If you suffer an injury at work, it’s only fair that your employer takes care of you. After all, that’s why they have workers compensation insurance. However, there are times, usually when your injuries are serious, when they deny your claim instead. If this happens, you should talk to an experienced Sunrise workers comp attorney.
Here, we’ll explain what happens if your workers’ compensation claim is denied. We’ll also discuss what happens if the insurance company fails to act in good faith.
Your Employer’s Insurance Carrier Must Fairly Evaluate Your Claim
When your Sunrise workers comp lawyer first submits your claim, the insurance company will assign an adjuster to review it. They’re required to do a fair and unbiased evaluation of your claim.
The problem is that it’s only natural for the insurance adjuster to err on the side of your employer. If they can find a reason to deny your claim, you can bet they’ll do it. The last thing an insurance company wants to do is pay out large claims.
Your Sunrise Workers Comp Attorney Still Has to Demonstrate That You Qualify for Benefits
Even if you think the insurance adjuster has acted in bad faith, you still have to prove your case. Your Sunrise workers comp attorney must demonstrate that you meet the basic criteria for workers compensation benefits.
Some of the requirements for workers compensation include the following:
- Your injuries occurred on company property and on company time
- You were acting within the scope of your employment at the time of your workplace accident
- You reported your accident and injuries within thirty (30) days
- You weren’t under the influence of drugs or alcohol at the time of your injury
Of course, this isn’t an exhaustive list. However, this gives you an idea of what your Sunrise workers comp attorney will need to prove. If you meet these criteria and your claim is still denied, there could be a problem.
Why Did the Insurance Adjuster Say They Were Denying Your Claim?
If the insurance carrier denies your claim, they need to provide your Sunrise workers comp lawyer with a reason. There are numerous reasons why they may have done this. Of course, the reason they give for denying your claim may not be the real reason why they did it.
Some of the more common reasons why your workers compensation claim may have been denied include:
- The insurance adjuster thinks you were injured on personal time
- They don’t believe your injuries are as serious as you claim them to be
- You have a history of filing workers compensation claims
- They believe you had a pre-existing medical condition
- You didn’t report your injury to your manager or HR in a timely manner
- You failed your drug test
Once your Sunrise workers comp lawyer has the reason in writing, they can get to work on your appeal.
Your Sunrise Workers Comp Lawyer Can Always Appeal Your Claim
If your claim is denied, your attorney can file an appeal. In fact, you’re required to file an appeal if you plan on taking further action after the fact. When you file your appeal, both sides will be given a chance to have their say.
The administrative judge will decide whether your claim should have been approved. They’ll typically give their final opinion at the end of your hearing. If you still aren’t happy with the outcome, you can always request a final appeal to be heard by a judge with the 1st District Court of Appeals.
What Options Do You Have if Your Appeal is Denied?
If all of your appeals have been exhausted, you do have other options. One thing your Sunrise workers comp attorney can do is file suit against your employer. This is to be used as a last resort.
Typically, between mediation and your appearances in court, your attorney will come to some sort of resolution with the insurance company. If that doesn’t happen, you do have the option of pursuing legal action.
What Will Your Sunrise Workers Comp Lawyer Do if the Insurance Company Acts in Bad Faith?
One other option you may have is to file a bad faith claim against the insurance carrier. Whether you’re successful with this type of claim will depend on several factors, including:
- Whether your employer was the one who pressured the insurance company to deny your claim
- Whether you submitted all the necessary documentation so that the insurance adjuster could make an educated decision
- The insurance company’s history of denying workers compensation claims
- The facts of your case
- Your prior medical history
The good news is that your Sunrise workers comp lawyer will handle all this for you. This isn’t something you’ll have to handle on your own.
What Are the Odds of Succeeding in Your Bad Faith Claim Against the Insurance Company?
It’s not a given that you’ll succeed in your bad faith claim. In fact, there is a lot of backlash against bad faith claims in Florida. Your Sunrise workers comp attorney will have to demonstrate that the insurance company did not fairly evaluate your claim.
They may also have to prove that your claim should have been approved had it been handled properly. What this means is that if a reasonable insurance adjuster would have approved your claim, your employer’s insurance carrier may be found liable.
If you prevail in your bad faith claim, you’ll be entitled to the original benefits you demanded. You can also demand reimbursement for any attorney fees you spent as well as costs associated with the bad faith action.
The First Thing You Should Do Is Contact an Experienced Sunrise Workers Comp Attorney
If you get hurt on the job, the first thing you should do is contact a Sunrise workers comp attorney. Of course, you’ll want to see that you get medical attention first. But before you file your claim, it’s a good idea to sit down with a skilled Sunrise workers comp lawyer.
Your lawyer will explain what you can expect throughout the workers’ compensation process. They’ll also discuss what your options will be if the insurance company denies your claim.
All you have to do is contact our office at 954-833-5226. Speak with one of our representatives and schedule your free, initial consultation.