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Denial of Workers’ Compensation Medical Benefits Can Be Legally Challenged

Posted on Friday, July 31, 2015
Blog, Workers' Compensation

Your ability to receive medical benefits under Florida workers’ compensation is dependent on strict guidelines–guidelines that can, nevertheless, be challenged in court. According to the Florida Division of Workers’ Compensation, your employer may have to provide you with medical treatment, but it is your responsibility to quickly report any on-the-job illness, or injury. And, the doctor who aids you at the scene of the workplace mishap may not be the doctor who continues your treatment under your employer’s insurance plan. Likewise, be sure to advise hospital emergency-room personnel–if they are your “first responders”– to forward your records to your employer, and/or your insurance carrier.

Florida Workers’ Compensation laws declare, also, that you can only receive initial, ongoing and “specialist” medical care for a (supposed) on-the-job injury if insurance-company physicians declare this “medically necessary.” However, the term “medically necessary” is subject to interpretation, and you can, therefore, present a legal challenge whenever the carrier denies medical help you feel is crucial.

The types of medical care usually offered by workers’ compensation for physical-health problems–doctor’s visits, hospitalization, therapy, exams/tests and prescription medications–also apply to “mental and nervous injuries,” as described by Florida Statute 440.093. In order for “mental/nervous” treatments to be covered, though, your mental “stressors” must be directly attributable–by at least 50%–to the “compensable physical injury” that occurred while you were working. This 50% is used in comparison with any other possible causes of your mental-health issues. And, the term “directly attributable” is another that can be viewed differently by you, and by your insurance company.

Your “mental and nervous injuries,” therefore, must be proven by clear and convincing medical evidence, and this evidence can only be provided by a licensed psychiatrist–not a psychologist–who can give your condition a unequivocal diagnosis by employing the criteria now extant in the DSM-IV, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Asserts Florida laws: A mental injury that results from stress, fright or excitement are not an “accidental injury,” even if it was, you believe, engendered from an on-the-job incident. Workers’ Compensation, in other words, must see a trauma to your physical body in order to permit your employer’s insurance to help you to heal. –Can this “nervous injury” interpretation be legally challenged? Yes!

But can the insurance company claim, in a situation such as this, that your “mental challenges” existed prior to your current employment? Yes!

Some physically injured employees have, conversely, been accused of mental malingering, when in fact; the trauma they experienced was real–just not easily diagnosable.

This overview of actual, nameable and feasible workplace injuries–which may be denied by Florida Workers’ Compensation–should convince any employee with questions to seek legal help.

Know Your Rights Regarding Employee Retaliation

Posted on Friday, June 26, 2015
Blog, Workers' Compensation

Individuals seeking worker’s compensation are faced with hours upon hours of paperwork, doctors’ evaluation appointments, legal fees, and other miscellaneous activities regarding their case. As if this wasn’t enough, sometimes employers retaliate. As of 2013, recorded workplace injuries had dropped by 31% over a period of ten years, but a growing number of companies were reported to have retaliated against workers’ compensation claims within the same time period. How are the interests of the worker best protected in this situation? Don’t be intimidated by employer retaliation.

Know Your Rights

Fear of retaliation should not deter you from seeking the legal rights afforded to individuals injured at work. These are:

  1. Entitlement to worker’s compensation benefits throughout their career (not a contract worker or someone who signed away rights to worker’s compensation).
  2. Filing for worker’s compensation as remuneration for a serious work-related injury or illness.
  3. Termination or experience of negative changes to conditions of employment due to filing aforementioned worker’s compensation claims.

Federal Law

A majority of states have laws, which prohibit employers from retaliation against injured workers, but federal law outlines no specific stipulations regarding worker’s compensation retaliation. Most federal laws target other kinds of retaliation, so it is important to understand your state’s legal stance on this issue. Qualified and experienced attorneys will be familiar with state specific worker’s compensation retaliation laws, so consider them a resource if state law statutes are not clear from personal research.

State Law

Florida state law outlines anti-retaliation provisions found in Title VII of the Civil Rights Act of 1964, the Florida Civil Rights Act, the Fair Labor Standards Act, the Age Discrimination in Employment Act, the Americans with Disabilities Act as Amended, and the Family Medical and Leave Act. Any worker seriously injured due to work conditions will usually qualify for worker’s compensation benefits. Unless fraud is proven, there is very little chance an employer can challenge a worker’s right to fair compensation.

Once work termination or change to conditions of employment has been linked with recent worker’s compensation claims, workers have a right to protect themselves legally. It’s advisable to hire a knowledgeable legal team that has experience in state law, regardless of severity of company action. Larger corporations may attempt to mask retaliation through loopholes in legal statutes or even fraud, however this should not deter anyone from seeking legal assistance that will allow fair receipt of compensation for work-related injuries. Don’t let employer retaliation threaten the future of your livelihood. Get informed with the appropriate legal knowledge.

Dealing With Your Employer During A Workers’ Comp Case

Posted on Monday, April 27, 2015
Blog, Workers' Compensation

Workers’ compensation cases are often adversarial, because they pit the interests of an injured worker against a company that wants to contain its financial losses. Dealing with the employer during this time is often extremely stressful. However, you can always control your own attitude. Make it a point early on to act professionally, even if your boss or other people in management do not act the same way towards you.

Attend Medical Appointments as Requested

You must produce strong medical proof that the injuries you sustained at work continue to affect your everyday life. That is why it is so important to go to all medical appointments and to follow your doctor’s advice. Since this information goes back to your employer, you want it to reflect you in the best possible light. If you do not like your doctor do not ask for or accept a new one without consulting an attorney. You only have the right to a new doctor one time in any case. The carrier can always choose that new doctor, unless they do not respond to your request in a timely manner. If the response is late you can chose your doctor. It is best to have a lawyer help you with the process of requesting your one time change of doctors.

Show up on Time for All Hearings and Depositions

When you receive a notice of an upcoming hearing or deposition, try to clear your schedule immediately so that you can attend it. If that’s not possible, let your attorney know so he or she can reschedule. It won’t look good to your employer if a company representative makes it to each legal meeting and you do not.

What to Do If You Feel You’re Being Treated Unfairly

Unfortunately, your employer may choose to act in unfair or illegal ways towards you after you file a workers’ compensation claim. Your employer may demote you, wrongfully terminate you, or encourage others to treat you in an openly hostile manner. Documentation is extremely important if any of these things happen. You should write down the date, time, and the employer’s actions for anything you feel is unjust. Your next step is to contact a workers’ compensation attorney for guidance and possible representation.

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