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Workers’ Compensation Claim Denials

If you are unlucky enough to be injured on the job, you are at least entitled to file for workers’ compensation in most situations. However, you are not necessarily entitled to that claim being accepted. Workers’ compensation claims are denied for a variety of reasons, especially in Florida, where the system can be quite strict in terms of what an employee must show in order to prevail.

An Employer-Friendly State

Florida has, somewhat justifiably, a reputation as an employer-friendly state in terms of workers’ compensation claims. There are multiple reasons for that, including an inability to choose the doctor you see in most situations (the insurance company or the employer will generally get to choose which medical professional you are evaluated by) and the absence of a job protection guarantee for injured workers (in many other states, a worker is guaranteed to retain their job while they are recuperating). One fairly insidious law in effect is that even attorney’s fees are regulated by the employer and insurance company in that they can elect to take their time paying an employee’s attorney – this tactic may eventually backfire, but it still deters significant amounts of attorneys from even taking many cases unless they are all but guaranteed to succeed.

In order to have a chance to prevail on your workers’ compensation claim, you must be able to show not only your injuries, but also that you reported them to your employer and the relevant authorities within the appropriate time frame. Insurance companies are very fond of taking advantage of any loophole available to try and have the claim denied, so there must be none for them to take advantage of.

The Process

The standard process after a denial is to file an appeal with the appropriate authorities. In Florida, the Employee Assistance Office through the Division of Workers’ Compensation can help try and resolve the dispute, but if this is unsuccessful, the next step is usually to file an appeal directly with the relevant District Court of Appeals. Unlike many other states, Florida refers workers’ compensation claims directly to the courts, rather than to a commission. The initial judge of disputes between employers and employees is referred to as a judge of compensation claims (JCC), but they are essentially officials at large – they do not represent any body. Their decisions are only reviewable by the Courts of Appeals, and the process ends there.

At the Appeals level, it is important to keep in mind that the standard of review is that of abuse of discretion, or sometimes clear error. The standard is not de novo, in other words; no new information may be introduced into the record. You may only allege that the JCC erred or misinterpreted the relevant statutes; you may not argue any new tacks, and if you try, it will not be factored into the court’s decision.

Contact A Winter Park Workers Compensation Attorney

While Florida’s employer-friendly climate can intimidate some attorneys out of taking workers’ compensation cases, the knowledgeable attorneys at the Hornsby Law Group in Winter Park are made of stronger stuff. Contact us today, via phone or web, to set up an initial appointment to discuss your case.

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