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Workers’ Comp Denial: How To Appeal Your Claim

workers comp denial
workers comp denial

Imagine a situation in which you are injured on the job. While your primary concern is your health, well-being, and making a full recovery, you’ll soon have something else on your mind: the financial ramifications of your accident and injury. Should you come to find that you’ll miss work as a result of your injury, it’s critical that you learn more about the Florida workers’ compensation system, your legal rights, and how to obtain all the compensation you deserve. Although your claim may appear simple on the surface, you could soon run into trouble by way of a workers’ comp denial. When this happens, it’s crucial to consult with an experienced Florida work injury lawyer to explain the appeal process.

Common reasons for a workers’ comp claim denial

Understanding the reasons why you might have received a workers’ comp claim denial can help you avoid this from happening:

  • Missed deadline: You only have so much time to file a workers’ compensation claim in the state of Florida (more on this below). It’s imperative to take action as quickly as possible.
  • Neglecting to obtain medical care: It’s essential that you receive care immediately after your injury. This goes a long way in proving that you were injured at work. 
  • Disputes about whether your injury is work-related: Your employer may argue that you weren’t injured on the job, but instead brought the injury into work. Protect against this by reporting your accident and injury to your supervisor or HR department. And as noted above, be sure that you receive medical care. 
  • Your condition doesn’t meet state guidelines: Just because you’re injured on the job doesn’t necessarily mean you’re eligible to receive benefits. The state has guidelines regarding the types of injuries that apply to the workers’ compensation system. 
  • You filed the claim after you left your job: If you’re injured at work, file a claim while you’re still an employee. Don’t do so after leaving your job, as this will disqualify you from receiving benefits. 

How long do you have to file a workers’ comp claim in Florida?

In the state of Florida, you have 30 days from your accident to notify your employer that you’re filing a workers’ compensation claim.

Should your symptoms develop in the days following the accident, you have 30 days from your doctor’s diagnosis to take action. 

It’s never a good idea to wait until the last minute, as challenges can arise along the way. You want to leave yourself and your Florida work injury lawyer with as much time as possible to deal with any roadblocks.

How to appeal a Florida workers’ comp denial

appeals court for a workers' comp denial
Our experienced Florida work injury lawyers can help you through the appeals process if you receive a workers’ comp denial.

A workers’ comp denial is not the end of the line. In Florida, you have the legal right to appeal the denial with the hopes of having it overturned. To increase your odds of a successful appeals process, be sure to consult with an experienced Florida work injury lawyer.

Below are the basic steps you can take:

1. Contact the insurance company

This is a natural first step, as it allows you to learn more about the reason for the denial. It’s also a good time to ask them to reconsider their decision, especially if you can provide additional information to back up your claim.

2. File an appeal

Doing so means filing an application for adjudication of the claim. Carefully adhere to the application instructions, as you don’t want to make an error that will slow down the process. Better yet, you can rely on the services of a knowledgeable Florida work injury lawyer to file this form on your behalf and make sure you’re off to a strong start in the appeals process.

3. Mediation

If your appeal comes up short, it’s time to move to mediation. This allows you and the insurance company to share your stance with a neutral third-party mediator. 

The mediator does their best to help resolve the dispute, but they don’t have the authority to make legally binding decisions. Your attorney can support you through the mediation process towards a favorable outcome.

4. Formal hearing

Should mediation lead you nowhere, a formal hearing is scheduled. During this time you have the opportunity to:

  • Present evidence, such as medical records
  • Hear what the other party has to say
  • Share reports from your independent medical exams

5. Board appeals

If you’re unsuccessful at your formal hearing, you can file a second administrative appeal. The appeals process is managed by an appeals board. In many ways, this is the same as the formal hearing. 

6. Court appeals

If your board appeal falls short, your last option is a court appeal. This allows you to appeal through Florida’s court system, with a jury or judge making the final determination on your workers’ comp denial. 

Will an appeal bring an approval? This depends on a variety of factors, including the evidence you’re able to present in your favor. One survey shows that 47 percent of people who received a workers’ compensation settlement were initially denied. How do you increase your chances of an approval, working with an experienced Florida workers’ comp lawyer.

Don’t let a workers’ comp denial be the end

Should you find yourself faced with a denial and the appeals process, it’s best to consult with a Florida work injury lawyer. Not only does this improve your odds of success, but it allows you to spend less time worrying about the outcome and more time recovering from your work injuries. 

At Sternberg / Forsythe, PA, we have more than 40 years of combined experience helping injured workers across Florida receive the compensation they deserve. Contact us online or give us a call to schedule a free consultation.

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