If you have been injured at work in Florida and your workers’ compensation claim has been denied by the employer or carrier, you have a right to appeal the decision. A successful appeal can get you the medical benefits and wage reimbursement you deserve. However, it is important to understand the reasons your claim was denied and how to overcome the deficiencies in your case.
Workers’ compensation claims in Florida can be denied for various reasons, ranging from mistakes in the filing process to the employee’s failure to meet specific requirements. Common reasons for denial include the following:
- Failure to report the injury on time — In Florida, employees must report all job-related injuries or illnesses to their employer within 30 days of the incident or of the diagnosis.
- Lack of sufficient evidence — At a minimum, you must have supporting medical evidence that you were injured or became ill on the job and that it impaired your ability to work.
- Pre-existing conditions — Your claim may be denied if it is found to be related to a pre-existing condition that was not caused or worsened by a workplace accident or illness.
- Non-work-related injury — The insurance carrier could find that your injury or illness was suffered while you were engaged in activities that were not part of your job description.
- Improper filing process — Filing deadlines and procedures for submitting a workers’ compensation claim are specified by state statute and failure to follow them can result in a denied claim.
- Unrevealing medical diagnosis — An independent medical examination might not support your claim of partial or total disability.
- Faulty paperwork — Errors and omissions in the documentation of your claim can lead to denial.
A workers’ compensation attorney can be invaluable in your appeal of a denied claim. If you receive a notice of denial, your attorney can analyze the stated reasons. The attorney can meet with the employer’s insurance company representatives to gain information about what may be needed to overcome the denial. If no solution can be negotiated, your attorney can submit a petition to the Office of the Judges of Compensation Claims (OJCC), which hears and decides appeals.
Most appeals are decided through mediation by a neutral third-party, with your attorney appearing in your behalf. If no resolution is reached, a workers’ compensation judge will hold a factfinding hearing and consider evidence and arguments. If the judge denies your claim, your attorney can seek review from the 1st District Court of Appeal.
Vassallo, Bilotta & Davis specializes in helping injured workers obtain the workers’ compensation they are entitled to under Florida law. Please call 561-471-2800 or contact us online to schedule a free consultation at our Stuart and West Palm Beach offices.
