Why Was My Workers’ Compensation Claim Denied?

For most cases involving workplace injuries, workers’ compensation is the only possible avenue for an employee to obtain relief. However, not every claim for benefits is approved; between 10 and 25 percent are denied each year. If you have received a notice that your claim for benefits was denied, it can be a frightening moment, but in some cases, you may be able to file a petition for appeal.

Timing Issues

Perhaps the most common reason a workers’ compensation claim is denied is due to timing-related problems. Florida law requires that anyone injured on the job inform their employer of what happened within 30 days of the accident (or within 30 days of an occupational disease being diagnosed). There are many reasons why people report late – they may fear retaliation from their employer, they may have thought the injury was more minor than it actually was, or they may have simply forgotten.

Another timing-related reason given for denying a workers’ compensation claim is an argument that an injury was not work-related. Depending on the timeline of a specific incident, an insurer may try to argue that the person was injured while engaged in a non-work activity or on their own time, using medical records (or lack thereof) and surveillance to try and prove their point.

(Alleged) Pre-Existing Conditions

Another common, if more insidious, argument for denial of benefits is an alleged pre-existing condition. If a person has a pre-existing condition affecting the same bodily area where an injury occurs, it can be more difficult to assess how much of a person’s pain stems from their injury and how much from a pre-existing condition. However, this should not immediately mean a denial of benefits – evidence like medical expert testimony can help make a better case on appeal.

While some refusals can be hard to overcome, it is often possible to file a Petition for Benefits, which is essentially an appeal to the Office of the Judges of Compensation Claims (OJCC). That said, it is crucial to act fast: while there is a time limit on making one’s original claim, there is a time limit on filing an appeal as well.

Contact An Orlando Workers’ Compensation Attorney

If you have been injured at work, it is important to file a claim for workers’ compensation benefits as quickly as possible, but the right Orlando workers’ compensation attorney from the Hornsby Law Group can help, and if your claim has been denied, an attorney can make the process of filing an appeal go more smoothly. Contact our office today to schedule a consultation.

Source:

leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.185.html