What to Do If Your Coral Gables Workers Comp Claim Is Rejected

If you’re a worker in Florida and have been injured or fallen ill due to your job, you may be eligible for workers’ compensation benefits. However, if your claim is denied, the process can be quite challenging. This blog post will provide a step-by-step guide on what to do about a denied workers comp claim in Coral Gables.

Our Coral Gables workers comp lawyers can help you navigate the appeals process. Contact us today for a free consultation.

Initial Claim Filing – Receiving a Notice of Denial

The journey to receiving workers’ compensation benefits begins with reporting the injury to your employer using the “First Report of Injury or Illness” form. Your employer is then obligated to report the injury or illness to its workers’ compensation carrier. If you receive a Notice of Denial, it means that your claim for benefits has been rejected.

Steps to Challenge a Denied Workers Comp Claim in Florida

  • Reach out to the Insurance Company: This allows you to understand why your claim was denied. It’s also an opportunity to ask the insurance to reconsider their decision, particularly if you can provide additional supporting information.
  • Submit a Petition for Benefits: To challenge a denied claim, you generally need to file a Petition for Benefits within two years of your injury or one year of your last wage loss or medical payment, whichever is later.
  • Mediation Conference: According to Florida’s workers’ compensation laws, mediation must take place within 130 days after a Petition for Benefits is filed. The Office of the Judges of Compensation Claims (OJCC) informs all parties by order within 40 days after filing the Petition for Benefits that a mediation conference has been scheduled.
  • OJCC Hearing: If mediation doesn’t resolve the issue, your case will be scheduled for a hearing in front of the OJCC.
  • Appeal to the First District Court of Appeals: If you disagree with the decision of the judge, you can appeal to the First District Court of Appeals. This must be done within 30 days after receiving the judge’s decision.

Reaching Out to the Insurance Company

You and your attorney may try to resolve the dispute with your employer through informal negotiations. If your claim was denied due to a lack of documentation or a mistake in filing the claim, the insurance company may approve it once the issue is corrected.

If these efforts don’t yield results, your next step is filing the Petition for Benefits.

you can appeal a denied workers compensation claim in Coral Gables, Florida

Submitting a Petition for Benefits

In the event of a denial, you have the right to contest it. If you’ve filed a timely notice of injury or illness and received a Notice of Denial, you can file a Petition for Benefits with the Office of the Judges of Compensation Claims, or OJCC.

The Mediation Conference

Once your petition is filed and a judge is assigned, the judge will likely order a mediation conference. In mediation, a neutral party (the mediator) tries to help both sides reach a mutually agreeable solution. Mediation is more of an informal meeting than a trial, with no evidence presented or testimony given.

OJCC Hearing

If mediation doesn’t resolve the issue, your case will be scheduled for a hearing in front of the OJCC. This is similar to a civil trial, where evidence is introduced and testimony may be given. After the hearing, the judge will decide within 30 days whether or not you will be awarded workers’ compensation benefits.

Appeal to First District Court of Appeals

If the decision at this stage of the process is still unfavorable, you have the right to appeal the decision to the First District Court of Appeals. At the appellate level, a claim is reviewed based on the record, meaning you will not be able to present new evidence or give testimony.

The court may overturn the OJCC’s decision, agree with the decision, or send the case back to the OJCC for further deliberations.

Typical Reasons for Denied Workers Comp Claims in Florida

  1. Deadline missed: In Florida, you have a 30-day window from the date of your accident to inform your employer about your intention to file a workers’ compensation claim.
  2. Failure to seek immediate medical care: It’s crucial to get medical attention right after your injury. This helps substantiate your claim that the injury occurred at work.
  3. Disagreements over the work-related nature of your injury: Your employer might dispute that your injury occurred at work, suggesting instead that you were already injured when you came to work.
  4. Your condition doesn’t align with state guidelines: Being injured at work doesn’t automatically qualify you for benefits. The state has specific guidelines about the kinds of injuries that are eligible for the workers’ compensation system.
  5. Filing the claim post-employment: If you sustain an injury at work, it’s important to file a claim while you’re still employed. Filing a claim after leaving your job can disqualify you from receiving benefits.

Call Our Coral Gables Workers Compensation Lawyers

Legal counsel can guide you through the entire process of a work injury claim, including helping you decide whether to accept a workers’ comp settlement offer.

If your claim has been denied, you should consider hiring a Coral Gables workers’ compensation lawyer from Work Injury Rights to handle your appeal. Contact us at 954-833-5226 for a free consultation.