If you are injured on the job in Florida, workers’ compensation insurance should provide compensation for your lost wages, medical costs, and other related expenses. Unfortunately, this compensation isn’t automatic, nor is it guaranteed.
While most Florida employers are required to carry this coverage, there are situations when a claim may be denied. If this happens to you, understanding your rights is important. One part of this is knowing why your claim was denied. Another part of it is getting in touch with our workers’ compensation attorneys at Sternberg Forsythe P.A. we can help with denied workers’ comp claims and work to help you get the benefits you deserve.
Reasons Your Workers’ Compensation Claim May Be Denied
Our attorneys are here to help if your claim for workers’ compensation benefits has been denied. However, it’s also beneficial to learn some of the most common reasons this may occur.
Insufficient Medical Evidence
When you make a claim to receive workers’ compensation benefits, they must include all information and documentation from your treating doctor. This includes test results, medical records, treatment plans, and more. The insurance company must investigate all related evidence to your claim before they decide if they will approve or deny it.
If the evidence is insufficient to prove that the injury was related to your job, then it is likely that your claim will be denied. Additionally, if you have an injury that doesn’t seem too serious, you may not get compensation at all.
For true injuries, contacting our legal team at Sternberg Forsythe, P.A. for help is highly recommended. We will ensure the proper evidence is gathered to prove why your denied workers’ comp claims should be approved.
Your Illness or Injury Isn’t Covered
According to Florida Statutes, workers’ compensation will cover illnesses, injuries, and even deaths that occur while a person is working. If you suffer an injury while you are on your lunch break, or if you are on your way to work or going home from work, then benefits may not be a possibility.
If your injury resulted from intoxication or the use of drugs that your doctor didn’t prescribe, you would not be able to receive compensation. Also, in situations where you attempted to injure or even kill yourself deliberately, you won’t receive benefits. It’s also impossible to receive compensation caused by mental anguish resulting from on-the-job stress.
Mistakes on Your Workers’ Compensation Claims
Most insurance companies are going to do anything they can to avoid having to pay out anything for insurance coverage. Because of this, even making a small and seemingly insignificant mistake or omitting information on a required form may prevent you from having your claim approved. Because of this, it is best to let our attorneys review your documents before they are submitted.
You Submitted Your Claim Late
In some situations, the reason your workers’ compensation claim is denied is extremely simple. For example, the insurer or employer may deny your claim if you did not submit your paperwork by the established deadlines. When you are injured at work, you should report it to your employer or manager within 30 days in Florida. Even if you can’t do it right when the situation occurs, it must be done within 30 days. If you fail to let your employer know about the situation and give them information from your doctor within 30 days, then the application may be denied.
There are a few exceptions to this. These include the following situations:
- The workers’ employer was aware of the illness or injury
- You did not receive a medical evaluation or opinion on the injury cause within 30 days
- The illness or injury wasn’t reported due to some exceptional circumstances
A Pre-Existing Condition is Blamed for the Injury by Your Employer or Their Insurer
Even if you suffer a workplace injury that is worsened by some type of pre-existing condition, then you can still receive workers’ compensation benefits. While this is true, in some situations, an employer or the workers’ compensation insurance provider will make the claim that your pre-existing condition was the cause of your injury. If this situation occurs, then you must provide proof that the condition wasn’t related to the accident that resulted in the injuries you experienced.
There Are No Witnesses to the Incident
In many workers’ compensation claims, witness testimony is crucial. If there was no one who witnessed the accident or situation that resulted in your injuries, then your boss and insurance provider must rely on your side of the story and any provided medical evidence. No witnesses are not something that should result in your claim being denied, but you do need to ensure that the other evidence you have is strong. Hiring our legal team at Sternberg Forsythe P.A. is one of the best ways to ensure you have a strong case to help you recover the compensation you deserve.
Let Our Workers’ Compensation Attorneys Help Fight for Your Rights
As an injured worker in Florida, you may not know where to turn if your workers’ compensation claim is denied. However, at Sternberg Forsythe, P.A., we have you covered. Our attorneys have years of experience representing individuals and cases just like yours. Because of this, you can count on us to provide you with the quality representation you deserve.
Workers’ compensation cases can be complex. Showing that your injury occurred on the job can also be challenging. We are here to help with each step of the legal process. When you have our legal team on your side, you can feel confident that you will get the compensation deserved. We will fight for your rights aggressively and ensure that all your questions are answered. Call us today to get started. We are here to fight for you.