- Workers' Compensation
If your workers compensation claim was denied, the St. Petersburg, Florida Workers Compensation Disputes Lawyers at WorkInjuryRights can help.
Any employee injured in Florida while at work might be eligible to claim for workers compensation benefits to cover for injuries and/or work-related illnesses. If the claim is approved, you will receive compensation to pay for the medical care and part of the wages you lost while you were unable to work.
However, many employers and insurers dispute valid claims to protect their profits, leaving workers struggling to make ends meet and pay for medical treatment.
At WorkInjuryRights, our St. Petersburg attorneys have handled denied workers compensation claims for decades now. Our team of Workers compensation disputes lawyers have represented workers whose claims were denied for one reason or another, and successfully appealed cases in higher courts.
Call 954-833-5226 today if you have any questions about how we can help and speak with an attorney about your claim.
Causes of Workers Compensation Disputes
Employment status
One common workers compensation dispute that could arise for an employee who was injured is when their employer asserts that the worker was actually an independent contractor and the worker claims otherwise. Worker misclassification is a major problem that could easily cause problems.
Understanding the laws for independent contractors and how to handle the issue might be the difference in being approved for benefits.
Outside Scope of Employment
Another reason your employer or their insurer may deny your claim is if there’s an issue about whether the injury is related to your scope of work. Workers comp only covers injuries or illnesses that occur in the course of your employment. Any injuries that occur while on a lunch break or off the clock don’t qualify.
Lack of Causation
You are not eligible for workers comp benefits if you engaged in some actions that contributed to the accident. For instance, if you were high or drunk at the time of the accident, the insurance company might deny the claim as your intoxicated state might have prevented you from avoiding the accident.
Missed deadlines
Florida law requires that you give your employer a written notification of your work-related illness or injury within 30 days. If you miss the deadline, you might not get the much-needed benefits to cover your medical expenses.
Keep in mind that failing to report your injury within 30 days doesn’t necessarily prohibit you from receiving benefits. But you shouldn’t take any chances. It’s always best to act fast.
Inadequate information
Your employer might claim that the accident did not occur the way you claim it did. They might say there are gaps or discrepancies in your story, or even try blaming your injuries on pre-existing conditions.
This is especially true if witness statements are inconsistent, there are missing medical records, or if you went to a physician they don’t yet approve of
Your best bet is only discussing the details of your accident only with people that are actually involved in the claims process. By telling your version of the story to different coworkers, they might start comparing stories, leading to misunderstandings and inconsistencies.
Let your St. Petersburg workers compensation lawyer speak for you and handle any interactions with your employer and the insurance company.
What To Do If Your Workers Comp Claim Is Denied In Florida?
Your employer and their insurer don’t have the final word. You can appeal their decision and even any subsequent denials. Here are some of your options:
Request a Hearing Before the Industrial Commission
In case your claim was denied for whatever reason, you might have to file a Petition for Benefits claim within 2 years after the accident. A judge will be allocated to your case in due time. They will most likely propose the case be handled using mediation or other workers compensation dispute resolution avenues first.
If mediation is unsuccessful, you could push for a hearing at the Office of the Judges of Compensation Claims (OJCC). The judge typically issues a decision on the workers comp benefits and delivers their verdict within 30 days after the proceedings.
If you find the ruling unsatisfactory, you could file a petition with the state’s First District Court of Appeal within 30 days of the ruling.
Contact an Attorney
Once you receive a notice that your workers comp claim was denied, your best course of action is to contact a professional attorney. At WorkInjuryRights , a St. Petersburg workers compensation dispute attorney will enter into negotiations with your employer’s insurance carrier on your case and ensure that you end up with the benefits you need and deserve.
Types of Workers Compensation Disputes
Medical disputes
After suffering an injury during work, your employer’s insurance provider should cover all your medical expenses. However, your employer or their insurer might deny paying on medical grounds. This could be because they think you already had pre-existing conditions, had suffered the claimed injuries before the accident, and that other factors actually caused your occupational injuries or illness.
Claim disputes
These usually come about when your employer and their insurer reject your claim asserting that you failed to adhere to the rules and guidelines of Florida’s workers compensation laws. For instance, they might claim you missed the deadline for submitting your claim.
Workers Compensation Dispute and Appeals Process in Florida
If your claim was denied, you can appeal the decision through the following steps:
- File a petition with the Division of Administration hearings
- You will receive a conference date from the Judge of Compensation Claims
- You will then be required to attend the pretrial hearing where you need to present evidence of your injuries
- The next step is typically participating in Alternative Dispute Resolution (ADR), such as mediation, to try to agree with your employer
- The final hearing is held within 90 days of the mediation and no later than 210 days after filing for Petition for benefits.
If the matter is resolved voluntarily by both parties before the Final Hearing, then the parties will draft and sign a stipulation or agreement, which sets the agreed terms.
Let Us Help You Appeal Your Workers Compensation Case
You want to work with a knowledgeable attorney who understands Florida’s justice system, including the deadlines, procedure, and legal strategies when appealing a workers comp denial. At WorkInjuryRights, we provide expert legal advice and guidance to help you find a way during these trying times.
Our team can help you get the maximum compensation available for your case so that you can receive the support and care you need following a workplace injury or illness. Call WorkInjuryRights at 954-833-5226 now to schedule a consultation with a St. Petersburg, Florida Workers Compensation Disputes lawyer.
