Contributed by: Dan Rose
Getting a denial letter on a workers’ compensation claim feels like a door slamming shut. You have been dealing with pain for months, maybe years. You finally reported it, saw a doctor, filed the paperwork, and then the insurance carrier said no. I understand the frustration, and I want to be direct with you. A denial is not the end of your case. In fact, for repetitive stress injuries in New York, initial denials are so common that experienced attorneys often plan for them from the start. The appeals process exists for a reason, and workers who push forward with the right strategy frequently end up receiving the full benefits they were owed all along.
If your repetitive stress injury claim has been denied or your benefits have been reduced, here is what is actually happening and how to fight back effectively.
Why Insurance Carriers Love Denying Repetitive Stress Claims
Let me be blunt about the dynamics at play. Insurance companies are businesses. Their job is to pay out as little as possible. Repetitive stress injuries give them more room to maneuver than almost any other type of workplace claim, and they know it.
With a broken leg from a fall on a job site, there is usually a clear incident, a date, witnesses, and a medical report that ties everything together neatly. With carpal tunnel syndrome, chronic tendonitis, or a deteriorating lower back from years of repetitive lifting, none of those clean facts exist. There is no single event. The onset is gradual. And there are almost always alternative explanations the carrier can point to.
I have seen denial letters that blame a worker’s age, their weight, a prior medical history, recreational hobbies, even genetics. One carrier argued that a food service worker’s shoulder condition was caused by playing with her children, not by the overhead reaching she did forty hours a week for six years. These arguments are not always made in bad faith, but they are almost always designed to test whether you will fight back.
- Common Denial Reasons: The carrier claims the injury is not work-related, attributes it to a pre-existing condition, argues the worker waited too long to report, or states that the medical documentation does not establish a clear occupational link.
- Strategic Testing: Many initial denials are a calculated bet that the worker will give up rather than go through an appeal. Statistics show that represented workers are far more likely to overturn denials than those who go it alone.
- Burden of Proof Reality: Under New York law, repetitive stress injuries are classified as occupational diseases. That means you must demonstrate that your condition arose from hazards specific to your type of work, a higher standard than for acute injuries.
What a Denial Actually Means Under New York Law
A denial does not mean the Workers’ Compensation Board has reviewed your case and ruled against you. In most situations, it means the employer’s insurance carrier has decided not to accept liability, and now the matter will go before an administrative law judge for a hearing. Think of it less like a verdict and more like the other side saying, “Prove it.”
That hearing is your opportunity to present medical evidence, employment records, and testimony that connects your repetitive stress injury to your job duties. The judge evaluates the evidence from both sides and issues a decision. If the evidence supports your claim, the denial gets overturned and your benefits begin, sometimes with back pay included.
This is also where having a Queens attorney for workplace injury claims makes the biggest difference. The insurance carrier will have legal counsel at every hearing. Walking in without representation puts you at a serious disadvantage, especially in cases where the medical causation is being contested.
- Hearing Process: You will appear before a Workers’ Compensation Board judge who reviews evidence from both parties and makes a determination.
- Back Benefits: If your denial is overturned, you may be entitled to retroactive wage replacement going back to when your disability or lost time first began.
- No Upfront Cost: In New York, workers’ compensation attorney fees are set by the Board and paid by the insurance carrier after an award is issued. You do not pay out of pocket to get representation.
Strengthening Your Case After a Denial
If your claim has been denied, the single most important thing you can do is improve your medical documentation. In my experience, weak or vague medical reports are the leading cause of unsuccessful repetitive stress claims, not because the injury is not real, but because the paperwork did not tell the full story.
Your treating physician needs to provide a clear, detailed opinion that your condition was caused or significantly worsened by specific, identifiable work activities. A report that says “patient has tendonitis” is not nearly as effective as one that says “patient has tendonitis in the right shoulder consistent with repetitive overhead reaching performed during employment as a commercial painter for approximately five years.” The second version gives the judge something concrete to evaluate. The first gives the insurance carrier room to argue.
Beyond medical records, gather anything that helps paint a picture of your daily work routine. Job descriptions, shift schedules, photographs of your workstation, communications with your employer about the physical demands of your role. If coworkers can attest to the repetitive nature of your tasks, their statements can add meaningful support.
- Medical Report Upgrade: If your doctor’s initial report was generic, ask for a supplemental opinion that explicitly ties your diagnosis to the repetitive motions your job required. Specificity wins these cases.
- Employment Evidence: Collect job descriptions, duty rosters, or any internal documents that describe the physical requirements of your position. These help establish that the repetitive exposure was a core part of your role, not incidental.
- Witness Statements: Coworkers, supervisors, or even clients who observed your work tasks daily can provide written or verbal statements supporting the repetitive nature of your job duties.
The Pre-Existing Condition Problem (and Why It Does Not Disqualify You)
One of the most discouraging things I hear from Queens workers is, “They said I already had this condition before I started the job, so I cannot get benefits.” This is one of the most misunderstood aspects of New York workers’ compensation law, and insurance carriers rely on that misunderstanding.
Here is the reality. New York explicitly allows workers’ comp claims even when a pre-existing condition is involved, as long as you can show that your job duties made the condition measurably worse. If you had mild arthritis in your wrist before you took a data entry position, and five years of constant typing turned that mild arthritis into debilitating carpal tunnel syndrome requiring surgery, your claim can absolutely succeed. The law recognizes that jobs aggravate existing conditions, and it provides benefits accordingly.
In fact, New York law even allows a worker who previously received comp benefits for a repetitive stress injury to file again if they returned to work and the condition worsened. The system is designed to account for the way these injuries evolve over time.
- Aggravation Standard: You do not need to prove your job was the sole cause of your condition. You need to prove it made a pre-existing condition materially worse.
- Re-Filing Rights: If you returned to work after a prior repetitive stress claim and the same condition has deteriorated, you may be eligible to file a new claim.
- Insurance Carrier Tactics: Expect the carrier to use your medical history against you. An experienced attorney will anticipate this strategy and prepare counter-evidence, including updated medical opinions and functional assessments.
Do Not Let a Denial Letter Write the Final Chapter
Insurance carriers count on workers giving up after a denial. The paperwork is intimidating, the process feels adversarial, and the pain you are already managing makes fighting an uphill battle feel impossible. But here is what I have seen over and over again in Queens. Workers who push forward, who get proper representation and build a documented case, recover the benefits they were owed from the beginning. A denial is not a determination of your claim’s merit. It is just the starting line of the next phase.
If you have received a denial on a repetitive stress injury claim, or if your benefits were reduced or cut off, a Queens workers’ comp attorney for repetitive stress injuries can evaluate your case, identify where the gaps are, and represent you at hearings where it counts.
Contributed by Dan Rose, A Senior Workers’ Compensation Legal Analyst.
Dealing with a Repetitive Stress Injury from Work?
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