Injured workers in New York should be able to receive medical coverage and certain other benefits after work injuries or illnesses occur. Unfortunately, there are circumstances in which injured workers have their claims denied and are not provided with the benefits that they deserve. There are also situations in which a worker is denied coverage for a legitimate medical treatment that he needs because of his workplace accident or workplace illness, as well as times when workers are forced back to work before they are truly ready to go.
When adverse actions are taken against you in a workers’ comp claim, like a denial of a claim or a denial of benefits that you should be receiving, you have the right to appeal. The appeals process, however, can be a complicated process and it is one that many workers may have a hard time navigating — especially as they also have to deal with the effects of their injury at the same time as they fight for benefits. A New York workers’ compensation law firm should be consulted for help with the appeals process due to the challenges inherent in filing an appeal and making a successful argument.
Workers’ Compensation Appeals are Difficult for Workers
Workers’ comp appeals can be difficult because insurers often use a variety of different tactics in order to try to fight paying benefits that they should be providing to injured workers. Workers’ comp insurers have experts who help them try to find ways around paying. In many states, they have also successfully lobbied to change laws in ways that adversely affect the rights of workers.
Recently, for example, NBC reported on reforms which were passed in California in 2013 which changed the way that appeals were handled in the workers’ compensation system. The change altered who hears appeals of workers’ comp claim denials. A for-profit corporation which the state has entered into a contract with now reviews appeals under the Independent Medical Review process. Previously, before the change, treatment denials were appealed before a judge. Since the shift to the private corporation, there were an estimated 600,000 situations in which employees appealed the denial of medical treatment they believed was necessary following their work injury. In 90 percent of appeals, the insurer won and did not have to pay.
Every state is different and has its own appeals process, but this troubling outcome shows how precarious the rights of workers are and how difficult it can be for employees to get fair compensation in a system where it seems as if the deck is often stacked against them.
Although workers’ compensation appeals can often be a challenge for injured and sick employees, appealing is important because you likely have no other options for recovery. You cannot sue an employer for an injury on-the-job in most circumstances, so if your workers’ comp benefits are denied and you don’t fight the denial in an appeal, you could be left with out-of-pocket loss. Rosenberg, Minc, Falkoff & Wolff can provide you with help appealing so you can try to make certain your injury or illness-related losses and damages are all covered.
