By Rosalind Asch-Hobeck

Denied Workers’ Compensation Claim? Here's Why—And What You Can Do About It

You did everything by the book. You followed the rules. After getting hurt on the job, you reported your workplace injury within the required 30 days. You filed your claim with the Workers’ Compensation Board within the two-year deadline. You assumed that doing everything right would guarantee a smooth process and the support you need to recover.

So, when the denial notice came in the mail, it felt like a punch to the gut.

If you’re in this situation, you’re not alone. And more importantly, you still have options. While a denial may feel like the end of the road, it can actually be the beginning of a process that—if navigated wisely—can still lead to financial relief and justice.

The Uncomfortable Truth About Workers’ Compensation Denials

The harsh reality is this: workers’ compensation claims are frequently denied, even when they seem legitimate. It’s important to understand that your claim isn't judged by a neutral third party right off the bat. The first decision-maker in your case is usually the insurance company—or, in some cases, a self-insured employer.

These are not impartial actors. They’re businesses. And like any business, they prioritize their bottom line. Every approved claim is an expense. Every denied claim is a financial “win” for them. Understanding this dynamic is the first step toward protecting yourself.

Inside the Insurance Company’s Playbook: Why Claims Get Denied

Once your employer reports your injury, it triggers a formal review process by their workers’ compensation insurance carrier. This sets off an investigation that can be surprisingly adversarial. The insurance company will carefully examine every aspect of your case. Surveillance footage, incident reports, co-worker statements, and medical evaluations—all are fair game in the insurer’s effort to poke holes in your story.

Here are some of the most common reasons they use to justify a denial:

1. Delayed Reporting

One of the most frequent reasons claims get denied is a delay in reporting the injury. Even though New York law gives you 30 days to report a workplace injury, in practice, any delay—especially one beyond a few days—can raise red flags.

Workers often delay reporting for understandable reasons. Maybe the injury seemed minor at first. Maybe they feared retaliation or didn’t want to “make waves.” Unfortunately, that hesitation can come back to haunt them. An insurer may argue that the delay casts doubt on whether the injury was work-related—or if it even happened at all.

2. “Not in the Course of Employment”

Another common justification is the so-called "course of employment" defense. Insurers may dispute whether the injury actually occurred while you were performing job-related duties. This can get especially tricky if you were injured off-site, during a break, or while doing something that the insurer argues was outside the scope of your employment.

For example, if you slipped in the parking lot before clocking in, the insurer might argue that you weren’t technically “on the job.” If you were injured during an argument with a co-worker or while engaging in horseplay, they may claim your actions broke the chain of employment-related causation.

3. Pre-Existing Conditions

Insurers love to blame injuries on pre-existing conditions. If your medical records show any prior complaints, even if unrelated, they may argue that your current pain or disability isn’t due to a new injury but rather a continuation of an old one.

Let’s say you injured your back lifting boxes. If you saw a chiropractor three years ago for a different issue, expect the insurer to potentially latch onto that and argue that your current symptoms are unrelated to your work.

4. Lack of Medical Evidence

Workers’ compensation hinges on medical documentation. If your records are inconsistent or incomplete—or if your treating doctor doesn’t provide a strong enough opinion about how your injury is related to your work—your claim may be denied.

Something as simple as a missing report, a vague diagnosis, or a delay in seeking treatment can be used to attempt to discredit your case.

5. Witness Disputes

In some cases, your co-workers may not support your version of events. Or worse, there may be no witnesses at all. Without corroboration, the insurer might argue that the injury never happened, or happened outside the workplace although Section 21 may result in a decision in your favor.  That Section of the law relates to unwitnessed accidents and a presumption under the law.

Even honest workers find themselves in this situation. You could have slipped in the restroom or strained your shoulder lifting equipment when no one was around. That doesn’t mean the injury isn’t real—but it does give insurers room to cast doubt.

What Happens Next: How to Respond to a Denial

If your claim is denied, don’t panic. This is not the final word on your case. It’s simply the first decision in a process that includes your right to challenge that decision through a formal appeal.

