Why Was My Workers’ Compensation Claim Denied?

Being injured on the job is always a difficult thing, particularly if the injury is severe. Workers’ compensation benefits are intended to compensate you for the injury, but sometimes, those benefits are denied. Florida law allows an insurer to deny a claim for benefits for a variety of reasons, but also gives the injured employee the right to appeal. While each case is different, it can sometimes help to discuss yours with a knowledgeable attorney.

Many Reasons To Deny 

Even though workers’ compensation benefits are held up as the “exclusive remedy” for employees if they are injured on the job, this does not translate into benefits being paid in every case. There are several potential reasons that an insurer can use to legally deny benefits, with some of the most common being:

• Your claim lacked medical evidence. In order to receive benefits, an injured worker must establish that the injury was significant, and that it occurred on the job (though not necessarily on their employer’s premises). Failure to do either will result in a denial.
• You submitted your claim too late. In all but the rarest exceptional cases, an injured employee must provide notice of their injury and intent to file for benefits within 30 days of the accident. Failing to do this closes the proverbial window in which to file.
• Your injury did not occur within the scope of your employment. Florida law allows workers’ compensation benefits to be paid for injuries that occur in a very specific window during the work day. Injuries that happen, for example, while commuting, or on lunch, may not be eligible for benefits.

Steps After Denial 

If you have had a workers’ compensation claim denied in Florida, this does not mean all is forever lost. Depending on the reason for your denial, it may be possible to appeal the ruling, or to negotiate with your employer or their insurer. If negotiation is unsuccessful, you would then file what is known as a Petition for Benefits. The Petition being filed with the Florida Workers’ Compensation Office will result in a judge being assigned to your case.

Most of the time, the judge will attempt to mediate the dispute between you and your employer, but if this is unsuccessful, there will be a hearing at the Office of the Judges of Compensation Claims (OJCC). It is important to keep in mind that this is not a re-filing of your original claim; rather, it is a new presentation of the facts, and will be ruled on accordingly. The judge may grant your request for benefits, but if they do not, you may have a difficult choice to make.

Contact An Orlando Workers’ Compensation Attorney

If you have been injured on the job, you have the right to seek workers’ compensation benefits, but you are not guaranteed to receive them. An Orlando workers’ compensation attorney from the Hornsby Law Group can help guide you through the process of negotiation and appeal (if necessary). Contact our office today for a free consultation.

Source:

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