As a worker in Florida, it’s possible to file a work accident compensation claim if you are injured on the job or if you develop a work-related illness. For some workers, the process of making a worker’s compensation claim goes smoothly, and they begin receiving benefits promptly. However, for workers who have a work injury claim declined initially, the appeal process can be complex and frustrating.
If you find yourself in this situation, but believe you are entitled to receive work injuries compensation for your injury or illness, contact our legal team at Sternberg | Forsythe, P.A. for work injury advice and assistance. Not only can we review your case but also create a plan to help you appeal the work injury damages claim that was denied.
Learn more about what you can do if this happens here.
Reasons Your Work Injury Claim May be Denied
The insurance company your employer uses for workers’ compensation coverage is often hesitant or reluctant to pay claims. This is especially the case if the claim involves a serious or debilitating injury requiring ongoing and extensive medical treatment and long periods of time away from work. Insurance companies want to keep costs low, which is why they deny claims.
They do this because many injured workers don’t appeal the denial, which means they don’t have to pay. However, when it comes to work accident compensation payouts, if you truly believe you are entitled to this, appealing the denial with the help of an experienced workers’ compensation attorney is recommended.
Some of the reasons that your employer or their insurance company may deny your claim are by stating:
- The injury you filed a claim for was not work-related
- The injury was the result of a pre-existing condition
- You engaged in wrongful or negligent behavior (such as intoxication) when the injury occurred
- You are a volunteer, independent contractor, or not an employee and therefore cannot recover workers’ compensation benefits
- Workers’ compensation insurance doesn’t cover the condition or injury based on the state’s guidelines
- You did not notify your employer or file the claim within the specified time period
- There are mistakes on your work injury compensation claim documents
It’s important to remember that while your claim may be denied, it does not mean you cannot recover benefits. You can dispute the denial by filing an appeal.
Taking Action When Your Workers’ Compensation Claim is Denied
The first step in receiving the workers’ compensation benefits you are entitled to is reporting the injury to your employer. Ensure that proper documentation is used and that your employer reports the incident to their insurer.
Once these steps are taken, you should receive a brochure from the insurance provider that outlines the benefits you are entitled to. However, you may also receive a Notice of Denial for your workers’ compensation accident. When this happens, you have the right to file an appeal.
Filing Your Appeal to Receive Work Injury Damages
Workers who have reported their injury or illness to their employer and received the Notice of Denial can file a Petition for Benefits. This is filed with the Judges of Compensation Claims.
Before taking this step in your work injury damages cases, speak to an attorney. With a lawyer, you may be able to resolve the situation with your employer through negotiations. If these efforts are unsuccessful, then the next step is to have your attorney file the Petition for Benefits on your behalf.
Once the petition is submitted, and a judge is assigned to your case, a mediation conference is scheduled. At this point, a mediator will help you and the other party reach a solution.
What if Mediation Is Unsuccessful?
If mediation is unsuccessful and you still haven’t received a workers’ compensation injury settlement, then your case will be scheduled to be heard by the OJCC. The legal process from this point is like a civil trial. Once the hearing is concluded, the judge must issue a decision within 30 days regarding if you receive benefits.
At this point, if the decision made still isn’t in your favor, you can appeal it through the First District Court of Appeals. On this level, the claim and your workers’ compensation accident in Orlando, FL, will be reviewed based on the information in the record. You nor your lawyer can give testimony or provide evidence. You will probably never even go into the courtroom.
Pursuing Your Workers’ Compensation Claim
If your workers’ compensation injuries claim is denied initially, the process to have it approved is complex. Because of this, it’s best to work with a Florida workers’ compensation attorney. They will help you with the process and work with your employer or their insurer to negotiate a solution.
For many people receiving workers’ compensation injury payouts after a work-caused injury or illness is imperative to ensure they can pay the bills and support their families. If your claim is denied, it can cause a lot of stress and frustration. While this is true, you do have options to recover the benefits you deserve, even after an initial denial.
Contact Our Experienced Workers’ Compensation Attorneys for Help with Your Claim
When you file a workers’ compensation claim, you expect to recover benefits to cover your medical bills and lost wages. If your claim is denied, you may wonder what to do and where to turn.
At Sternberg | Forsythe, P.A., our legal team has years of experience providing legal services to people just like you. We will work on your behalf to help ensure you receive the benefits you are entitled to. We understand the laws and can use them to help with your case.
The first step is to contact our office to schedule a free initial consultation. We can discuss your situation and make a plan to move forward to help you have your claim approved.
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