If your workers’ compensation claim is denied, this is not necessarily the final word on your case. You can try to settle the dispute by meeting with your employer and/or the employer’s insurance company to see if the denial is due to a typo or other minor error in your paperwork that can be corrected easily. If an informal meeting does not solve the problem, you may file a formal appeal with the help of a workers’ compensation attorney.
More than 10% of workers’ compensation claims are denied. Reasons for denial may include:
- The application provided incomplete information.
- There was a discrepancy between the accident report and documented injuries.
- The applicant missed the filing deadline.
- Medical treatment was not sought.
- The medical provider was not on the certified list of providers.
- The injury did not happen at work.
- The injury is not severe enough to warrant benefits.
- The employer disputes the claim.
If your claim is denied, you should receive a letter that states the exact reason for the denial and gives information regarding a possible appeal. You generally have two years from the date of the injury to appeal unless you are appealing the denial of one specific benefit. In that case, you have one year from your last benefit payment or treatment date. Filing your appeal sooner is always better.
What You Should Do If You Disagree With the Denial of Your Workers’ Compensation Claim
When you receive your initial denial, your first step should be to meet with your employer and/or the employer’s insurance company to see if the denial is due to an issue that can be corrected without court intervention. The Employer Assistance and Ombudsman Office (EAO) can assist you with this at no cost.
If you are unable to resolve the issue with EAO help, a Petition for Benefits should be submitted to the clerk of the Office of the Judges of Compensation Claims (OJCC). You must provide the details of your accident, the type of injury you have, any wage loss you’ve suffered, and what benefits you seek.
When the OJCC receives your petition, it will notify your employer and the insurance carrier. They must either pay your claim or respond to the OJCC within 14 days. A case number will be assigned to your claim, so you can track the status of your appeal online.
The OJCC will arrange for a neutral third-party mediator to help you resolve your dispute at an informal mediation hearing, which should take place within 130 days after you file. Your attorney will negotiate on your behalf.
Most appeals are decided at the mediation stage. If the mediation is not successful, however, a workers’ compensation judge will schedule a pretrial hearing with the OJCC to establish the issues in the case and let the parties exchange evidence. You may submit a written statement, and your lawyer can attend the hearing on your behalf.
You’ll have your final hearing within 90 days. There, both parties will present evidence, and any witnesses will give testimony. The judge will issue a written decision, which you should receive within 30 days.
If you don’t agree with the judge’s decision, you have 30 days to appeal to the First District Court of Appeals. This step of the appeal process will be even more complicated and might take a year or more to resolve. The Court of Appeals may confirm the OJCC’s decision, overturn the decision, or send the case back to the OJCC for more findings.
Have You Been Injured At Your Florida Job?
If you've been hurt on the job in Florida you need to speak with an experienced workers' compensation lawyer as soon as possible. Please contact us online or call our Coral Springs office directly at 954.755.7803 to schedule your free consultation. We proudly serve Florida residents including all of Fort Lauderdale, Boca Raton Miami-Dade County, Broward County, Palm Beach County and all points in between.