Getting hurt at work is a stressful experience. Receiving a notice that your workers’ compensation claim was denied can make a bad situation worse.
Now you’re probably worrying about paying medical bills, covering lost wages or returning to work before you are ready. The good news is that a denial doesn’t necessarily mean the end of your case, because you have the right to challenge a denied claim.
Why are workers’ compensation claims denied?
There are various reasons why a workers’ comp insurance company may deny a claim, such as:
- The employer disputes that the injury occurred at work
- The injury wasn’t reported within the required time limit
- The insurance company claims the injury is from a pre-existing condition
- There isn’t enough medical evidence to support the claim
- The insurance company believes the injury didn’t happen at work
The denial letter should state why the claim was rejected.
In Florida, workers must report their workplace injury or illness to their employer within 30 days of the accident or discovery of a work-related illness.
Missing this deadline can make receiving benefits more difficult.
If your claim is denied, you can file a Petition for Benefits with the Florida Bureau of Employee Assistance. Your case will typically go through several stages:
- Mediation: You, your attorney, the employer and the insurance company try to resolve the dispute without going to a hearing.
- Hearing before a judge: Both sides can present evidence, medical records and witness testimony. The judge will review the facts and decide whether you’re entitled to workers’ comp benefits.
- Further appeals: If you disagree with the judge’s decision, you may be able to appeal to a higher court.
Strong evidence can improve your chances of a successful appeal, such as:
- Medical records
- Treatment notes
- Accident reports
- Statements from anyone who witnessed the accident
- Communications with your employer and insurance company
- Photos of the accident scene
Legal guidance can also improve your chances of a positive outcome. They can help you understand why your claim was denied, gather evidence, protect your rights throughout the process and advocate for you during mediation and hearings.