On average across the United States, more than 7% of all workers’ comp claims are denied at the initial application phase. That number varies by state. In Florida, it is believed to be above 10%. The good news is that an initial denial is not an end to your claim. More than 67% of all claims that are initially denied are ultimately approved within a year of the initial denial.
Our Florida work injury lawyers at Berlin Law Firm represent workers of all fields who are seeking their rightful workers’ compensation benefits after they have suffered on-the-job injuries.
We have over 30 years of experience handling workers’ compensation appeals, and our team has managed the legal department of workers’ comp insurance carriers. We understand their tactics and are highly knowledgeable when preparing appeals to the denial of a workers’ comp claim. We proudly pursue each client’s case through to its optimal conclusion.
How Do You Verify That You Qualify for Workers’ Comp Benefits in Florida?
Whether you are denied workers’ compensation for one of the reasons listed here or another excuse the insurance carrier gave you, wait before you respond. It’s important to verify that you qualify for the benefits you are claiming.
To do this, consider the following questions as they apply to your claim:
- Is the medical evidence of your injury consistent with your petition for benefits? If you are unsure of what your medical evidence shows, consult with a Florida workers’ compensation lawyer who can analyze your evidence and compare it to your petition.
- Did your injury happen while you were performing work-related services for your employer? For example, if you slipped and fell while walking to your workplace, your employer’s insurer might argue that your injury did not happen at work, even if you fell on your employer’s property.
- You made mistakes, or there are inconsistent witness statements in your benefits petition. Again, an experienced work injury lawyer is your best resource to confirm that your petition is error-free and internally consistent.
This and other information will be critical when you challenge or appeal a denied workers’ compensation claim. The claims adjusters and attorneys who work for insurance companies often reject workers’ compensation claims for what may seem like minor or inconsequential reasons. A knowledgeable Florida workers’ compensation attorney is your best resource to challenge the reasons for the denial and get you the largest benefits award that may be available.
What Can You Do if Your Workers Comp Claim is Denied?
A worker might be tempted to simply give up rather than appeal when a workers’ comp claim is denied because they think there’s little chance that the decision could be overturned. However, many claims that are denied at first are later approved and paid out. A claim denial is frustrating and stressful, but it isn’t the end of the story. The appeals process is in place to make sure that legitimate claims are recognized.
Workers’ compensation benefits can be substantial and can include:
- Replacement of a portion of lost wages
- Prescription drug reimbursement
- Costs and expenses associated with medical and rehabilitation services, such as surgery to correct injuries and occupational therapy.
The average workers’ compensation settlement is in excess of $20,000. Workers who suffer multiple job-related injuries might be able to recover three to four times that amount.
Rather than forfeiting this compensation when your claim is denied, the best course of action is almost always to retain an experienced workers’ comp lawyer who can file an appeal on your behalf.
Why Your Workers Comp Claim May Be Denied
Your employer’s worker’s comp insurance premiums will increase in response to successful claims from injured employees. This incentivizes your employer to deny a claim if there is a legitimate reason under Florida law to do so.
In Florida, your employer and its insurance carrier can, and likely will reject your workers’ compensation benefits petition if:
- The evidence suggests you were under the influence of drugs or alcohol when you sustained injuries in a work-related accident. Or a belief that your injuries were in part due to your intentional neglect, or that those injuries happened apart from your performance of job-related duties
- You did not promptly notify your employer about the injury, or you missed doctors’ appointments or other important deadlines that you had to meet to substantiate your claim. (e.g., you did not notify your employer within 30 days after the injury
- Your employer suspects that you got hurt while you were not at work. Your injuries are due to a pre-existing medical condition
- You did not take prescribed medications or follow through with therapy or other recommendations from the approved workers’ comp physician. Alternatively, you are seeking out-of-network medical care or services that are not allowed or covered by your employer’s workers’ comp insurance
- Your employer uncovered evidence of your activities away from your job contradicting the activity limitations you claimed in your workers’ compensation petition, e.g. your employer has pictures of you climbing a ladder and working around your house when you claimed a leg injury that limited your mobility.
- Other legal or insurance company challenges that are specific to the facts of your claim
When you are faced with a denial, call a Florida work injury attorney for an explanation of your next steps to challenge that denial and get the benefits you deserve.
What Are the Rules in Florida for Filing a Workers’ Comp Appeal?
Under Florida law, a worker has 30 days to report an injury to your employer. Once that happens, the employer MUST report your claim to its insurance company within 7 days. Then, it is in the hands of the insurance company to decide whether they wish to accept your claim.
If your claim is denied you can appeal that decision. However, it is essential that you begin the process immediately after you receive a notice that your claim has been denied, which can be done by:
- Getting professional legal help right away
- Focusing on the reasons for the denial as stated in the denial notice
- Scheduling a meeting with your employer and the employer’s workers’ comp insurance company to attempt to resolve the denial short of filing a formal appeal
- Preparing a Petition for Benefits with full details of your job-related accident, your injuries, your lost wages and medical expenses, and a statement of the benefits you are requesting
- Planning for mediation and hearings associated with your appeal
What Options Do You Have if Your Appeal Does Not Work?
Your appeal to the denial of your workers’ comp claim will proceed through administrative channels before an administrative law judge. That process is relatively quick (the Florida statute indicates that it must be completed within 210 days). During that time, your workers’ comp lawyer will negotiate on your behalf and attend mediation sessions to advocate for your benefits. If the administrative judge issues a final order denying your petition and appeal, you will then have 30 days to file a formal legal appeal in a District Court. This legal appeal, presuming no appeal, usually is concluded within 3-6 months.
Call Berlin Law Firm in Tampa or Sarasota
The workers’ compensation lawyers at Berlin Law Firm offer free consultations to Florida workers who are seeking their just benefits after they suffered on-the-job injuries.
Please call our offices in Tampa or Sarasota to speak directly with an attorney as soon as possible after you receive a notice of a denial of your workers’ compensation claim. We will review your claim and outline the necessary steps to get the benefits you deserve.
Related Information
- What to do if your employer fails to report a work injury
- What happens to medical bills if workers’ comp is denied?
- Why choose Berlin Law Firm to handle your claim
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