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What is the Administrative Review Process and How Will it Affect My Claim?

Some people assume that once their workers compensation claim is denied, they have no choice but to walk away. They pray that their primary health insurance will take care of their medical treatment. They may find another job or continue to work through the pain. They may not realize that there are workers comp lawyers in Coral Springs who can help them. While this administrative review process can take a long time, it’s worth it if you feel that you have a valid claim.

Here, we will discuss the stages of the workers compensation administrative review process. We’ll also explain what each stage means as far as your claim is concerned. If you still have questions regarding your workers comp case, feel free to contact our office and speak with one of our Coral Springs, Florida personal injury lawyers.

You Have Several Options if Your Workers Comp Claim is Denied

If your workers compensation claim is denied, the first thing you should do is retain a workers compensation lawyer in Coral Springs to help you with the administrative review process. You only have 120 days from the date of your injury to file this initial appeal. If your attorney doesn’t file the petition within that timeframe, there’s a good chance that your claim will not only be denied, but it can be closed as well. 

Rather than risk this happening, you can hire an experienced attorney who’s familiar with the process who will do everything in their power to get your claim approved.

Your Workers Compensation Lawyer in Coral Springs Can File an Initial Appeal

The first thing you and your attorney can do is reach out to the Employee Assistance Office. They’ll try to negotiate payment with the insurance company on your behalf. This rarely works. If the insurance company continues to deny your claim, your Coral Springs, Florida personal injury lawyer can file an appeal. This appeal will be filed with the Offices of Judges of Compensation Claims in Florida. 

Once your petition is filed, both sides will be given the chance to make their case. Your workers compensation lawyer in Coral Springs will have the chance to submit evidence in support of your claim. Similarly, the insurance company will have a chance to submit their own evidence for the administrative review process. 

The administrative judge will review the information provided and make their final decision. It’s important to remember that every time you move to the next stage in this administrative review process, it takes time. Several months can go by between each hearing or appeal. At a certain point, it makes sense for both sides to consider a settlement. 

If Your Claim is Still Denied, You Will Attend Mediation Next

By this stage, most cases have either been resolved or closed. Every now and then, we encounter a client whose claim simply has no merit. It may take our workers compensation lawyer in Coral Springs some time to realize this. If they no longer think your case has a chance of being approved, they can ask to withdraw from your case. 

If, however, they truly believe that your claim for benefits should be approved, they can always move forward through the administrative review process and attend mediation with the other party.

workers comp lawyers in Coral Springs

At mediation, an independent party will meet with both your Coral Springs, Florida personal injury lawyer and the attorney for the insurance company to discuss the claim. They will listen to both sides and try to hash out a settlement, as part of the administrative review process.

The person who oversees your mediation and administrative review process is usually a retired attorney or workers compensation judge. They know what will likely happen if your case goes to the final appeals stage. They’ll express their opinion to both parties in the hopes of convincing them that it’s in both of their best interests to settle. If this doesn’t work, then you’ll have no choice but to move forward with a final appeal.

If your case is still not resolved, you can ask the Offices of Judges of Compensation Claims to hold one final hearing in your administrative review process. This will be your last chance to resolve the matter before it goes to trial with the district court. 

Your Coral Springs, Florida Personal Injury Lawyer Can Request a Final Hearing

As a last resort, your workers compensation lawyer in Coral Springs can petition for a final appeal. This final appeal is handled by the 1st District Court of Appeals. Your attorney and your employer’s attorney will each have a chance to submit a written argument in favor of their client. The judge will make their decision based on the papers. You will not attend a final hearing. 

Once this decision is made with your administrative review process, there are no options left for either party. If the appellate judge orders the insurance company to pay your claim, you’ll be entitled to retroactive pay. Whatever benefits you would have received from the initial date of injury will have to be paid to you, with interest. 

A Workers Comp Lawyer in Coral Springs Can Help With the Administrative Review Process

If your workers compensation claim in Florida has been denied, you do have options. You can file an appeal with the Offices of Judges of Compensation Claims. If this doesn’t work, ultimately, your workers compensation lawyer in Coral Springs can file an appeal with the First District Court of appeal in Florida. This is a last resort, and most cases are settled long before it gets to this point. If you and your attorney truly believe you have a valid claim, you have the option of working through all the administrative review process and appeals available to you.

We suggest you contact our office and speak with a Coral Springs, Florida personal injury lawyer as soon as possible. Once your claim has been denied, you only have a certain amount of time to file your appeal. If you miss this deadline or don’t file your appeal properly, your claim will be denied and dismissed. This is why we recommend that you meet with one of our attorneys and take advantage of your free, initial consultation.

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