Anybody is at risk of suffering a severe workplace injury no matter their occupation. Luckily, the state of Florida requires that employers who have four or more personnel should carry a workers’ compensation insurance policy to protect their employees in case they suffer an injury or illness.
Unfortunately, getting benefits isn’t always easy as employers and their insurance carriers often delay, deny, or significantly lower the payable amount. This in turn leads to workers’ compensation disputes in Clearwater, Florida.
If you believe your claim has been unjustly denied, the Clearwater workers’ compensation lawyers at WorkInjuryRights can assist you to receive your rightful benefits. We can assist you through the appeals process and prove your denial of benefits case.
Contact us at 954-388-8616 for a no-cost, no-obligation consultation.
Causes of Workers’ Compensation Disputes
There is a plethora of reasons why your workers’ comp claim may get denied. Knowing what are the precise grounds for the denial is key to determining your next move and whether your claim has merit. The insurance provider must send you a ‘Denial of Claim’ letter highlighting the grounds for Denial.
Your employer and their insurer may use the following factors to reject your workers’ compensation claim.
Employment Status
Your employer may argue that you are not a staff member in their business and thus disqualify you from workers’ comp benefits. Don’t wait to get fired to file a claim. Report and file your workers’ comp claim in Clearwater immediately following your work injury.
Outside Scope of Employment
Your employer may dispute the claim based on the location the injury occurred. If you got hurt outside the scope of work, it will be difficult to prove your eligibility to get workers’ compensation benefits.
Lack of Causation
Your employer may contest that your injury wasn’t directly caused by a work accident.
Missed Deadline
Florida law requires you to report your work accident within 30 days to your supervisor or employer. Missing the deadline to notify your employer and filing the workers’ compensation claim too late are grounds for Denial.
Inadequate Information
The insurance carrier and your employer can cite that you don’t have sufficient evidence to prove the work injury. For example, you may not have reports from witnesses or an official report to the supervisor.
What to Do if Your Workers’ Comp Claim Is Denied in Florida
There are several grounds your employer and their insurance provider may deny your workers’ compensation claim, but you’ll be pleased to hear that they don’t have the final say. In Florida, you can appeal for your denied claim. Here’s how to go about it.
Request Hearing
Regardless of why your compensation claim has been denied, you’ll have to submit a Petition for Benefits claim within two years after the work injury with the Division of Workers’ Compensation in Florida, where a judge will be given your worker’s comp case. The judge often gives room for both parties to resolve the matter through mediation.
Mediation
If dispute resolution methods fail, you can request a hearing with the Office of the Judges of Compensation Claims (OJCC). The judge will review the case and make a verdict within 30 days.
Contact an Attorney
Immediately you receive the ‘Denial of Claim’ letter, you should consult with a skilled worker’s compensation lawyer. Our dispute attorneys at WorkInjuryRights are versed in negotiation techniques and will aggressively fight for maximum compensation during the mediation. We will fight to get a favorable settlement for you.
Our attorneys will conduct an independent investigation into your case, gather necessary medical documents, carry out legal research, handle discovery, and take depositions from relevant parties including physicians and medical experts.
Types of Workers’ Compensation Disputes
Workers’ compensation disputes happen for various reasons. The most common ones include:
Medical Disputes
After a workplace injury, the insurance coverage of your employer should cover all your medical treatment costs. But there are cases when your employer and their insurance carrier may reject your claim based on medical grounds.
Your employer may argue that you already had a pre-existing condition, had suffered the injury prior to the said accident, or that injuries sustained were self-inflicted.
Claim Disputes
Claims disputes arise when your employer and their insurance carrier deny your claim on the grounds that you didn’t follow the rules and guidelines of workers’ comp claims in Florida. For instance, the insurance carrier may argue that you missed the deadline for reporting your claim or that you sustained the injury outside the scope of employment, and so on.
Workplace injuries can put your financial future in jeopardy, interfering with your goals and disrupting your life. Florida employment laws safeguard injured workers, and you are entitled to seek coverage for medical treatment, lost wages, and other expenses if you suffer an injury while on the clock.
If your employer or the insurance carrier denies or tries to underpay your claim, you can turn to our Clearwater workers’ comp lawyers at WorkInjuryRights.
Workers’ Compensation Dispute and Appeals Process in Florida
Contact the Employer Assistance and Ombudsman Office to put forward your worker’s compensation dispute. They will reach out to the insurance provider to see if there’s an amiable to resolve the dispute.
If that doesn’t go through, our Clearwater lawyers will help you file a Petition for Benefits within two years from the date the work injury occurred. Our lawyers will present this to the OJCC. The OJCC will then move to notify your employer and their insurance carrier, who are mandated to give a response within two weeks or pay the worker’s comp benefits.
Your case may go through mediation. These are unofficial meetings that occur outside the court and have an unbiased party present. Our workers’ compensation dispute lawyers will push your agenda to get maximum compensation during this meeting.
If negotiations fall through, the case will go to a pre-trial hearing. The judge will review the case and make a judgment. A hearing will be convened in 90 days and the ruling will be made within 30 days of hearing the closing statements.
Consult Us Now to Evaluate Your Clearwater Workers’ Compensation Dispute!
An employer and their insurance provider may contest the employee’s right to coverage and deny their claim. If this happens to you, you should hire a seasoned worker’s comp dispute attorney in Clearwater, Florida.
Our WorkInjuryRights attorneys are experienced and know how to traverse these proceedings and can help with the Florida workers’ compensation disputes and resolution process.
Call us today at 954-388-8616 for a free consultation and case review!
