When you are injured while on the job, being denied Worker compensation benefits can hurt all the more. Denials of benefits are not always fair. Because insurance companies are big businesses, their interests may not be served by approving all or part of a claim. Fortunately, you can take steps to get the compensation you need.
When you are denied Worker comp benefits, the insurance company sends you a Notice of Denial form. This form tells you, your employer and the Division of Worker Compensation that your claim is denied in whole or in part as well as which benefits are denied and why. To appeal the insurance company’s decision, you must file a Petition for Benefits. In general, there is a two-year statute of limitations, or time limit, for filing this petition.
Once you receive your denial and seek an appeal, you can request help from the Employment Assistance Office (EAO) or hire a skilled Worker comp attorney who is experienced in dealing with insurance companies. An attorney will help you understand your options, including whether to negotiate with the insurer for a settlement or seek a hearing before an administrative law judge. Under Florida law, everyone involved in the Worker comp system, including insurance providers, is required to deal in good faith and attempt to resolve disagreements. In addition, the EAO can force the parties to attend conferences to resolve disputes over your benefits. If a settlement is reached during a conference, it must be approved by the Office of the Judges of Compensation Claims.
If you cannot reach a settlement, you can file a petition with the Division of Administrative Hearings (DOAH) and the Judges of Compensation Claims (OJCC) to schedule a hearing. An experienced Worker comp attorney can be extremely helpful at this point to gather and present evidence of why you should be getting benefits. If a claim is denied again, there is still hope — you can appeal the denial in the Florida First District Court of Appeals.