer & DeAngelo, PLLC, are Standing Tall for Workers in Monroe County, New York. Our Local, Trusted, and Experienced lawyers work hard for our clients and are approachable, warm, and welcoming.
If you were injured on the job, had your workers’ comp claim denied, or have an upcoming contested claim hearing, contact our law firm to schedule a consultation with a member of our legal team. We’re dedicated to helping employees seek the compensation they deserve following workplace incidents.
The timeline for a contested hearing before a Workers’ Compensation Law Judge in Monroe County varies based on the court’s current backlog. Generally, once a “Notice of Controversy” is filed, a pre-hearing conference is scheduled within 30 to 45 days. Our attorneys work to ensure all documentation is filed correctly to avoid unnecessary administrative delays.
Most hearings for Rochester and surrounding Monroe County areas are held at the New York State Workers’ Compensation Board District Office, typically located in downtown Rochester. However, many hearings are currently conducted virtually through the Board’s vibe (Virtual Hearings) platform. We provide the technical support and legal guidance to ensure you are prepared for either format.
Yes. This is the most common reason for a denial in New York. Insurers often claim an injury is “pre-existing” or happened outside of work hours. We counter this by gathering objective medical evidence, witness statements, and expert testimony to prove the causal relationship between your job duties and your injury.
An Independent Medical Examination (IME) is a medical exam requested by the insurance carrier. While the name sounds neutral, the doctor is paid by the insurance company. Yes, you must attend, or you risk losing your benefits. However, you have the right to have a legal representative review the IME report for inaccuracies or bias immediately afterward.
In New York, this is known as a Section 32 Waiver Agreement. It allows you to close your claim in exchange for a single lump-sum payment. Whether this is a good idea depends on your future medical needs and disability status. Our lawyers can calculate the true value of your claim to ensure a settlement offer isn’t “low-balling” your future security.
In New York State, workers’ compensation attorneys work on a contingency fee basis. This means you pay no upfront costs or out-of-pocket legal fees. Our fees are set by the Workers’ Compensation Law Judge and are deducted only if we successfully win or settle your case.
