When you get a "no"
NY workers' comp claim denied? Why it happens — and what to do
A denial is not the end of your claim. Most denials come from fixable problems — a missed deadline, thin medical proof, or a dispute over whether the injury is work-related — and New York gives you a clear path to challenge them.
- The most common causes are missed deadlines and insufficient medical documentation.
- You can request a hearing before a judge and appeal up a four-level ladder.
- An appeal to the Board (Form RB-89) must be filed within 30 days of the decision.
- Representation is free up front — attorney fees come out of any award.
Why claims get denied
- Missed deadlines — no written notice to the employer within 30 days (WCL §18), or the claim filed more than 2 years after the injury (WCL §28).
- Insufficient or late medical evidence — no timely, specific provider report tying the condition to work.
- Dispute that it's work-related — the carrier argues the injury didn't arise out of and in the course of employment.
- Pre-existing condition — the insurer attributes the problem to something other than the work injury (apportionment).
- Clerical errors or inconsistencies in the paperwork or accident description.
- Intoxication alleged as the sole cause of the injury.
- Missed an IME — failing to attend the insurer's independent medical exam.
How to respond
Read the denial for the exact reason
The Notice of Controversy or the judge's decision states why. Fix the specific problem it names.
Get complete, specific medical proof
Ask your treating provider for a detailed report connecting the diagnosis to your work injury — generic notes get rejected.
Request a hearing
Ask the Board for a hearing before a Workers' Compensation Law Judge to present your evidence and testimony.
Consider representation
A workers' comp attorney or licensed representative costs nothing up front — fees are set by the Board and taken from any award.
Appeal within 30 days
If the judge rules against you, file Form RB-89 within 30 days for Board Panel review, then up the ladder if needed.