Workers’ compensation is designed to provide financial support and medical care to employees who are injured or become ill due to their jobs. However, the process isn’t always straightforward, and disputes can arise between the injured worker, the employer, and the insurance company. These workers’ compensation disputes can lead to delays in receiving benefits or even a denied workers’ comp claim.
If you’re facing a workers’ compensation dispute in Port St. Lucie, Florida, our team at Work Injury Rights is here to help you. Contact our Port St. Lucie workers’ compensation lawyers today for a free case review!
Common Causes of Workers’ Compensation Disputes
Workers’ compensation disputes can happen for a variety of reasons. Below are some of the most common causes of denied claims and disagreements over benefits:
- Cause of Injury: The employer or insurance company doesn’t believe the injury or illness is work-related.
- The Extent of Injury: The employer or insurance carrier thinks a worker is exaggerating their injuries or argues certain medical treatment isn’t necessary.
- Pre-Existing Conditions: The insurance company may argue that the injury is related to a pre-existing condition rather than a new work-related incident.
- Delayed Reporting: Your workers’ comp claim can be denied if you don’t report a work injury or illness within 30 days.
- Intoxication: Workers’ compensation won’t pay if an employee is hurt while drunk or under the influence of drugs. Your workers’ comp claim can be denied if you fail or refuse to take a drug test.
- Disability Rating: There may be disagreements over the impairment rating assigned by the doctor, which affects workers’ compensation benefits.
What to Do If Your Florida Workers’ Compensation Claim Is Denied
Having your workers’ compensation claim denied can be frustrating and stressful, especially when you are relying on benefits to cover your medical expenses and lost wages. If your workers’ compensation claim is denied in Florida, there are specific steps you can take to challenge the decision and seek the benefits you deserve.
The first thing you should do is contact a work injury lawyer for help.
Understand the Reason for Denial
The first step is to determine why your claim was denied. The insurance company should provide a written explanation outlining the reasons for the denial. Common reasons include a lack of evidence that the injury is work-related, late reporting of the injury, or disputes over the severity of the injury.
Contact the Bureau of Employee Assistance and Ombudsman
The Bureau of Employee Assistance and Ombudsman is a resource provided by the state of Florida to help injured workers understand their rights and resolve disputes with their employers or the insurance company. They can help mediate disputes.
File a Petition for Benefits
If your claim is denied, you have the right to file a Petition for Benefits with the Florida Office of the Judges of Compensation Claims. This petition formally requests a hearing where you can present evidence to support your claim and challenge the denial.
Gather Additional Evidence
To strengthen your case, gather any additional evidence that supports your claim. This may include medical records, witness statements, or documentation of how the injury has affected your ability to work. Your workers’ compensation attorney can help you build a strong case.
Contact a Workers’ Compensation Attorney
Navigating the appeals process can be complex, and having an experienced workers’ compensation lawyer on your side can significantly improve your chances of success. Our Port St. Lucie workers’ compensation lawyers can help you understand your rights, gather evidence, and represent you in hearings or negotiations with the insurance company.
Types of Workers’ Compensation Disputes in Port St. Lucie
Our Port St. Lucie workers’ compensation lawyers have helped countless injured employees resolve workers’ compensation disputes. Here are some of the most common types of disputes.
Medical Coverage Disputes
Your employer’s workers’ compensation coverage should pay for all necessary medical bills after a workplace accident in Florida. However, disagreements over medical treatment are common. The insurance company may argue treatments are not necessary or that the injury does not require ongoing care.
Benefit Disputes
Workers’ compensation disputes often involve disagreements over the amount of benefits the injured worker should receive. This can include disputes over the calculation of the average weekly wage, the disability rating, or the duration of benefits.
Return to Work
After an injury, disputes may occur over the worker’s ability to return to their job. The employer or insurance company may push for the employee to return to work before they are fully healed, while the worker may feel they are not yet capable of performing their duties.
Only the authorized workers’ compensation can determine if an injured employee is ready to go back to work. Workers have the right to request a one-time change of physicians.
Claim Denial
A denied workers’ compensation claim is one of the most significant disputes, as it can prevent the injured worker from receiving any benefits. This can happen for a variety of reasons, including late reporting, insufficient evidence, or disputes over the cause of the injury.
The insurance company may argue that the injury occurred outside of work or is related to a pre-existing condition. If your claim is rejected, you’ll need a skilled workers’ compensation attorney to appeal the decision.
The Workers’ Compensation Appeals Process in Florida
If your workers’ compensation claim is denied, you have the right to appeal the decision. The workers’ compensation appeals process in Florida involves several steps.
Having a knowledgeable workers’ compensation attorney by your side is essential. An attorney can help you navigate complex legal procedures, gather evidence, and advocate for your rights during hearings.
File a Petition for Benefits
The first step in the appeals process is to file a Petition for Benefits with the Florida Office of the Judges of Compensation Claims. This petition must be filed within two years of the date of injury or within one year of the date you received your last benefit. The petition should detail the nature of the dispute and the benefits you are seeking.
Mediation
Before a formal hearing, the parties involved in the dispute are typically required to participate in mediation. Mediation is an informal process where a neutral third party helps the worker, employer, and insurance company reach a mutually agreeable resolution. If the parties cannot agree during mediation, the case will proceed to a hearing.
Pretrial Hearing
If mediation is unsuccessful, a pretrial hearing may be scheduled. During this hearing, the judge will review the case, determine the issues to be addressed, and set a timeline for the formal hearing. The pretrial hearing is an essential step in the workers’ compensation appeals process, as it helps streamline the issues for the judge to consider.
Formal Hearing
The formal hearing is where both sides present their evidence and arguments before a judge. This may include medical records, witness testimony, and other documentation that supports the claim. The judge will then review the evidence and issue a decision regarding the disputed benefits.
First District Court of Appeal
If you disagree with the judge’s decision, you have the right to appeal the ruling. The appeal must be filed with the First District Court of Appeal within 30 days of the judge’s order. The appeals court will review the case and issue a decision based on the legal arguments presented.
How a Port St. Lucie Workers’ Compensation Lawyer Can Help
Dealing with a workers’ compensation dispute can be overwhelming, especially when you are trying to recover from an injury or illness. A skilled workers’ compensation lawyer in Port St. Lucie can provide the guidance and support you need to navigate the process and secure the benefits you deserve.
Here’s how a lawyer can help:
- Evaluate Your Case: A workers’ compensation attorney can review your case, identify potential issues, and help you understand your rights and options.
- Gather Evidence: To support your claim, a lawyer can help you gather the necessary evidence, including medical records, witness statements, and expert testimony.
- Negotiate with the Insurance Company: A lawyer can negotiate with the insurance company on your behalf to resolve a workers’ compensation dispute.
- Represent You in Hearings and Appeals: If your case goes to a formal hearing or appeal, a workers’ compensation lawyer can represent you and advocate for your rights before the judge.
Contact Us Today for a Free Case Review
Workers’ compensation disputes in Port St. Lucie, Florida, can be challenging and stressful, but you don’t have to face them alone. Whether your claim has been denied or you are dealing with other issues related to your benefits, the experienced Florida workers’ compensation attorneys at Work Injury Rights are here to help.
We understand the complexities of the workers’ compensation system and are committed to fighting for the rights of injured workers. Contact us today for a free consultation to discuss your case and learn more about how we can assist you.
