- Sternberg Law Office
A denial letter reads as final. It is not. Florida provides a formal process for contesting denials, and a substantial share of denied claims are resolved in the worker’s favor once they enter it.
What matters is acting within the deadlines and understanding that the process is a legal proceeding rather than an appeal to the same people who denied you.
Common Reasons for Denial
- The carrier disputes that the injury arose out of and in the course of employment
- The injury is attributed to a pre-existing condition
- The worker is characterized as an independent contractor rather than an employee
- Notice of the injury was allegedly given too late
- A dispute about whether specific treatment is medically necessary
- An intoxication or wilful misconduct defense
- Alleged misrepresentation in the claim or in a pre-employment questionnaire
Pre-existing condition denials are the most common and, in Sternberg Law Office cases, the most frequently overcome. Florida uses a major contributing cause standard, and where the workplace accident is the major contributing cause of the need for treatment, the claim is compensable even though a prior condition existed.
A worker with degenerative changes on imaging, which nearly every adult has, is regularly told the condition is pre-existing. Where an accident made an asymptomatic condition symptomatic, that denial is contestable.
The Petition for Benefits
The formal mechanism for contesting a denial is to file a petition for benefits with the Office of the Judges of Compensation Claims.
The petition must specify what is being sought — particular medical treatment, a category of indemnity benefits, penalties, interest — and state the factual basis for entitlement. It is not a general complaint about the carrier’s handling.
Once filed, the carrier must respond within a specified period, either by providing the benefit or by stating its defenses.
Mediation Is Mandatory
Florida requires mediation in these cases, and it is scheduled relatively quickly after a petition is filed.
A neutral mediator meets with both sides. The mediator makes no decisions and does not report to the judge who was reasonable. Discussions are confidential.
A significant proportion of disputes are resolved here, often because filing changed the dynamic. Treatment requested for months without response is sometimes authorized within days of a petition being filed.
Attending prepared makes a real difference. Knowing exactly what treatment is being sought, what the medical opinions say, and what the claim is worth produces better outcomes than arriving to see what happens.
If Mediation Does Not Resolve It
Where mediation fails, the matter proceeds to a final hearing before a judge of compensation claims.
This is a genuine evidentiary proceeding. Both sides present evidence; medical testimony is usually submitted by deposition, and witnesses may testify. The judge issues a written order.
Either party may appeal to the appellate court, though the record is what was developed at the hearing, which is why the hearing itself matters more than the prospect of appeal.
Continuing Care During a Dispute
A denied claim does not mean treatment should stop, and workers frequently stop because they cannot pay.
Using health insurance during a dispute is generally the practical option, though insurers sometimes deny coverage when the injury is work-related. Where that occurs, the denial letter from the compensation carrier is what supports the health insurer covering treatment in the interim.
Any health insurer that pays will typically assert a right to reimbursement if the compensation claim is later accepted, which is handled at the time of resolution.
What matters most is that the medical record continues. A gap during a dispute is used to argue that the injury was resolved, and it is difficult to reconstruct afterward.
The Deadlines
Florida imposes a short reporting period for workplace injuries to the employer, measured in days. Late reporting is a defense the carrier will raise, and the exceptions are narrow.
The period for filing a petition for benefits generally runs two years from the date of the accident, with provisions extending it where benefits were furnished, subject to a further limit measured from the last payment of benefits or provision of medical care.
Those provisions interact in ways that catch people out. A worker who received treatment for a period, stopped, and returned two years later may find the claim has closed.
Where a claim has been denied, the safe approach is to treat the deadline as running from the date of the accident rather than relying on tolling.
Recorded Statements and Written Statements
Carriers request a recorded statement early, and workers give them believing cooperation will resolve the matter.
The statement becomes the account against which everything else is measured. Inconsistencies between it and the medical records, however innocent, are used to attack credibility, and a worker describing an incident from memory while medicated is not at their most precise.
Questions are also framed to elicit particular answers — whether you had prior back problems, whether you were doing something outside your normal duties, whether anyone saw it happen.
You are entitled to advice before giving a statement, and the request can be deferred while you obtain it.
Attorney Fees Work Differently Here
Florida restricts attorney fees in workers’ compensation cases, and the framework has been the subject of significant appellate litigation.
A worker generally does not pay a fee out of pocket as a private client might. Where benefits are secured, the carrier may be responsible for a fee under the statutory framework, though the amounts are constrained.
The practical effect is that representation is available to injured workers regardless of means, and a worker should not decline advice on the assumption that they cannot afford it.
Independent Contractor Denials
Denials on the basis that the worker was an independent contractor rather than an employee are common in construction, landscaping, delivery, and service industries.
Florida examines the substance of the relationship rather than the label. Control over how the work is performed, whether the worker holds themselves out as a business, who supplies tools and materials, the method of payment, and the permanence of the arrangement all bear on the analysis.
Being paid on a tax form associated with contractors does not settle the question. Neither does having signed a document describing yourself as a contractor.
Florida also has specific provisions that apply to the construction industry, where the criteria differ from those in other sectors.
Employers Who Never Reported the Injury
A recurring problem is an employer who discourages reporting, tells the worker to use health insurance, or offers to pay cash rather than filing a claim.
That is not permitted, and it damages the worker. Late reporting becomes a defense, no claim number exists, and the medical record does not connect the injury to work.
Florida prohibits retaliation against an employee for pursuing a workers’ compensation claim, and a worker who is fired, demoted,d or has hours reduced for making a claim may have a separate action.
Where an employer refuses to report, the worker can pursue the claim directly. Documenting the report you made, in writing and with a copy retained, is what protects the claim in that situation.
What to Do After a Denial
- Read the denial carefully and identify the specific basis stated
- Gather your medical records and the incident report
- Document when and how you reported the injury and to whom
- Continue treating, using health insurance if necessary, and keep the records
- Do not give a recorded statement to the carrier before getting advice
- Note the deadline and do not let it approach
Continuing treatment matters even where the carrier is not paying. A gap in the record is used to argue the injury resolved, and reconstructing what happened during an untreated period is difficult.
Partial denials are also common and are frequently overlooked. A carrier may accept the claim in general while denying a specific treatment, a referral, or a period of wage benefits. Each of those denials is separately contestable, and a worker who accepts the overall claim as approved may not realize that pieces of it were refused.
If your Florida workers’ compensation claim has been denied, call Sternberg Law Office. A denial is a position rather than a conclusion.
Fields marked with an * are required
