Anyone is in danger of sustaining a serious work injury regardless of the job field they are in. Fortunately, Florida state law mandates that employers with four or more workers must provide workers’ compensation benefits to injured employees. Sadly, this isn’t always the case as employers and their insurers often delay, reject, or offer significantly less on the amount payable. This subsequently results in workers’ compensation disputes in Miami, FL.
If you have had your claim denied, and you believe the underlying reasons were unmerited, the Miami workers’ compensation lawyers at Work Injury Rights can help you get your rightful compensation for injuries suffered. Our skilled attorneys will investigate your case, acquire pertinent evidence regarding your workers’ comp case and guide you through the appeals process. Our devoted attorneys will stop at nothing to ensure you recover your deserved compensation benefits.
Give us a call TODAY at 954-833-5226 to receive a FREE, no-obligation case assessment.
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Causes of Workers’ Compensation Disputes
There is a myriad of reasons why your workers’ comp claim may get rejected. Knowing the exact cause can assist you to determine the next course of action and if your claim is valid. The insurance carrier should send you a ‘Denial of Claim’ letter detailing the reasons your claim was refused.
Here are some of the reasons your employer and their insurer may use as the basis:
- You are not an employee.
- The injury happened outside the scope of employment.
- Your injury was not caused by a work accident.
- You missed the deadline to report your injury and file a claim.
- You did not provide adequate information on the application.
What to Do if Your Workers’ Comp Claim Is Denied in Florida
Your employer and their insurer don’t have the final word after denying your claim. You can appeal the decision made along with other consequent denials. Here’s what you can do:
Request Hearing Before the Industrial Commission
If your claim has been rejected for whatsoever reason, you’ll have to put forward a Petition for Benefits claim within 2 years following the accident with the DWC in Florida, from where a judge will be allotted your case. The judge will typically propose that the case be settled using other dispute resolution avenues like mediation.
In the event the case can’t be settled using mediation, you can push for a hearing with the Office of the Judges of Compensation Claims (OJCC). The judge will issue a decision on the compensation benefits and deliver a verdict within 30 days following the proceedings. If the ruling is unsatisfactory, you can make a petition with Florida’s First District Court of Appeal within 30 days of the judge’s ruling.
Contact an Attorney
Upon receiving notice that your workers’ comp claim has been declined, the next logical step to take is contacting a professional attorney. We at Work Injury Rights will enter into negotiations with the insurance carrier on your stead and facilitate a satisfactory settlement for you.
Types of Workers’ Compensation Disputes in Miami
Here are some of the workers’ comp disputes our experienced Work Injury Rights lawyers in Miami, FL handle:
Following a work injury, your employer’s insurance plan should cater to all your medical expenses. However, there are instances when your employer and their insurer may decline to pay on medical grounds. Your employer may claim that you already had a pre-existing condition, had sustained the injury before the said incident, other factors caused your occupational illness or the injuries suffered were self-inflicted.
Claim disputes come about when your employer and their insurer reject your claim on the basis that you didn’t adhere to the procedures and rules of Florida’s workers’ comp claims. For example, the insurer may say that you missed the deadline for submitting your claim or that your injury didn’t occur in the course of fulfilling your work duties, and so forth.
Workers’ Compensation Dispute and Appeals Process in Florida
Once your claim has been declined, the first thing you should do is talk to your employer and their insurer. If there was a clerical mistake, it can be sorted out without the court needing to interfere.
The next action to take when putting forward a dispute is to reach out to the Employer Assistance and Ombudsman Office. They will contact the insurance carrier to learn whether there’s a cordial method to solve the workers’ comp dispute.
If it doesn’t succeed, our Work Injury Rights attorneys in Miami, FL will assist you to put forth a Petition for Benefits within 2 years following the work-related accident. Our attorneys will file this form with the OJCC. The OJCC will proceed to inform your employer and their insurer, who are obliged to make a response to the petition within 2 weeks or else payout your benefits.
The next phase is mediation. These negotiations will be held with an unbiased third-party present who can be a prior judge or another workers’ comp attorney. We at Work Injury Rights will be on your side during this unofficial meeting.
If negotiation breakdown, the case will proceed to a pre-trial hearing. A judge will listen to both sides’ arguments and make a verdict on your case. The final hearing will be convened within 90 days. When the judge has listened to the closing statements, they’ll provide a ruling within 30 days.
If the judge’s decision is unsatisfactory, you can submit an appeal to the First District Court of Appeals. The time limit for this is 30 days. Here, the OJCC’s decision may be overturned, agreed with, or sent back for further debate.
We at Work Injury Rights are conversant with these legal proceedings and can assist you with your workers’ compensation dispute and the appeals process.
Contact Us Today to Review Your Miami Workers’ Compensation Dispute
A business and its insurance provider may challenge the employee’s entitlement for coverage or contest the magnitude of injuries suffered. If you happen to find yourself facing this type of situation, you should consider enlisting the services of a professional workers’ comp dispute lawyer.
Our committed workers’ comp attorneys at Work Injury Rights have helped thousands of injured workers in Miami, FL receive the benefits they’re entitled to. We will conduct an independent investigation into the cause of injury, review the insurance carrier’s underlying reasons for declining your claim and fight for the highest compensable amount possible.
Get in touch with us at 954-833-5226 so we can look through your workers’ compensation case.