Appealing A Florida Workers’ Compensation Denial

Work injuries are a fact of life for many Florida workers, particularly those employed in dangerous industries. When an injury happens, though, many rest easy because they have workers’ compensation coverage, which will cover their medical bills while they recover. If an injured worker’s claim is denied, however, it can be catastrophic, particularly if they are the family breadwinner. Thankfully, a denied claim can be appealed.

Why Deny?

There are many different reasons why a person’s claim might be denied. Some are merely clerical, while other times, a person’s injury may not qualify them for workers’ compensation benefits. Some of the most common include:

• Missed deadlines. A Florida worker only has 30 days from the date of the injury or diagnosis in which to file a workers’ compensation claims;
• The injury is deemed to be their own fault, which makes it non-compensable;
• The injury is deemed to not have happened at work; and/or
• The worker does not seek medical care for their injury, meaning there is no medical data attached to the claim.

There is a specific process an injured worker must follow in order to have a chance at being granted benefits on appeal, but in addition, they must be able to overcome the reason for the initial denial. For example, if they did seek medical care but failed to attach the relevant records, this eliminates the original reason for denial.

Mediation First?

If you want to appeal a denial, your first stop should not be to file suit, but to discuss the matter with your employer and/or their insurer. It may be that you will resolve the dispute without needing to resort to the legal system – but if you do not, the first step is to file a Petition for Benefits with the Office of the Judges of Compensation Claims (OJCC). The OJCC will essentially facilitate mediation between an injured worker and their employer, hoping to work out a settlement.

Florida law allows up to 2 years in which to file a Petition, but it is crucial to move as quickly as possible in order to get benefits more quickly if you prevail. The majority of workers’ compensation appeals are settled by the OJCC, via mediation, but if you are turned down again, you will receive a formal hearing in front of the judge. This must occur within 90 days, with a ruling available within another 30.

Call An Orlando Workers’ Compensation Appeals Attorney

Most of the time, a workers’ compensation claim made in good faith is approved with little fanfare – but sometimes, the information provided will not be enough. If you have been denied workers’ compensation benefits, an Orlando workers’ compensation appeals attorney from the Hornsby Law Group may be able to help you get the coverage you deserve. Call our office today to schedule a consultation.

Source:

leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.185.html