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Employer Disputing Workers' Comp Claim

What happens when your employer disputes your workers’ compensation claim?

If you are injured on the job, you have 30 days to report that accident in writing to your employer. Injured employees who do not report their injuries may lose their right to obtain compensation under state workers’ compensation insurance. In New York, just about every employer is required to provide their employees with workers’ compensation coverage, but what happens when an employer disputes an employee’s claim that they were injured on the job?

Because injured employees submit a claim with the New York State Workers’ Compensation Board directly via a C-3, your employer won’t be making the decision regarding coverage for your injuries.

Workers’ compensation insurers that provide coverage to New York employees typically receive a C-3 form and quickly begin paying benefits. If a workers’ compensation claim is disputed, that is most likely because the Workers’ Compensation Board doesn’t agree with your claim, not because your employer doesn’t agree with your claim. Employers have relatively little sway when it comes to whether injured employees receive workers’ comp benefits or not.

Workers compensation insurers dispute claims for a variety of reasons. Some of the most common reasons include –

  • They don’t think you were really injured
  • They don’t think the injury happened during a time you were covered by workers’ comp
  • They don’t believe the injury occurred at your workplace

So a worker is injured, notifies their employer, and whether that employer agrees or not, the employee files a claim with the New York State Workers’ Compensation Board. The Board receives the claim and has a problem with it. Now what? If the Board is having trouble validating your claim, it will typically put claim examiners or people called “conciliators” on the case to resolve the dispute outside of a hearing. If the issues can’t be resolved this way, the disputed claim will go to a hearing before a workers’ comp law judge. If the judge makes a decision you do not agree with, you have the right to appeal.

So to reiterate the answer to the main question, your employer’s feelings about your claim have little bearing on the outcome. It is the NY State Workers’ Comp Board that will ultimately make the decision, and if the case is still disputed, it can go before a workers’ comp law judge. Because these cases can be exceedingly complex, you’ll need a seasoned workers’ compensation attorney in your corner, especially if the case becomes disputes. Contact The Perecman Firm for a free review of your work injury case!


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