Many people take it for granted that their workers’ compensation claim will be approved if they were injured on the job. It is true that most employers in Florida are required to have workers’ compensation insurance to cover work-related injuries and illnesses. However, the system operates much like any other type of insurance and there are circumstances under which a workers’ comp claim can be denied.
If you’re planning to file a claim or your application for benefits was recently denied, you should seek advice from a Florida workers’ compensation lawyer. In the meantime, let’s look at some of the most common reasons for denied claims.
You Didn’t Supply Adequate Medical Evidence
Your claim for workers’ compensation benefits must include medical records, test results, and documentation from a doctor. The insurance company needs to examine all the evidence relating to your claim before they approve or deny your claim. If there’s not enough evidence to show that your injury was work-related, the claim is likely to be denied. Also, if the injury doesn’t seem particularly serious, you probably won’t get compensation. If your injury is genuine, you should contact a Florida workers’ comp lawyer for assistance with appealing the denial before the Workers’ Compensation Commission.
Your Injury or Illness Is Not Covered
Under Florida Statute 440.02, workers’ compensation covers injuries, illnesses, and deaths that arise out of or in the course of employment. If you were injured during your lunch break or on your way to or from work, you may not be eligible for benefits. If your injury was caused by your intoxication or the influence of drugs not prescribed by a doctor, you won’t be able to get compensation. Similarly, your injuries won’t be covered if you deliberately tried to injure or kill yourself or another person. You also can’t get compensation for mental anguish caused by job-related stress.
You Made a Mistake on Your Forms
Insurance companies will do anything to avoid making a payout. Therefore, even a small mistake or omission on a form could prevent you from getting your claim approved. This is why it’s a good idea to have a lawyer look over your documents before you submit them.
The Claim Was Submitted Late
Sometimes, the reason behind a denied claim is quite simple. Either the employer or their insurer can deny a claim because the worker submitted the paperwork late. If you received a work-related injury, you must report it to your employer in 30 days. However, you should do it as soon as possible. If you don’t notify your employer and provide notes from your physician within this timeframe, your application may be denied.
There are some exceptions to this including situations where:
- Your employer had clear knowledge of the injury or illness
- You didn’t have a medical opinion on the cause of the injury within 30 days
- You didn’t report the injury or illness in a timely manner because of exceptional circumstances
The Employer or Insurer Blames a Pre-Existing Condition
If a workplace injury exacerbated a pre-existing medical condition, you should still be able to claim workers’ compensation benefits. However, sometimes employers or their insurers claim the pre-existing condition caused the injury. In such a case, you would have to prove that the condition was not related to the accident that caused your injuries.
No One Saw What Happened
Eyewitness testimony can be very important in a workers’ compensation claim. If no one saw the incident that led to your injuries, your employer and their insurance company will have to rely solely on your account and the medical evidence. A lack of witnesses shouldn’t result in a denial but you will need to make sure that the rest of your evidence is strong. A workers’ comp attorney can help you to ensure that you make a strong case for compensation.
Contact the Experienced Attorneys at Work Injury Rights!
Many injured employees need to fight to get the benefits they deserve. However, they don’t do it alone. If you need to request an administrative hearing after your claim was denied, you should seek help from a workers’ compensation lawyer in Florida. Hiring legal representation increases your chances of getting compensation for your injuries. You can even consult a lawyer before you submit your claim. This makes it more likely that your claim will be approved the first time.
If you’ve suffered a work-related injury or illness, reach out to the attorneys at Work Injury Rights. You can focus on your recovery while we take care of all the legal matters. Contact us today to schedule a free consultation.