- Workers' Compensation
Most employers have every intention of doing the right thing when an employee gets hurt on the job. Unfortunately, there are certain businesses that will do whatever they can to deny their employees’ workers compensation claim. Our Tampa workers comp attorneys will find out why your claim was denied and file an appeal. If need be, they will sue your employer on your behalf.
Here, we’ll discuss some of the more common reasons why the insurance company may deny your workers compensation claim. If your claim has been denied and you are looking for a Tampa workers comp attorney to get you the benefits you deserve, contact our office directly.
Did the Insurance Company Deny Your Claim Because You Weren’t Acting Within the Scope of Employment?
When you’re injured at work, the last thing you want to hear is that your claim has been denied. The first thing you should do is find out why it was denied. One of the main reasons your work injury claim would be denied is that you weren’t acting within the scope of your employment.
What Does Scope of Employment Mean?
Our Tampa workers comp attorneys handle many cases where a client’s injury claim was denied because they weren’t acting within the scope of their employment. What this means is that, at the time of your accident, you were performing duties that are not part of your job description.
While the insurance company is the one who denies your claim, this decision is often based on information your employer provided to them. For example, if you’re a waitress, it wouldn’t be part of your job description to carry in new delivery crates.
However, if your manager demands that you perform this task, you shouldn’t be penalized.
Determining Your Scope of Employment Is Often Subjective
It doesn’t seem fair that you could be denied benefits for doing your job. It’s easy for an employer to argue that an employee was not acting within their scope of employment at the time of their accident.
What your Tampa workers comp attorney will do is gather evidence to show that you were, in fact, doing your job as instructed. Your Tampa injury lawyer will demand the following information from your employer:
- A copy of your job description
- Copies of any disciplinary forms issued to you for behaving this way in the past
- Company policies and procedures relating to this topic
- A copy of the Employee Handbook
- The names and contact information for all employees in the same position as you
This last piece of information will be critical. Your Tampa workers compensation lawyer is going to want to talk to your coworkers. They will specifically be looking to see if other employees typically work outside their normal scope of employment.
What If the Insurance Company Still Refuses to Pay You Benefits?
If the insurance carrier denies your appeal, you still have options. Florida law allows you to appeal your claim further to the Offices of the Judges of Compensation Claims (OJCC). The process can be a bit dauting. However, your Tampa workers comp attorney will handle all this for you.
Your initial appeal to the OJCC must include the following information:
- Your claim identification information
- Details of your workplace accident
- The type of injuries you suffered
- The benefits you’re demanding
Your employer, through their insurance carrier, will have a chance to respond. The OJCC will require the two parties to attend informal mediation. Ideally, the issue will be resolved there.
If the insurance company continues to deny you benefits, you can always file an appeal with the First District Court of Appeals in Florida.
Your Tampa Workers Comp Attorney Will Try to Resolve the Matter as Quickly as Possible
Filing an appeal is one thing. Having to wait months or even a year to get a final answer can be frustrating. By the time the First District Court of Appeals hears your case, a year may pass.
Most workers cannot afford to go that long without income. Not only that, but your medical bills will continue to pile up while you’re waiting on the court’s final order. Thankfully, while this is all going on, your lawyer will continue to try to settle the matter with the insurance carrier.
What Are the Odds That the Insurance Company Will Relent and Pay Your Claim?
While they aren’t in the same position as you, the insurance company does want to resolve your claim. They want to resolve the matter and close your file. By the time your formal appeals are filed, there’s a good chance that you’ll be back to work.
If this is the case, your Tampa workers comp attorney will demand back pay for the weeks you were out of work. They’ll also want to make sure any medical bills are paid.
Ideally, once your lawyer submits proof that you were acting within the scope of employment, the insurance company will agree to settle your injury claim. Most workers compensation cases are settled at some point before you get to the final appeal. There is a strong likelihood that yours will too.
If Your Claim Is Denied, Contact One of Our Tampa Workers Compensation Lawyers
If your injury claim has been denied and you need help filing your appeal, contact an experienced Tampa workers comp attorney. All you have to do is call our office at (954) 324-COMP and speak with one of our representatives. They can help schedule your free, initial consultation.
