
Some Workers’ Comp Claims in New York Get Fought Harder Than Others. Here’s What That Means for You.
New York’s workers’ compensation system is supposed to be straightforward. You get hurt on the job, you file a claim, and you receive medical care and wage replacement while you recover. The reality, for many injured workers, is considerably more complicated.
Employers and their insurance carriers have every financial incentive to limit what they pay out on claims, and certain types of claims draw a level of scrutiny and resistance that others don’t. When that resistance turns into a denial or a prolonged dispute, the worker is the one left without income and without answers.
The New York workers’ compensation lawyers at Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP have been representing injured New Yorkers for over 90 years. We know how employers and insurers approach these cases, and we know what it takes to push back effectively when a legitimate claim gets challenged.
The Landscape Has Shifted Against Workers
Before getting into the specific claim types, it’s worth understanding the environment in which these disputes play out. According to reporting by New York Focus, workers’ compensation payouts in New York have dropped significantly over the past decade. Workers’ comp attorneys describe a system that has shifted from an outreach-oriented approach to one in which claimants must actively fight to get a hearing.
The New York Focus report notes that one employer-side attorney recently recommended “always file the denial if it’s in question,” reflecting how insurers now approach borderline claims. For injured workers, that means even strong, well-documented claims can face an uphill fight if the worker doesn’t know their rights or doesn’t have experienced legal representation.
The Claims Employers and Insurers Resist Most
Soft Tissue and Subjective Injury Claims
Back strains, neck injuries, shoulder problems, and other soft tissue conditions are among the most commonly disputed claims in the New York workers’ compensation system. Because these injuries don’t always show up clearly on imaging, insurance carriers frequently challenge the severity of the injury, the causal connection to the workplace, or both.
A worker who reports back pain after lifting on the job may face demands for multiple independent medical examinations, disputes over treatment authorizations, and challenges to their reported disability level, all before receiving a single benefit payment.
Mental Health and Psychological Injury Claims
As of 2025, all New York workers are now eligible to file claims for mental health conditions triggered by workplace circumstances, and workers no longer need to prove their stress exceeds a normal work environment threshold, a previous barrier that prevented many legitimate claims. This expansion is significant, but it also means that psychological injury claims are now a target for employer and insurer pushback.
Workers’ comp claims for PTSD, acute stress, and depression are among the most aggressively contested in the system because the injury is harder to quantify than a broken bone, and because carriers are acutely aware of the financial exposure the new rules create.
Pre-Existing Condition Claims
When a worker has a documented history of a prior injury or medical condition, insurers routinely argue that the workplace incident didn’t cause the injury; it merely aggravated something that already existed, and that they therefore have limited or no liability.
New York law recognizes that pre-existing conditions aggravated by work are compensable, but winning those claims requires medical evidence that directly links the workplace event to the worsening of the condition, and insurers know how to challenge that evidence effectively.
Repetitive Stress and Occupational Disease Claims
Injuries that develop gradually over time rather than from a single identifiable incident are among the most aggressively disputed in the New York workers’ compensation system. Repetitive stress injuries like carpal tunnel syndrome develop from years of repeated motion, awkward positioning, or sustained physical demands on the job, and insurers routinely challenge whether the condition is truly work-related or simply the result of age, lifestyle, or activities outside of work.
That dispute over causation is the central battleground in these cases, and it almost always comes down to competing medical opinions.
The challenge is compounded by the fact that many workers don’t connect their symptoms to their job until the condition has progressed significantly, by which point the employer will argue the claim was filed too late or that the connection to any specific workplace is too attenuated to establish liability.
These cases require consistent medical documentation over time, a clear record linking the physical demands of the job to the diagnosis, and an attorney who understands how to build that evidentiary foundation before an insurer’s expert tries to dismantle it.
High-Value Disability Claims
Any claim that could result in a significant schedule loss of use award or permanent total disability finding draws immediate and sustained attention from the insurance carrier.
In 2017, New York reduced the amount of a cash benefit that pays workers for the loss of a body part under the schedule loss award guidelines, a change that saved insurers significant money and that labor attorneys have been pushing back against ever since.
The higher the potential payout, the more resources an insurer will commit to disputing the degree of disability, challenging the medical evidence, and pushing for a lower classification of the worker’s limitations.
Claims Involving Independent Contractor Status Disputes
When an injured worker was classified as an independent contractor rather than an employee, the employer will typically argue that no workers’ compensation obligation exists at all.
New York law looks at the actual nature of the working relationship rather than simply the label the employer assigned, but proving employee status when a company insists otherwise requires a detailed factual analysis and often a contested hearing.
Workers misclassified as contractors frequently don’t realize they may still be entitled to benefits, and employers count on that lack of awareness.
What Employers Do When They Dispute a Claim
When an employer or insurer decides to fight a workers’ compensation claim in New York, the playbook typically includes some combination of the following:
- Sending the worker to an independent medical examination (IME) conducted by a doctor selected and paid by the insurance carrier, whose findings may differ significantly from the treating doctor’s assessment of the injury and need for ongoing care.
- Delaying or denying pre-authorization for recommended medical treatment, forcing the worker to either go without care or appeal through a system that workers’ comp attorneys describe as increasingly designed to slow access.
- Challenging the causal connection between the injury and the workplace, particularly in soft tissue and occupational disease cases, where that connection relies heavily on medical opinion.
- Disputing the worker’s average weekly wage, which directly affects the benefit amount, particularly in cases where the worker had variable hours or was paid partially off the books.
- Filing a denial on the theory that some legitimate defense exists, even when the claim is otherwise solid, because even a temporary delay in benefits reduces the insurer’s total payout exposure.
In New York, workers generally must notify their employer of a workplace injury within 30 days, and delays in reporting are often used by insurers to question whether the injury was actually work-related.
Why Having a Lawyer Makes a Measurable Difference
According to the New York Focus report, one injured worker described navigating the New York workers’ comp system as being “assumed fraudulent the minute you have your injury.” That experience isn’t unusual, and it reflects a system in which the procedural complexity and the institutional resources available to employers and insurers are not matched by equivalent support for injured workers unless they have legal representation.
An experienced workers’ compensation attorney knows how to respond to IME findings, challenge improper denials, ensure that the correct average weekly wage is established, and navigate the hearing process before the Workers’ Compensation Board when a dispute can’t be resolved without a judge.
The workers’ comp claim process in New York has deadlines and procedural requirements that can cost a worker their benefits if missed, and having someone in your corner who knows how that process works is one of the most important decisions an injured worker can make.
Hurt at Work in New York? Don’t Let a Disputed Claim Go Unanswered.
Pasternack Tilker Ziegler Walsh Stanton & Romano LLP represents injured workers throughout New York City, Long Island, the Hudson Valley, and across the state. If your claim has been denied, disputed, or delayed, or if you’re not sure whether you’re receiving everything you’re entitled to, we want to hear from you.
We handle cases on a contingency fee basis, meaning there are no upfront costs and you owe us nothing unless we recover benefits for you. Contact us today for a free consultation, available 24 hours a day.
“The firm treated me with respect and dignity and handled all my workers’ comp issues with ease. I highly recommend them. Thank you.” – E.D., ⭐⭐⭐⭐⭐
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