What Happens When My Workers’ Compensation Claim Is Denied?

Most employers in Florida carry workers’ compensation coverage, so that if any of their employees are injured on the job, the employee can immediately seek medical coverage without having to worry about paying for it. However, sometimes the employer’s workers’ compensation carrier refuses to cover the injury – if this happens to you, it is usually in your best interests to try and consult a workers’ compensation attorney, so you clearly understand your options going forward.

Not All Claims Are Approved

Most of the time, when an employee is injured at work, they inform their employer of what has happened, who in turn informs their workers’ compensation insurer. The insurer then consents to cover the medical bills incurred by the injured employee. However, insurers can and do decline to do this, for a variety of reasons. Statistics from the Florida Department of Financial Services (FLDFS) show that in 2020 so far, as many as 25,000 claims did not end with the claimant receiving benefits.

That said, if you have been evaluated and sufficient medical evidence exists to warrant you receiving benefits, you do have options to try and get a reconsideration. Be advised that there is a statute of limitations on filing an appeal; generally the time frame is two years from the date of your accident. The rationale behind such a relatively short time frame is that any longer would lead to badly eroded memories, as well as to the possibility that injured employees might sustain other bodily harms that would be too hard to separate from the damage caused on the job.

The OJCC

In order to have your case reevaluated, you will need to submit what is called a Petition for Benefits to the Florida Workers’ Compensation Office. This will assign a judge from the Office of the Judges of Compensation Claims (OJCC) to your case. That said, the judge will generally urge you and your employer to try mediation or other forms of alternative dispute resolution first, so as to potentially avoid adding to the already-busy docket of the OJCC. Only if mediation is unsuccessful will you have a trial-type hearing before the judge.

During an OJCC hearing, you will present your case information to the judge and try to arrive at a workable settlement arrangement. If you fail to agree, and the judge issues an unfavorable ruling, the next step is to file in the First District Court of Appeal (it must be the First District, regardless of where you reside). This is the last chance to prevail on your workers’ compensation claim, and the standard of proof in order to do so is high – but not impossible.

Call An Orlando Workers’ Compensation Attorney

Being hurt at work can lead to a host of problems in your life – physical, emotional, and financial. Workers’ compensation can be a saving grace, if you are able to receive it. The Orlando workers’ compensation attorneys at the Hornsby Law Group can help make certain that you have the best chance to succeed in seeking the benefits you are due. Contact our offices today to speak to an attorney.

Resource:

floridabar.org/the-florida-bar-journal/a-primer-on-workers-compensation-appeals/

ecure.fldfs.com/wcapps/claims_research/Stats_Results.asp

https://www.hornsbylawgroup.com/business-trip-injuries-can-be-compensable/