What are the reasons I can be denied workers’ compensation?

If you are hurt on the job, the odds are very high that you are entitled to workers’ compensation payments.  The carrier has a few defenses, however, and the following is a list of the most common reasons carriers will fight your claim.

  • Your company simply tells the insurance company that your accident didn’t happen. Or, you weren’t working that day. Or, they claim you didn’t really get hurt.
  • They claim you didn’t tell anyone. You normally have 30 days to notify your company and two years to file the claim. But, the insurance says you didn’t do either.
  • You were drunk or high and this is what caused the accident.
  • You tried to hurt yourself or someone else. For example, you started a fight or you punched a wall out of anger after receiving a phone call from home.
  • You were really working for yourself as a private business person and not an employee.
  • You really got hurt at home, but, you came to work and said it happened there.
  • You worked as a NYC police officer, fire fighter, teacher or sanitation worker and are covered under different laws.
  • You are covered under the laws of a different state, country or the Federal government.
  • You performed casual work.
  • You worked as clergy.


So why do we put etcetera? Well, there can be many reasons you are denied workers’ compensation, but these are the primary reasons covering almost all the denials we receive. Sometimes, your company issues a denial because they just don’t want you to receive your benefits. Maybe they are afraid their premiums will go up or they want to punish you for perceived infractions they say you committed at work.

Other times, they will accept your case by agreeing you hurt one part of your body but fighting you on providing coverage for other injuries you claim. Or they will say that the real reason you are not working is because they fired you.

People often ask whether a lawyer is necessary in workers’ compensation. Well, if your case is denied, it seems obvious that you will need legal help to obtain the benefits you deserve.

And, if you are denied, the case will go to a workers’ compensation judge who will hear the evidence and make a decision. This will mean that you need to prepare your case. For example, if you have witnesses who were there when you got hurt, you may wish to subpoena them and prepare their testimony. Or, you may want to review the documents your employer intends to show the judge to make sure they are authentic.

Contact Worker Comp Attorney Robert A. Koenigsberg

In any event, the stakes in workers’ compensation can be high. Proper medical care and lots of money can turn on whether a judge believes you or believes your employer. The insurance company will have a lawyer representing them. You should make sure to level the playing field and have a workers compensation lawyer represent you. Contact New York workers comp attorney Robert A. Koenigsberg at (212) 964-9292 or fill out an online contact form to schedule your consultation today.