Late workers’ compensation claims with no witnesses, no notice, and no documentation can be frustrating and costly for employers. If you are a New York employer facing such a scenario, there are actionable steps you can take to contest these claims effectively. This article will guide you through the process of challenging these questionable claims at the New York Workers’ Compensation Board and protecting your business.
Understand the Workers’ Compensation System in New York
In New York, workers’ compensation laws provide employees with benefits for workplace injuries or illnesses. However, the system also imposes specific reporting requirements and burden-of-proof standards to protect employers from fraudulent or unfounded claims. Here are some critical rules to be aware of:
1. Notice Requirement: Employees must notify their employer of a workplace injury within 30 days of the incident.
2. Filing Deadlines: Employees generally have up to two years to file a claim with the New York Workers’ Compensation Board.
3. Proof of Injury: Employees bear the burden of proving that their injury occurred at work and is compensable under workers’ compensation laws.
Key Issues with Late Claims
When an employee files a workers’ compensation claim months later, without notifying you and without witnesses, red flags should go up. Late claims are problematic for several reasons:
• Lack of Documentation: Without timely notice, employers cannot investigate the incident or gather evidence.
• No Witnesses: Claims without corroboration from coworkers are harder to verify.
• Potential Fraud: Delays in reporting may suggest the injury occurred outside of work.
Steps to Fight a Late Workers’ Compensation Claim in New York
If you believe a claim is suspicious or lacks merit, take the following steps:
1. Gather Evidence
Start by collecting all relevant evidence to counter the employee’s claim:
• Time Records: Verify whether the employee was present at work on the alleged injury date.
• Surveillance Footage: Review any video recordings from the workplace.
• Witness Statements: Interview coworkers who were present around the time of the alleged injury.
• Incident Reports: Document whether the injury was reported or observed by anyone at the time.
2. Investigate the Claim Thoroughly
Conduct an internal investigation to identify inconsistencies in the employee’s account. Questions to consider:
• Was the injury reported to anyone at work?
• Did the employee seek medical attention right away?
• Does the injury align with their job duties?
3. Report to Your Insurance Carrier
Notify your workers’ compensation insurance carrier about the claim as soon as possible. Provide them with all the evidence you’ve gathered and explain why you believe the claim is unfounded. Your carrier may conduct its own investigation to strengthen your defense.
4. Challenge the Claim at the Workers’ Compensation Board
You have the right to dispute the claim through the New York Workers’ Compensation Board. To do this:
• File a Controverted Claim: Indicate that you contest the claim by submitting a Form C-7.
• Present Evidence: During hearings, present documentation, surveillance, and testimony to refute the employee’s allegations.
• Request a Medical Examination: Insist on an independent medical exam (IME) to determine the validity of the injury.
5. Consult with Legal Counsel
An experienced workers’ compensation attorney can help you navigate the legal process and ensure your rights are protected. They can represent your case during hearings and provide advice on complying with New York labor laws.
Common Defenses Against Late Workers’ Compensation Claims
To successfully contest a claim, you’ll need to provide strong arguments. Here are some common defenses:
1. Failure to Provide Timely Notice: If the employee didn’t notify you within 30 days, argue that this delay prevented you from investigating the injury.
2. No Witnesses: Point out the lack of corroborating testimony from coworkers.
3. Inconsistent Statements: Highlight any discrepancies in the employee’s account of the injury.
4. Evidence of Non-Work-Related Injury: Show proof that the injury may have occurred outside of work (e.g., social media posts, medical records).
5. Preexisting Condition: Argue that the injury is related to a preexisting condition rather than workplace activity.
Preventing Late Workers’ Compensation Claims
To minimize the risk of late and fraudulent claims, adopt proactive measures:
1. Create a Clear Reporting Policy
Ensure all employees know they must report workplace injuries immediately. Post reminders in breakrooms and include policies in employee handbooks.
2. Train Supervisors
Train your management team to handle injury reports properly and document incidents promptly.
3. Maintain Accurate Records
Keep detailed records of employee attendance, job duties, and any reported incidents.
4. Install Surveillance Cameras
Video footage can be invaluable for confirming or disputing injury claims.
5. Partner with a Workers’ Compensation Specialist
Working with a workers’ compensation insurance expert can help you identify risks, ensure compliance, and manage claims effectively.
The Role of BGES Group in Supporting Employers
If you’re a New York, New Jersey, or Connecticut employer dealing with workers’ compensation challenges, consider partnering with BGES Group, one of the Tri-State area’s top workers’ compensation specialists.
BGES Group offers:
• Tailored Insurance Solutions: Customized policies to meet the unique needs of your business.
• Expert Guidance: Decades of experience navigating complex workers’ compensation laws.
• Claims Support: Assistance in challenging questionable claims and minimizing costs.
For a consultation or to discuss your workers’ compensation insurance needs, contact Gary Wallach at BGES Group today.
• Phone: 914-806-5853
• Email: bgesgroup@gmail.com
• Website: bgesgroup.com
By taking the right steps to contest late workers’ compensation claims, you can protect your business from unnecessary costs while ensuring compliance with New York labor laws. And when you need expert support, BGES Group is here to help. Call or email us today to learn more about our services and how we can provide peace of mind for your business.