How To Navigate The Denial Of Workers’ Compensation Claims in Florida

Key takeaways:

• Employers are expected to accept or deny a claim within 14 days, but the reality is often different.
• If a claim is denied, it’s best to hire a lawyer promptly to help litigate the denial.
• It’s unlikely for an injured worker to successfully navigate a denied claim on their own, due to the technical specifics required by the system.

If a workers’ compensation claim is denied, it can be a frustrating and overwhelming experience, but hiring an attorney as soon as possible can give the injured worker the best chance at getting the care and treatment they deserve.

What Are Some Of The Most Common Reasons That Workers’ Compensation Claims Are Denied?

One of the most common reasons for workers’ compensation claims to be denied is when the employer or carrier believes that the main cause of the injury is not related to the employee’s work. This can happen when there is a question of whether an employee has made a pre-existing condition worse during their employment.

Another common reason for denial is when the employer or carrier believes that the employee has made a false statement about their injury or condition. This can include misrepresentations to the employer, the carrier, or a treating medical provider. It is important to note that in Florida, making a false statement about a workers’ compensation claim can result in felony charges.

How Long Does An Insurance Company In Workers’ Comp Have To Accept Or Deny A Claim In East Central Florida?

Employers are typically expected to accept or deny a claim within 14 days of their knowledge of it. However, if an employer simply fails to respond to a claim, the employee is required to confer with the employer and carrier in good faith and try to resolve the matter without judicial intervention.

If they cannot, and the employee files a formal petition for benefits, the carrier has up to 30 days to respond to that petition. It is important for injured workers to confer with a lawyer sooner than later to start the clock ticking with the petition being filed with the office of the Judge of Compensation claims.

What Step Do I Need To Take If My Florida Workers’ Compensation Claim Is Denied?

If a workers’ compensation claim is denied, the first step is for the employee or their representative to confer with the employer and carrier in good faith to try and resolve the claim without the need for litigation.

If an agreement cannot be reached, a formal petition for benefits must be filed with the Office of the Judge of Compensation Claims. While some employees may be able to file a claim on their own, it is generally recommended to seek the assistance of counsel to ensure the claim is technically precise and complete.

Do I Appeal A Denied Workers’ Compensation Claim Or Should I Just Start Over And Reapply?

In Florida, if a workers’ compensation claim is denied, the best course of action is to seek the assistance of an attorney to litigate the denial before the Office of the Judge of Compensation Claims. This is the most efficient and effective way to challenge the denial, rather than pursuing other administrative appeals.

However, it’s important to note that in rare cases, a carrier may involve a managed care agreement for providing care and treatment. In these cases, an injured worker may be required to exhaust any grievances through the managed care agreement before bringing the claim to the judge’s attention. Experienced workers’ compensation attorneys can help determine if this process applies to a specific case.

When Should I Hire A Daytona Beach Area Workers’ Compensation Attorney To Help With My Denied Claim?

If a workers’ compensation claim is denied, it is important to seek legal assistance as soon as possible. An experienced attorney can help ensure that the denied claim is properly litigated, and that the injured worker receives the care and treatment they are entitled to in a timely manner. Delaying legal action can prolong the process and prevent the injured worker from getting the benefits they deserve.

Do I Need To Hire An Experienced Daytona Beach Area Workers’ Compensation Attorney? Or Can I Handle A Deny Claim On My Own?

It is possible for an injured worker to handle a denied claim on their own, but it can be difficult due to the administrative process and the legal requirements for proof. A lawyer can help navigate these complexities and increase the chances of a successful outcome. For more information on the Denial Of Workers’ Compensation Claims In FL, an initial consultation is your next best step.