Denied claims
When the claim is denied
A denial letter feels final. It isn't. Most denials come down to a missing record, a disputed fact or a doctor's report someone hasn't read closely, and each of those can be answered.
Why claims are turned down
- The injury wasn't reported in time, or not in writing
- The insurer says the condition was there before the job
- The medical records don't connect the injury to the work
- The employer disputes how or where it happened
What an appeal involves
There's a deadline to appeal, and it's short, so call as soon as the letter arrives. We read the file the insurer relied on, find what it's missing, and get it from your doctors, your coworkers or your employer's own records. Then we take it to a hearing, and we're beside you at it.
Treatment denials too
A claim can be allowed and a surgery, a scan or a referral still refused. We appeal those the same way, with a doctor's reasons in writing.
Sample matters
Two denials, reversed
Denial reversed
Forklift operator, lack of medical evidence
The records were under the wrong claim number. We moved them, and the claim was allowed at the first hearing.
2024
Scan approved
Neck injury, bus mechanic
An MRI refused as unnecessary was approved once the treating doctor explained why in writing.
2023
Sample matters, for the firm to replace with its own. Every claim turns on its own facts, and past results don't guarantee a similar outcome.
Questions about denied claims
How long do I have to appeal?
Not long: often a matter of days or weeks, depending on the rules where you work. The date is usually on the letter. Call us the day it arrives.
I had back trouble before. Is my claim over?
No. A work injury that makes an old condition worse can still be covered. The question is what changed, and your records can show it.
Do I have to speak at the hearing?
Usually you'll answer some questions. We'll go through them with you beforehand, so you know what to expect.
Tell us where your claim stands
The first meeting is free, at our office on Madison Avenue or by video.
Please don't send confidential details until we've spoken.