Appealing A Florida Workers’ Compensation Denial

When an employee is injured on the job, the fact that their employer has to carry workers’ compensation insurance (with rare exceptions) can give them some peace of mind. With workers’ compensation benefits, an injured worker can focus on healing so they can return to work more quickly. However, not every work injury qualifies for benefits – and it can be a shock to an employee who seeks them in good faith. Thankfully, many denied claims can be appealed, as long as the proper Florida procedures are followed.

Common Reasons For Denial

Not every Florida employer is required to carry workers’ compensation insurance, but most are – only those businesses not in the construction or agricultural industry, who have four or fewer employees, need not have coverage. (Requirements are different for construction and agriculture.) The majority of workers’ compensation claims are accepted and benefits are granted – but while denials can feel punitive, there are several reasons why your claim might have been refused.

The most common reasons for workers’ compensation denials range from simple mistakes to malice or interference on the part of one’s employer. Some examples include:

• Insufficient or missing medical evidence. It may seem like it should go without saying, but establishing a genuine medical condition is the first step in qualifying for workers’ compensation benefits, and many people simply forget to include their medical records;
• A ruling that the injury is not ‘work related’ or otherwise ‘not covered’ by workers’ compensation. This can happen, for example, when an employee is injured while off the premises, unless it can be shown that their trip was work-related;
• Small errors on the claim form, such as the wrong code or outdated personal information; and
• Missing the deadline to file a claim – Florida law requires that a workers’ compensation claim be filed within 30 days of the injury.

Act Fast!

In most cases, a person whose workers’ compensation claim is denied has leave to appeal, and it is important to do so as quickly as possible. A clerical error on your claim can be dealt with swiftly in most cases, but even if the issue was substantive, the more time one can take to ensure their appeal is properly drafted, the better. More documentation may be necessary, or eyewitness testimony – anything the employee and their attorney believe may help their chances of success.

One thing to keep in mind for an injured employee, particularly while waiting for a reply, is that medical continuity is crucial. In other words, continuing any kind of medical treatment can help to show an insurer that the person’s injury is serious and worthy of a doctor’s care. It may mean spending some out of one’s own pocket, but it is all too easy for an insurer to conclude that an injury is simply not serious if the injured employee stops seeking medical treatment.

Contact An Orlando Workers’ Compensation Attorney

Being denied workers’ compensation benefits can be frightening for an injured worker, but in most cases, a denial is not the end of the road. An Orlando workers’ compensation attorney from the Hornsby Law Group can help give you the best chance possible to receive the benefits you deserve. Call our office today to schedule a consultation.

Source:

myfloridacfo.com/division/wc/employer/coverage-requirements