Are you suffering from an on-the-job or work-related illness? You could be entitled to workers’ compensation benefits to pay for your medical care, offset a portion of your lost wages, and compensate you for a long-term disability. Unfortunately, the workers’ compensation system is administered in large part by a collection of powerful for-profit insurance companies. While these companies are required by law to accept valid claims and pay them at rates established by the New York State government, they will also deny claims on technicalities and exploit loopholes, whenever possible, as a way of saving money and putting more dividends in their shareholders’ pockets. The never-ending quest for profits puts the insurance carrier’s interests first and yours second. That’s not right, and when it happens, it’s important to fight back. For 38 years, Fessenden Laumer & DeAngelo, PLLC has successfully fought claim denials for injured workers across Southwestern New York.
The workers’ compensation system functions as a “grand bargain” between workers and their employers. New York State law requires nearly all employers to carry workers’ compensation insurance on behalf of their employees. When an employee suffers an on-the-job injury, or gets sick because of their working conditions, she/he can file a claim to receive benefits for medical care, lost income, and long-term impairment, among others. The worker does not have to prove that the employer is to blame for their injuries – only that the injuries arose from their employment. In exchange for offering these protections, employers are largely protected from lawsuits by employees, even in many cases where they are at fault for those workers’ injuries. Also, a worker’s possible negligence is irrelevant in a workers’ compensation case.
If your employer’s workers’ compensation insurer has denied your claim, Fessenden Laumer & DeAngelo, PLLC wants to help assert your rights so you receive the benefits to which you’re entitled. We have been proud to serve the people of Southwestern New York for the last 38 years, and to have made a meaningful difference in their lives. Let us do the same for you. Contact us today for a free consultation with a workers’ compensation attorney. We will aggressively pursue your claim to make sure that the insurance carrier pays you every dollar in benefits which you deserve.
Workers’ compensation laws are very complex, and there are many exceptions and limitations to what workers’ compensation covers. An insurer might deny a claim because:
Remember, the insurance industry is just that – and it’s an industry that runs by collecting more money in premiums than it pays out in benefits. As a result, insurers have a profit motive to deny claims whenever possible. They will not give you the benefit of the doubt. However, the law provides a remedy for injured workers whose claims are denied and you have the right to pursue a claim if it has been wrongfully denied.
You can dispute an insurance company’s denial of your claim. Relatively simply matters are resolved through administrative decisions and a process called conciliation. More complicated issues might require hearings before a Workers’ Compensation Law Judge (WCLJ). The WCLJ may want testimony from the involved parties, take testimony from the doctor(s) as well as review relevant medical records and wage information. Once this has been completed, the WCLJ will render a decision. Either party may formally appeal the WCLJ’s decision within 30 days.
After review, the Board Panel may affirm the previous decision, modify portions of it, reverse it, or return it for additional hearings. The Board Panel’s decision, in turn, can be appealed once more by either party within 30 days.
As you can see, the process of appealing a workers’ compensation denial is very complex. However, it’s not one you should navigate alone, as you have the right to legal representation. The insurance carrier will have representation, most often by a lawyer. The Judge is a lawyer and compensation laws are complex. Although every person has the right to represent themselves, due to the intricate nature of workers’ compensation laws, and the fact that the carrier will have legal representation, it is important to have an advocate looking out for your interests. Your focus right now should be on resting and recovering, not on cutting through bureaucratic red tape to get the benefits that should be yours by right. While you recuperate, a workers’ compensation lawyer with Fessenden Laumer & DeAngelo, PLLC, can:
What’s more, we will provide all this at no upfront cost to you. We only get a fee if we obtain benefits for you. That way, you’re not paying out of pocket to assert your legal rights and demand the benefits you’re entitled to under the law. Our fee is 15% of any new or additional money we obtain for you, 1/3 of one week’s compensation check if we must attend a hearing while you are receiving compensation payments, and/or 15 weeks of compensation payments if you become permanently disabled and are entitled to payments for years into the future.
Contact Fessenden Laumer & DeAngelo, PLLC to speak with a lawyer. Fessenden Laumer & DeAngelo, PLLC is dedicated to defending the rights of injured workers and their families. We believe that all working women and men deserve recognition and respect. We have deep roots in Chautauqua County & the Southern Tier and have chosen to reside in this area we call home.
For 38 years, Fessenden Laumer & DeAngelo, PLLC has helped thousands of clients and their families secure justice and the compensation they deserve.
In New York, if a Workers’ Compensation Law Judge (WCLJ) denies your claim at a hearing, you generally have 30 days from the date the decision is filed to submit a formal administrative appeal to the Workers’ Compensation Board. Because these deadlines are strict, it is critical to act immediately once you receive a written notice of denial.
No. At Fessenden Laumer & DeAngelo, PLLC, we represent injured workers on a contingency fee basis. This means there are no upfront costs or hourly fees out of pocket. We only receive a fee if we successfully obtain benefits or a settlement for you. Our fees are set and approved by the Workers’ Compensation Board, typically representing a small percentage of the additional money we recover on your behalf.
In the Southern Tier and Chautauqua County, we frequently see denials based on:
Yes, but it can be complicated. While your claim is being contested, the workers’ compensation carrier will not pay for your treatment. However, you may be able to use your private health insurance or apply for Disability Benefits (DB) through New York State to cover a portion of your lost wages and medical costs while the dispute is pending. If we win your appeal, the workers’ comp carrier is then required to reimburse your health insurance provider.
