Denial / Notice of Denial

Two very different kinds of denial

The distinction matters more than almost anything else on this page.

A compensability denial rejects the claim itself — the accident did not happen at work, the injury did not arise out of employment, the work accident is not the major contributing cause.

A benefit denial accepts the claim but refuses something within it — a surgery, a change of physician, continued wage benefits, a particular test.

Florida law treats them differently in a way that can decide your case. Section 440.19(2) provides that the one year tolling period for payments and treatment does not apply to the issues of compensability, date of maximum medical improvement, or permanent impairment. Which category your dispute falls into affects how the limitations period runs.

Pay and investigate — the 120-day rule.

Within 14 days after receiving a petition for benefits, the carrier must either file a response or pay the requested benefits—and paying is expressly without prejudice to its right to deny within 120 days of receipt of the petition.

So payment is not acceptance. A carrier can pay benefits for months and then deny. Workers reasonably read the arrival of checks as acceptance of the claim; under the statute, it may be nothing of the kind.

The late denial that surprises people most

The most disorienting denial is not the early one. It is the denial that arrives after a claim is accepted, sometimes years in.

The mechanism is a major contributing cause. Under § 440.09(1)(b), where a work injury combines with a pre existing condition, the employer pays only while the work injury is and remains more than 50 percent responsible and thereafter remains the major contributing cause of the disability or need for treatment.

That is a continuing test. A carrier can accept a claim, pay for a year or more, and then file a notice of denial asserting the accident is no longer the major contributing cause of your ongoing need for treatment. This is common, and it is precisely what happened in the case that reshaped Florida’s statute of limitations in 2026.

What a carrier must do when you challenge a denial

Filing a petition for benefits forces a response on a clock:

• 14 days to pay the requested benefits or file a response with the OJCC
• 30 days to assert any grounds for dismissal based on lack of specificity, or those grounds are waived
• The initial response is the carrier’s only opportunity to advance a statute of limitations defense. Under § 440.19(4), failure to raise it there means it is not available.

That last point is worth emphasizing. A carrier that overlooks the limitations defense in its first responsive pleading has lost it.

Common grounds for denial

• Late reporting — the injury was not reported to the employer within the statutory window.
• Major contributing cause — the accident is not, or is no longer, more than 50% responsible.e
• No objective medical findings — § 440.09 requires causation established to a reasonable degree of medical certainty based on objective relevant medical findings.
• Idiopathic or personal cause — the injury did not arise out of employment
• Intoxication or drug use — asserted as the cause of the accident
• Missed appointments — including failure to attend a carrier IME, which can bar compensation for the period of refusal
• Misrepresentation — including the narrow written false representation defense regarding prior conditions

What this means for your claim

Read the denial and find the stated reason. Denials are not generic — the ground the carrier gives determines what evidence answers it. A major contributing cause denial is a medical dispute that needs a medical opinion. A late reporting denial is a factual dispute about notice. They are answered completely differently.

Then be aware of the clock. A denial does not stop the statute of limitations from running, and how that period is calculated changed in 2026. If benefits have stopped, the time to work out where you stand is now, not after the paperwork settles.