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 in Florida?

Workers’ compensation claims may be denied as a result of procedural, medical, or factual errors. In many instances, you’ll find a denial occurs because the insurance company denies that the injury occurred at work, challenges the severity of the injuries, or claims that reporting procedures were not filed.

Common 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 procedural errors. Examples include:

• Failure to report the injury within Florida’s required reporting deadline
• Failure to complete paperwork correctly
• Missed medical appointments
• Failure to adhere to the medical advice
• Seeking treatment from an unauthorized provider
• Delays in medical care

Employer and Insurance Company Disputes

You’ll also find that claims may be denied if the employer or insurance carrier disputes:

• Whether the accident occurred during work-related duties
• If the employee can still perform work duties
• If the injury occurred while the employee was off the clock
• The severity of the injuries
• If the injury was pre-existing

Situations That May Disqualify a Workers’ Compensation Claim

• The employee was under the influence of drugs or alcohol
• The accident occurred during roughhousing or horseplay
• The accident happened during a physical altercation
• The worker intentionally caused the injury
• The employee substantially deviated from work duties

What Should You Do Immediately After a Workers’ Compensation Claim Denial?

If you receive notice that your workers’ compensation claim has been denied, you may be overwhelmed, especially when your medical bills pile up, and you cannot work because of your injuries. However, taking immediate action can help shield your right to seek benefits.

Steps After a Claim Denial

• Carefully review the denial notice
• Gather medical records in relation to your accident reports
• Document communications with the insurance companies
• Avoid posting about your injuries on social media
• Continue following the treatment recommendations of your authorized provider

Why Reviewing the Denial Letter Matters

The denial letter will explain:

• Why the claim was rejected
• If any additional information is necessary
• What deadlines apply
• If any legal options are available

Can I Appeal a Denied Workers’ Compensation Claim in Florida?

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.

The Workers’ Compensation Appeals Process

• File a formal appeal
• Submit additional medical documentation
• File a Petition for Benefits
• Negotiate with the insurer
• Attend scheduled mediation sessions
• Appear before a Judge of Compensation Claims

Workers throughout Florida, including employees in Tampa, Orlando, and Miami who work in warehouses, hospitals, hotels, and construction sites, may face denied claims. Insurers commonly challenge claims for repetitive stress injuries, lifting accidents, and pre-existing conditions.

Evidence That May Help Strengthen an Appeal

• Medical evaluations
• Imaging results (x-rays, CT scans, MRIs)
• Workplace incident reports
• Surveillance footage
• Employment records
• Expert witness testimony

What Happens if the Insurance Company Still Refuses the Claim?

If the insurance company refuses to overturn their denial decision, you can appeal the matter to a Judge of Compensation Claims. If this occurs, a hearing will be scheduled where:

• Both sides can present evidence
• Witnesses may provide testimony
• Medical documentation will be reviewed
• The judge will determine if benefits should be paid

Contact an Experienced Florida Workers’ Compensation Firm Today

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.