In Florida, tens of thousands of work-related injuries and illnesses are reported each year. However, just a handful of those that suffer these injuries and illnesses receive the workers compensation benefits they deserve. If your workers compensation claim was denied, the Spring Hill, FL workers compensation disputes attorneys at WorkInjuryRights can help you file an appeal.
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Causes of Workers Compensation Disputes
The most common causes of workers compensation disputes in Spring Hill, FL are:
Employers may try to dispute your employment status by claiming that you were an independent contractor to avoid paying your workers compensation claim. A knowledgeable workers compensation lawyer, however, can file an appeal and present evidence proving that you are an employee under the law and therefore eligible to receive workers compensation benefits.
Outside Scope of Employment
Insurers can also deny workers compensation claims leading to disputes by claiming that the injury or illness isn’t work-related. Only injuries and ailments that occur in the course of employment are covered by workers compensation. However, unusual circumstances sometimes mean that an injury that would otherwise lead to a denied claim should be covered.
Lack of Causation
A workers compensation claim can also be disputed if your employer or their insurer does not see a causal connection between your workplace or work-related accident and the injuries you claim to have sustained. In such instances, it can be prudent to obtain another doctor’s assessment of your injuries to help clarify the relationship between your job and the injuries sustained.
Failure to file or report the claim on time is one of the most common reasons for workers compensation disputes. According to Florida law, a worker is required to report a work-related injury within no more than 30 days. Similarly, your employer is required to report the injury to their insurer within 7 days. Failure to meet these deadlines often results in claim denial and subsequent disputes.
Your workers compensation claim can also be rejected because it contains inadequate information, discrepancies, or lacks sufficient medical documentation of your workplace or work-related injury. An experienced lawyer can review the claim and help you obtain the full medical records required to support your claim.
Types of Workers Compensation Disputes
Here are the two most common types of workers compensation disputes in Spring Hill, FL:
Medical disputes involve medical facts and opinions related to the treatment of injured employees. The dispute’s outcome doesn’t just depend on hiring the right lawyer. It also depends on the willingness of the medical professional to fight for the injured workers treatment.
Examples of medical disputes include:
- Denied surgery
- Denied therapy
- Denied services
- Denied medical supplies
Claim disputes, on the other hand, arise from your employer and/or their insurer rejecting your claim on the basis that you failed to adhere to the rules and procedures of workers compensation claims in Florida. Examples of claim disputes include:
- Disability: Whether or not you suffered income loss due to work-related injuries.
- Extent of the Injury: Whether or not the work-related injuries include other parts of the body or your health.
- Compensability: Whether or not the work-related injuries meet the eligibility requirements for coverage.
- Average Weekly Wage: Disagreements on the amount of money the employee is eligible to receive while on workers compensation.
What to Do If Your Workers Compensation Claim is Denied in Florida?
If your workers compensation claim was denied in Florida, the first thing you should do is determine the reason why, which should be outlined in the denial letter. The letter also includes detailed instructions on how to file an appeal.
File a Petition for Benefits with the DWC
You are required to appeal the rejection by filing a Petition for Benefits with the Florida Department of Workers Compensation within 2 years of the injury. While this gives you enough time to prepare for the appeal, you should do it as early as possible.
Contact an Attorney
Appealing a denied workers compensation claim will be an uphill battle. You need to gather the right evidence and make a solid argument to win your case. That’s why you need to have an experienced workers compensation lawyer from Work Injury Rights representing you.
Workers Compensation Disputes and Appeals Process in Florida
Appealing a workers compensation claim denial in Florida includes the following steps:
- Petition: You file a Petition for workers compensation benefits with Florida’s Office of the Judges of Compensation Claims (OJCC), and copies provided to your employer and their insurance provider. You can expect to receive a response within 14 days.
- Mediation: If the workers compensation benefits are still denied, the OJCC will order the disputing parties to have an informal mediation meeting. The mediation should be held within 130 days of the filing of the petition.
- Pre-Trial Hearing: If mediation doesn’t lead to an acceptable agreement that potentially includes a schedule of payments or lump sum payment, a pre-trial hearing will be scheduled. At the hearing, evidence is exchanged and issues defined further.
- Final Hearing: The OJCC final hearing comes next, which is held within 90 days of mediation and no later than 210 days after the petition. Once evidence is presented, the judge will issue a decision within 30 days, either allowing or denying the benefits claim.
- District Court Appeal: The decision by the workers compensation judge is only final if both parties agree with it. Otherwise, you can file a Notice of Appeal with the First District Court of Appeals within 30 days. You will then argue the facts of a case in a written legal brief and the opposing side will respond.
- Workers Compensation Judge Decision: The decision by the District Court Judge will either affirm or reverse the decision by the OJCC. Alternatively, the case can be handed back to the OJCC and the process starts again.
Have Your Workers Compensation Benefits Been Denied in Spring Hill, FL? We Can Help!
If your workers compensation claim has been denied and you don’t know what you should do next, our Spring Hill, FL workers compensation disputes lawyers can help you appeal and get the benefits you deserve. Call us today at [Phone] to schedule your free, no-obligation consultation.