Here’s what you can do:

1. Request a Hearing

In New York, you have the right to request a hearing before a Workers’ Compensation Law Judge (WCLJ). The hearing is your chance to present evidence, call witnesses, and submit medical records supporting your claim. You don’t have to do this alone. In fact, you shouldn’t.

2. Hire a Workers’ Compensation Attorney

You’re not just up against your employer. You’re going up against an insurance company with deep pockets and experienced legal counsel. If you don’t have representation, you’re at a disadvantage from the start.

Fortunately, hiring a lawyer in New York workers’ comp cases is risk-free. There are no upfront fees. Attorneys are only paid if they successfully secure benefits for you, and even then, their fee is a portion of your award as approved by the judge.

A skilled attorney can:

• Gather and organize your medical records
  
  

• Obtain supportive reports from your treating doctor
  
  

• Cross-examine employer witnesses
  
  

• Argue your case before the judge
  
  

• File appeals if necessary
  
  

Don’t underestimate the power of legal advocacy. It can be the difference between prolonged financial stress and receiving the support you need to heal.

3. Apply for Short-Term Disability Benefits

While your appeal is pending, you may qualify for short-term disability benefits through your employer’s disability carrier. These benefits aren’t as comprehensive as workers’ compensation, but they can provide essential financial support during the appeal process.

Keep in mind that these benefits are temporary and often come with a maximum weekly limit. But when rent is due and medical bills are piling up, every bit helps.

What If My Employer is Fighting My Claim?

It’s disheartening, but it happens more often than you think. Some employers dispute claims outright, fearing increased premiums or reputational harm. Others might offer subtle pressure to withdraw your claim, return to work early, or settle quickly.

You don’t have to accept these tactics. If your employer—or anyone connected to your employer—is making you feel uncomfortable or coerced, document everything. Talk to your attorney. Know your rights.

Retaliation for filing a claim is illegal. If you're being harassed, demoted, or threatened with termination, legal recourse may be available beyond workers' comp itself.

Your Next Steps: Take Action Today

Workers' compensation law is technical, time-sensitive, and emotionally exhausting to navigate alone. From the moment you receive a denial notice, the clock is ticking. You must act quickly to preserve your rights.

Here's what you should do right now:

1. Review the denial notice carefully – It should include the reasons for the denial. This gives your attorney a starting point to build your case or if necessary, appeal an adverse decision.
   
   

2. Gather all relevant documents – Medical records, incident reports, photos, emails with your employer, and anything else that supports your story.
   
   

3. Get a free case evaluation – There is absolutely no harm in talking to an attorney. It won’t cost you anything and could give you a clear path forward.
   
   

At LawyerLanding.com, we make it easy. Simply fill out our short questionnaire, and we’ll introduce you to a seasoned workers’ compensation attorney in your area. Someone who understands the system, knows the players, and can fight to get you the support you deserve.

Educate Yourself: Protecting Your Rights

You can still take steps to protect yourself by learning more about how workers’ compensation works. Here are a few resources we recommend:

📘 Are You Protecting Your Rights After a Work Injury?
Find out the key mistakes injured workers often make—and how to avoid them.

⚠️ What is Horseplay and Why Should it Be Avoided?
Learn how seemingly innocent behavior can jeopardize your claim.

👨⚖️ Workers’ Compensation Hearings – Don’t Wait to Get Legal Help
Hearings are legal proceedings. Don’t go in unprepared.

These articles are packed with actionable insights to help you stay informed and in control.

Final Thoughts: You Deserve Better

Suffering an injury at work is painful enough. Getting denied the support you need can feel like insult added to injury. But remember—just because the insurance company said "no" doesn't mean they're right.

Workers’ compensation law exists to protect you, not just your employer. And with the right legal help, you can fight back and win.

Don’t suffer in silence. Don’t go it alone. Get the help you need and the benefits you’re entitled to.