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What if my New York workers' compensation claim is controverted?

People who are injured in a workplace accident will expect that their workers' compensation claim will be approved, and they will receive the benefits they are entitled to for treatment and wage coverage as they try to recover. However, not all cases are immediately accepted at face value by the insurance company, and they will controvert a claim. When a claim is controverted (denied) and the worker has legitimate injuries stemming from the work he or she was doing, it is important to know when this might take place and what to do about it.

There are many reasons why the insurer can controvert the claim. They might say that the injury did not happen due to work, the employee's injuries are being exaggerated, the injuries happened on a second job and more. It is also possible that the employer will request that the insurance company controvert the employee's claim. Still, it is ultimately at the discretion of the employer as the insurer has responsibility for the claim's liability. It does not need to adhere to such a request from the employer.

After the claim has been controverted, there will be a hearing so a Judge will listen to the arguments of both sides. The New York State Workers Compensation Board can have a hearing or require that the hearings be held before a Workers Compensation Law Judge.

At the hearing, there can be testimony, depositions, medical reviews and assessment of other evidence to determine if the benefits should be provided. If the Judge decides that compensation should be provided, he or she will decide how much it should be and for how long it should last.

When a worker is injured and the claim is controverted, it can be a worrisome time for the employee as it is venturing into the unknown as to how the case will be decided upon. Fortunately, there are options when the claim is controverted and it is possible to receive workers' compensation benefits. To ensure that the process goes smoothly and the worker's interests are protected, a law firm experienced in workers' compensation benefits should be contacted immediately.

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