Getting your worker’s comp claim denied? You’re not alone—it actually happens a lot. Insurance companies are counting on you to just take the “no” and move on. Why? Because it saves them a ton of money in benefits they’d otherwise have to pay you.
But here’s the thing—you don’t have to just accept it. Nearly half (around 47%) of injured workers who ended up with a settlement actually started out with a denied claim. So yeah, fighting back can seriously pay off.
So what’s the game plan if you want to challenge the insurance company? How do you build a strong case and avoid the common mistakes that can tank your claim? Let’s walk through it step by step.
If your worker’s comp claim gets denied, the first thing you need to figure out is why. That reason will shape how you fight back. You’ll usually find the explanation in the denial letter the insurance company sends you.
Some of the common reasons for denial include:
The most common excuse? They’ll say your injury was caused by something that happened before—like an old sports injury. So if you hurt your back lifting something at work but also had a past back issue, they might claim it’s just that old injury flaring up.
In a case like that, you’ll need solid medical records showing your injury came from something that happened at work. If the denial’s for another reason—like they say you weren’t working at the time—you might need other proof, like statements from coworkers, to back you up.
Bottom line: the stronger your evidence, the better your chances of winning your appeal when you take it in front of a judge.
Appealing a denied workers’ comp claim can take time—sometimes up to a year depending on your state—but it’s often worth it. In fact, around 67% of denied claims end up getting paid within 12 months.
First, decide if you’re appealing on your own or hiring a lawyer. You can do it yourself, but most people go with a lawyer because the process is complicated—and they tend to get better results. On average, self-represented workers get $12,400, while those with a lawyer get about $18,200.
In New York, your first step is to file a notice of claim with the Workers’ Comp Board within two years of your injury. Then, start gathering evidence: medical records, witness statements, job records, video—anything that helps your case.
If your case is strong, you might not need a hearing. About 82% of denied claims are settled out of court because insurers want to avoid trial costs. But if talks fall through, you’ll present your case to a judge. If the judge denies it, you have 30 days to request a review. The Board can uphold, change, or reverse the decision—or send it back for another look. Appeals can go to the NY Supreme Court, but that’s pretty rare.
If you want your appeal to go through and get the benefits you deserve, make sure to steer clear of these common mistakes:
Want to give yourself the best shot at winning? Work with a workers’ comp lawyer. They’ll know how to build your case, deal with the insurance company, and fight for the highest settlement.
If you've had your claim denied in New York and need an experienced lawyer to help overturn it, call me, Rex Zachofsky, at 212-406-8989 for a free consultation. Our conversation is confidential, costs you nothing, and could result in thousands more in benefits than you’d get on your own.
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