Workers’ compensation is an insurance system designed to compensate workers for expenses and lost wages after suffering on-the-job injuries and illness. Under this system, such workers should receive benefits without having to file a lawsuit to make the compensation process simpler. Unfortunately, this isn’t always the case as employers and their insurance carriers prioritize their financial interests.
It is not uncommon to have your workers’ comp claim denied, and your employer or their carrier may cite any of the many reasons for the denial. If you’ve suffered a work-related injury and have had your claim denied, speaking to a workers’ compensation lawyer increases your chances of receiving the benefits you deserve.
Our attorneys are experienced in handling workers’ compensation disputes in Sunrise, Florida. Call the office of Work Injury Rights today at 954-833-5226 to speak about your legal options with one of our experienced Sunrise workers’ compensation lawyers.
What Are Some of the Causes of Workers’ Compensation Disputes?
Some of the reasons why employers and insurance carriers deny or dispute claims include:
In Florida, most businesses or companies with four or more employees, whether full-time or part-time, are required to carry workers’ compensation. However, some workers aren’t eligible for workers’ compensation benefits, and a claim may be denied even if such workers suffer a work-related injury or illness. Most notably, independent contractors aren’t eligible for benefits in Florida, and any claim filed is bound to be denied.
Outside Scope of Employment
Under workers’ compensation, you can only receive benefits if you suffer an injury out of and in the course of your employment. Any other injury is considered non-compensable as it most likely happens outside the scope of employment, or basically what is expected of you in your job.
Lack of Causation
If there lacks a relationship of cause and effect in your case, then your workers’ compensation claim may be denied. You have to show that your injury is “causally related” to your job, which helps prove that it happened because of your work.
Failure to report your injury or file a Petition for Benefits in time is also one of the reasons for workers’ compensation disputes in Sunrise. In Florida, you are required to report your injury to your employer no later than 30 days from the date of the injury, or when the injury becomes apparent. In the event that your claim is denied, you have 2 years from the date of your injury to file a Petition for Benefits.
When reporting a workplace injury, it is important that you provide sufficient information about the accident that caused your injury. Most importantly, you’ll need a co-worker who witnessed the accident to corroborate your report. Failure to provide such information, your employer could easily dispute your claim.
What Do You Do If Your Workers’ Comp Claim Is Denied in Florida?
Your workers’ compensation claim may be denied by your employer or their workers’ comp insurance company for various reasons. Denial of claim doesn’t necessarily mean that you won’t get the benefits you deserve. There are various options for injured workers to work around a denial of the claim for them to receive their benefits.
Generally, you can make an effort to resolve the dispute with the employer’s insurance carrier in a bid to receive your workers’ comp benefits. If these efforts are futile, you should file a Petition for Benefits with the Office of Judges of Compensation Claims (OJCC).
Most importantly, you should seek the legal assistance of an experienced workers’ compensation lawyer as the insurance carrier will definitely have a defense team to represent them in the appeal process.
What Are the Types of Workers’ Compensation Disputes?
Below are the two most common types of workers’ compensation disputes in Sunrise:
These are disputes that arise from medical facts and opinions that relate to the treatment of the injured employee. They can be resolved by hiring an experienced lawyer and turning to a medical professional who is willing to give accurate reports after evaluating the medical condition of the injured worker. Most medical disputes in workers’ compensation claims involve failure to accept or denial of medical services, supplies, surgery, or therapy.
Some of the issues involved in claim disputes include:
- Eligibility for compensation – these are questions that arise on whether your work-related injury meets the criteria for coverage under workers’ compensation.
- Weekly income benefits – conflicts involving the calculation of weekly benefits may also arise in workers’ compensation claims.
- Disability – your employer’s insurance carrier may also question whether the workplace injury suffered really caused loss of income.
- Extent of injury – there might also be disputes involving the seriousness of your on-the-job injury, and whether it is enough for you to receive workers’ compensation benefits.
What Is the Workers’ Compensation Dispute and Appeals Process in Florida?
After the workers’ compensation carrier notifies you of its decision to deny benefits, you can make a “good-faith effort” to resolve the dispute, especially if it’s a claim dispute. This involves talking to the insurance adjuster or administrator, or contacting the Florida Employee Assistance and Ombudsman Office for help.
Sunrise employees whose workers’ compensation claims are denied due to medical disputes have the right to file a Petition for Benefits with the Office of the Judges of Compensation Claims (OJCC). This should be done not later than 2 years from the date the injury became apparent. After the petition is filed, the insurance carrier has 14 days to either agree to pay workers’ comp benefits or file and serve a response.
In most workers’ compensation cases, the OJCC will order the involved parties to go to mediation, which is an informal meeting meant to resolve a workers’ comp dispute. The mediation has to be held within 130 days from the date of filing the petition.
If the case is settled through mediation, the insurance carrier will arrange for the payment of benefits. However, if the dispute isn’t resolved, a pre-trial hearing before the Judge of Compensation Claims (JCC) is scheduled. During the hearing, the JCC will listen to both parties and issue a decision within 30 days to award or deny your benefits claim.
If both parties agree with the decision, the case gets closed. If one of the parties disagrees with the JCC’s decision, they have 30 days from the date of the JCC’s decision to file an appeal with the First District Court of Appeal. The appellate court will listen to the arguments and make a decision, which either affirms or reverses the JCC’s decision.
Get Help With Workers’ Compensation Disputes in Sunrise, Florida
Among the commonest causes of workers’ compensation disputes in Sunrise include employment status, lack of causation, scope of employment, inadequate information, and missed deadlines. If your workers’ compensation claim is in dispute, you need legal assistance to ensure that you receive your much-deserved benefits. Reach out to Work Injury Rights today at 954-833-5226 to schedule a free legal consultation with us to start your appeal process as soon as possible.