As a worker in Florida, you may be entitled to workers’ compensation benefits if you suffered an injury or illness in a workplace accident. You can recover compensation for your economic expenses and you don’t even have to prove fault. The majority of claimants are able to recover compensation; however, there are several reasons why your workers’ compensation claim can be denied in Florida. In this blog, we will examine what happens if your claim gets denied.
Common Causes of Denial
A claim denial is frustrating and stressful. If you received a letter of denial, you might wonder why your claim was denied. Insurance companies or employers can find any possible reason to deny a worker’s compensation payout. However, the reason for denial has to be valid under Florida law. The most common reasons for denial include:
- Missed deadline for reporting an injury or filing a claim.
- The claim was filed after you left the job.
- Dispute about whether the injury happened due to a workplace incident.
- The injury or illness does not meet state guidelines.
- You did not follow the safety protocols outlined by the employer.
- Injury is a result of a pre-existing medical condition.
- Your job isn’t covered by workers’ compensation benefits.
Florida’s Rules for a Worker’s Compensation Claim
According to the laws in Florida, a worker has 30 days to report an injury to their employer. The employer must report the submitted claim to its insurance company within 7 days. Then it is up to the insurance company to determine whether to accept or deny the claim. The letter for the denial of your claim should include information about why your claim was denied but it might be challenging to understand the reason. This is one of the reasons why you must get a workers’ compensation attorney involved in the case as early as possible.
The insurance companies or employers have the right to choose the treating physician for the first 10 days after the injury. If the treatment is longer than that period, then the injured worker can choose a physician from the employer-approved panel. Florida states that the final hearing for a workers’ compensation case should be completed within 210 days after the receipt of a petition for benefits.
If workers’ compensation is denied, the claimant has the right to appeal the decision. The appeals process starts by filing a petition for benefits with the Florida Division of Administrative Hearing (DOAH). According to Florida law, the parties can enter into mediation before the case goes to trial. In some cases, going through the mediation process is often a requirement. A third party is chosen as a mediator to facilitate an agreement between the parties involved in the dispute.
If no agreement can be reached through mediation, then the appeal goes to a formal hearing, where a judge will review the case and render a verdict based on the workers’ compensation laws of Florida. If the worker is not satisfied with the decision by the court, they have to appeal to the District Court of Appeal, or in rare cases, to the Florida Supreme Court.
If you are considering filing an appeal for a denied workers’ compensation claim, consider consulting an attorney before taking this legal step. The appeals process can often be drawn out, leading to stress and frustration. Your lawyer can try to resolve the dispute with the insurance company or the employer without needing to go to court.
Consult with an Experienced Workers’ Compensation Attorney
If your claim is denied, one of the first things you need to do is to determine the reason for the denial. If the claim was denied due to a simple mistake, then you can get the issue fixed by consulting a workers’ compensation lawyer as soon as possible. If the reason for the denial is more complex, you may need to hire an attorney to review your case in detail and recommend the best course of legal action.
Keep in mind that the timeline for workers’ compensation appeals is strict and short, so you must ensure you file on time or you may lose your right to appeal. A skilled and experienced workers’ compensation attorney can help you with all legal aspects of the case. This includes mediation and negotiation with the opposing party, formal hearing representation, and ensuring prompt action so you don’t miss any deadlines. Workers’ compensation lawyers can also guide you on what benefits you are eligible for based on your coverage. 1-800-Injured is an attorney and medical referral service.