What Should I Do if My Workers’ Comp Claim is Denied?

The last thing you may expect when you arrive for your shift at work is to sustain an injury that leaves you with astronomical medical bills and out of work to heal. However, discovering that your workers’ compensation claim has been denied can make these matters even worse. As such, if you have sustained an injury at work and your claim is disputed by your employer or denied by the insurance company, understanding how to proceed is critical. The following blog explores what you should know about these difficult matters, as well as the importance of working with an experienced Florida workers’ compensation attorney to discuss your legal options.

What Are the Reasons a Workers’ Comp Claim Is Denied?

Unfortunately, there are quite a few reasons that someone’s workers’ compensation claim may be denied. In general, the most common reason is because of procedural errors. This includes failing to report the injury in a timely manner (which, in Florida, is 30 days from the date on which the injury occurred) or failure to correctly complete the necessary paperwork. Similarly, if you fail to attend doctor’s appointments or do not see a provider approved by the insurance company, your claim may be denied as a result.

However, you’ll also find that your claim may be denied if your employer has evidence to show that your injury did not happen at work, such as footage of when the incident allegedly occurred, or they have proof that the injuries you’ve sustained were not as serious as you initially claimed. For example, if your doctor limits you to lifting no more than ten pounds, but your employer sees you at the supermarket carrying a fifty-pound bag of dog food with ease, they can dispute your claim.

Finally, your claim can be disputed if you were under the influence of drugs or alcohol, the accident happened while you were off the clock, or the injury occurred while you were engaged in horseplay or a physical altercation with another employee.

Can I Appeal a Claim Denial?

In the event your workers’ compensation claim is denied by your insurance company or disputed by your employer, it’s important to understand that you have legal options. Generally, the first step you should take if your claim is denied is to carefully review the information sent to you, as this will detail the reason behind the denial. This is critical to ensure you can take the necessary steps when appealing.

Next, you should connect with an experienced attorney as soon as possible, as they can assist you in gathering supplementary evidence to help prove your claim while aiding you in the process of appealing. Generally, this includes filing a formal appeal with your employer’s workers’ compensation insurer and submitting a petition for benefits with the Office of the Judges of Compensation Claims. If the insurance company still refuses to overturn the appeal, you’ll find that generally, you are eligible to elevate this matter to a hearing in front of a judge.

Unfortunately, the process of appealing a denied workers’ compensation claim can be incredibly difficult to navigate. That is why it’s in your best interest to discuss your circumstances with an experienced attorney at the Law Firm of Kevin A. Moore. Our team understands how difficult this process can be, which is why we will do everything in our power to help you recover the justice you deserve. Contact us today to learn how we can fight for you.