What Do I Do If My Florida Workers’ Comp Claim is Denied?

For many of us, our jobs are our lives. It is not only to gain income, but a job gives us personal satisfaction, intellectual stimulation, and a sense of accomplishment. We often identify ourselves by the jobs we do. 

Thus, when something bad happens to us at work, it can be very frightening indeed to lose that stable sense of employment. The fear only intensifies because, if we are injured on the job, we also must deal with medical matters, doctor’s visits, and perhaps rehabilitation. 

Finally, the worst cut of all is if we are injured at work, and our employer denies a valid workers’ compensation claim, leaving us on our own for medical expenses. Such a denial of a workers’ compensation claim can add a whole new level to the stress and frustration that we already feel. Having an advocate in our corner at that point is vital to helping us through the workers’ compensation maze.

Florida workers’ compensation attorneys in Jacksonville , such as those at RITE Law can be in your corner. Our attorneys at RITE Law have years of experience with the Florida Workers’ Compensation Act. So, if you have additional questions pertaining to your own personal circumstances after reviewing this article, then we invite you to contact the Florida workers’ compensation attorneys in Jacksonville at RITE Law. Our number is (904) 500-RITE or you can fill out our contact form online. Remember, we provide a free case evaluation , so call today.

In this article, we are going to discuss what you need to do if your claim under the Florida Workers’ Compensation law was denied. 

Step #1 – Find Out the Reason for Denial

You are likely entitled to workers’ compensation benefits if you have been injured at work in Florida. Your employer’s insurance company, however, may have denied benefits or will only pay partial benefits in response to your claim. If that occurs, then you first need to know why your claim was denied. 

Normally, you will receive a written notice from your employer’s insurance company as to the reasons for the denial. Review that notice closely. There can actually be many reasons why a claim is denied. Here are just a few:

1. Technical Error. It is more common than you think that the denial has nothing to do with your valid injuries. Instead, it is because you missed a deadline or improperly filled out a form for your claim. In Florida, workers have 30 days within which to report the accident. If you miss that window, it is very possible that your claim will be denied. 

2. Not During Working Hours. Employers often claim that the injury is not work-related, i.e., you were “off the clock” when the injury occurred. For example, injuries resulting from horseplay or practical jokes at work may be viewed by your employer’s insurance company as non-work-related activities. Also, injuries that occur when traveling to and from work are not covered by workers’ compensation in Florida. Yet, if your travel is part of your job duties, then any injury will likely be covered. An experienced Florida workers’ compensation attorney in Jacksonville will help a great deal when faced with a benefits denial, such as an outside-of-work denial.

3. The seriousness of Injury or Pre-Existing Condition. Another reason an employer’s insurance company will deny benefits is if there is something indicating that there is no injury, or that it is not severe. A medical evaluation is generally necessary to demonstrate your eligibility for workers’ compensation benefits. More frequently, your employer’s insurance company may deny a claim because the company will claim, it is a pre-existing condition, unrelated to the work accident. Workers’ compensation benefits may still be provided at least partially, however, if a work accident aggravates a pre-existing condition. 

4. Failure to See a Doctor-Approved by the Insurer . Once you report a work-related accident, your employer will provide you with a list of approved medical providers for treatment. If you do not go to any of the providers on the list, that may result in a denial of benefits. By the same token, if you do not obtain medical treatment at all, then you are likely to get a claim denied. Having a medical professional note your injuries is typically the starting point to proving your eligibility for benefits.

Step #2 – An Appeal

After receiving a denial, your next move is to appeal that denial. Retaining a seasoned Florida workers’ compensation attorney in Jacksonville can help you with your appeal. In fact, a short attempt to seek a settlement, with the help of your attorney might be worth it in the early stages. Your attorney can be crucial in negotiating on your behalf. 

If negotiations are unsuccessful, then you need to file what is called a Petition for Benefits. That Petition will trigger the Florida Workers’ Compensation Office to have a judge assigned to your case. At that point, the judge will direct you to try to mediate the case first. 

If mediation does not resolve your case, then you will have a trial-like hearing before the Office of the Judges of Compensation Claims. Following that hearing, the judge will make a decision on benefits. The next step is to appeal that decision to the First District Court of Appeals in Florida. 

Get Help for Your Claim from Florida Workers’ Compensation Attorneys in Jacksonville

Our RITE Law attorneys focus on a workers’ compensation practice. That experience can be invaluable if you appeal under the Florida Workers’ Compensation Act, particularly during this time of COVID-19. At RITE Law, we started the firm for one reason – to help those in Florida and elsewhere have the resources of a firm that was “big enough to fight but small enough to care.” At Rudolph, Israel, Tucker & Ellis (RITE law), we have the resources and experience to go to trial when it is necessary, and we have the wisdom to advise you appropriately. 

Without help from the RITE Law, Florida Workers’ Compensation claims can be very difficult. When you turn to our firm, we spring into action, making sure that every detail of your claim is addressed. Call us for help. Our number is (904) 500-RITE or you can fill out our contact form online. We provide a free case evaluation , so feel free to call us today.