If your workers’ compensation claim was denied in Buffalo, it can feel like a serious blow. Workers’ compensation benefits are crucial for those who suffer injuries while on the job, and when these claims are denied, it can make the recovery process even more difficult. However, understanding why a claim might be rejected is the first step to fighting back. At Cole, Sorrentino, Hurley, Hewner & Gambino, P.C., we help injured workers navigate the complex world of workers’ compensation claims, ensuring that their rights are upheld. In this guide, we’ll explore the most common reasons why workers’ comp claims fail and what you can do if your claim is denied.
Richard H. Cole
Partner
Thomas F. Hewner
Partner
Donna L. Haslinger
Partner
Vivian P. Roche'
Partner
Keith R. Rosso
Attorney
Tasha D. Frazie
Attorney
Tyler I. Wood
Attorney
Marc A. Cangé
Attorney
Teresa M. Cappiello
Attorney
1. Failure to Report the Injury on Time 
One of the most critical steps in a workers’ compensation claim is reporting the injury to your employer. In New York, workers must notify their employer of an injury within 30 days of the incident. If this step is missed, even if your injury is severe, the insurance company may deny your claim outright.
Why is this time frame so important? The rationale behind this deadline is that prompt reporting helps ensure the injury was truly work-related and provides a timely opportunity for the employer to investigate. However, sometimes workers may not realize the full extent of their injury immediately, especially in cases involving repetitive stress or gradual injuries. Even in these situations, it’s important to inform your employer as soon as possible.
If you miss the deadline, your claim may be denied, but there are exceptions. In certain circumstances, the Workers’ Compensation Board might allow a claim to proceed if you can show a good reason for the delay in reporting. This is another area where legal assistance from a skilled attorney, like those at Cole, Sorrentino, Hurley, Hewner & Gambino, P.C., can make all the difference.
2. Insufficient Medical Evidence
Medical evidence is a cornerstone of any successful workers’ compensation claim. If you don’t have proper documentation from a doctor that links your injury to your work, the insurance company may argue that your injury is not work-related, which is a valid reason to deny your claim.
Your medical records must clearly state the nature of your injury, the treatment you have received, and the work duties that caused or aggravated the injury. If the insurance adjuster believes that the medical records don’t adequately support your claim, they might deny it, or at the very least, delay it.
It’s important that your doctor understands how your work activities are contributing to your injury. For example, if you’re a construction worker suffering from a back injury, the doctor should explicitly state how your lifting, bending, or repetitive tasks contributed to the injury. Without this clear link between the injury and the job, your claim may face unnecessary obstacles.
At Cole, Sorrentino, Hurley, Hewner & Gambino, P.C., we often help clients who need additional medical evidence to support their claims. We work with healthcare professionals who specialize in workers’ compensation cases to ensure that your documentation is complete and persuasive.
3. Employer Disputes the Injury
In some cases, employers may dispute whether the injury occurred on the job or whether it’s related to work duties. These disputes can arise if the employer believes the injury was caused outside of the workplace or by non-work-related activities.
For instance, if you hurt yourself in a car accident while driving to a work meeting, your employer may argue that the injury wasn’t work-related, even if it happened while performing job duties. In these situations, you may be required to provide further evidence, such as witness statements or additional documentation, to prove that your injury occurred in the course of employment.
Employer disputes are serious and can lead to significant delays in your claim. In some cases, the Workers’ Compensation Board may need to step in and resolve the issue. An experienced workers’ compensation lawyer can assist you in presenting a strong case and help you gather the necessary evidence to support your claim.
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4. Pre-existing Conditions
Workers’ compensation doesn’t typically cover injuries that are solely due to pre-existing conditions. For example, if you already had a bad back and then sustained a new injury while lifting a heavy object at work, the insurer might argue that your injury is due to the pre-existing condition rather than work-related activities.
This issue is especially common with conditions such as arthritis, back problems, and repetitive stress injuries like carpal tunnel syndrome. However, even if you have a pre-existing condition, you may still be entitled to compensation if the work-related duties aggravated the condition or made it worse.
To successfully claim compensation for an aggravated pre-existing condition, you’ll need strong medical documentation showing how your work duties directly contributed to the worsening of your condition. At Cole, Sorrentino, Hurley, Hewner & Gambino, P.C., we assist clients in these types of cases, ensuring that all medical evidence is presented clearly and that the insurer understands the full scope of the injury.
5. Failure to Follow Medical Advice
Insurance companies expect workers to follow all prescribed medical treatments and attend follow-up appointments. If you miss medical appointments, fail to follow your doctor’s instructions, or engage in activities that contradict your doctor’s advice, the insurance company may use this as grounds to deny your claim.
For example, if your doctor tells you to refrain from heavy lifting and you return to work too early or push yourself beyond what’s safe, the insurer may argue that your injury isn’t severe enough to warrant benefits, or that you’re not taking your recovery seriously.
It’s essential that you comply with your doctor’s orders throughout your recovery process. If you have difficulty following the advice or feel unsure about your treatment plan, it’s important to discuss your concerns with your doctor rather than risk non-compliance.
6. Not Meeting the Disability Threshold
In some cases, your injury may not meet the threshold required for workers’ compensation benefits. If your injury is deemed minor and doesn’t substantially limit your ability to work or perform job duties, your claim could be denied.
For example, if you suffer from a minor sprain or a temporary injury that doesn’t prevent you from returning to work quickly, the insurer may argue that you don’t meet the definition of a “disabling” injury.
To avoid this situation, ensure that your medical evidence clearly demonstrates the extent of your disability and how it affects your ability to perform your job duties. If you’re not able to work at all or if your work capacity is reduced, make sure your doctor’s notes reflect this.
What to Do After Your Workers’ Comp Claim Is Denied
If your claim is denied, it’s important not to give up. In New York, you have the right to appeal the decision. The first step is to file a request for a hearing with the Workers’ Compensation Board, where you can present your case.
A skilled attorney can help you gather additional evidence, represent you at hearings, and ensure that your claim is properly handled. Don’t let a denied claim prevent you from getting the compensation you deserve. Cole, Sorrentino, Hurley, Hewner & Gambino, P.C. offers free consultations for workers’ compensation claims, and we’re ready to fight for your rights.