If you are injured on the job or become ill because of the work you do in Florida, you may be entitled to receive workers’ compensation benefits. For many people in this situation, the process to receive benefits goes smoothly, and benefits start soon after you file your claim.
However, this is not always how things work. Some workers’ compensation claims are denied, and while you have the right to appeal this decision, it can be a difficult and frustrating process.
Reasons Your Orlando Workers’ Compensation Claim May be Denied
To determine what options you have to handle a denied workers’ compensation claim, you must know the reason for the denial. Several reasons are cited by insurance companies and employers when it comes to denying a claim. While some reasons are legitimate, others are not.
Some of the legitimate reasons your Orlando workers’ compensation claim may be denied include the following:
- Not filing your claim on time
- Not seeking treatment from an approved doctor
- Not providing the required information for the claim
- Submitting misleading or false information with your claim
- Being ineligible for benefits (this includes independent contractors or those who were high or drunk while on the job)
- Not proving the injury was related to your job
Unfortunately, insurance companies and employers often deny claims for illegitimate reasons. This is called “bad faith” and is illegal in Florida. If the insurance company or your employer denies your workers’ compensation claim in bad faith, you should hire an experienced attorney to help you fight for the benefits you are entitled to.
At Sternberg | Forsythe, PA, our legal team has decades of experience helping injured workers recover the benefits they are entitled to.
Options to Overcome the Denial of Your Workers’ Compensation Benefits
In some situations, even legitimate denials can be overcome. One example is if you are entitled to benefits but did not submit the needed information. In this case, you can submit the information required by the insurance company, which may be enough to overcome the initial denial.
Contact our office to determine if this is an option for your situation. We can review your case and determine what information is needed to show that you deserve to receive the benefits you filed a claim to receive.
The Process to Challenge an Orlando Workers’ Compensation Denial
It is impossible to overcome your claim being denied by working directly with the insurance company or your employer. Instead, you must take legal action. The steps you must follow to challenge a workers’ Compensation denial in Orlando include the following:
File Your Petition for Benefits with the Office of the Judges of Compensation Claims (OJCC)
You must file your Petition for Workers’ Compensation Benefits with the OJCC. You must send your petition to the OJCC and copies to the insurance company and your employer. The OJCC reviews your petition, and they make a decision based on the information you provide
Attend Mediation to Resolve the Claim
Sometimes, the OJCC orders mediation to resolve the situation. This is a non-binding process designed to help you and the other party agree on what benefits will be paid.
If you, the insurance company, or your employer, achieve an agreement, the process is complete. If no agreement is reached, the claim will continue to move through the appeals process with the OJCC.
The Pre-Trial Hearing
After mediation, you must attend a pre-trial hearing. This occurs in front of a JCC – Judge of Compensation Claims. You have a 14-day notice as to when this hearing occurs. Your attorney will work to ensure your claim for benefits is strong before this hearing.
Attend the Final Hearing
After the pre-trial hearing, the final stage of the OJCC process is the final hearing. During this hearing, your attorney will present your case, and your insurance company or employer will present a defense. Once the hearing is complete, the JCC will issue a decision. This decision is binding.
File a Lawsuit
You can file a lawsuit in court if you are not satisfied with the OJCC process’s outcome. The lawsuit’s goal is to challenge the decision reached during the final hearing.
Your attorney plays a crucial role in this process. They will help you go through the pre-trial process and present an argument to help you recover the benefits you are entitled to during the trial.
Contact Our Legal Team to Discuss Your Workers’ Compensation Denial
Receiving news that your workers’ compensation claim was denied can be disappointing and frustrating. Most injured workers utilize these benefits to cover their medical costs and make up for any income they lose while unable to work.
If you have received notice that your claim was denied, contact our legal team at Sternberg | Forsythe, PA, immediately. We can review the facts of your case and let you know what options you have available.
We offer free initial consultations to discuss your situation. You have nothing to lose to learn more about your situation and the options you have to recover the benefits you are entitled to after a work-related injury or illness.