Why Are Denial Rates So High for Workers’ Compensation?

Florida workers face some of the highest denial rates for workers’ compensation. The national denial rate averages at over 7%, while in Florida this denial rate sits at over 10% overall. As many as 25% of Florida workers comp claims are initially denied.

Why are so many workers comp claims rejected? This article explores the biggest reasons. If you are looking to file for workers’ compensation, our talented Florida work injury lawyers can give you the best chance of success. We also help many clients whose claims were denied appeal and obtain the benefits they need.

Call today and let us help you navigate the process.

Why Workers Comp Claims Are Denied

Once a claim is filed, there are a few common reasons why it could be denied. By working with an experienced workers’ compensation lawyer, you can improve the likelihood of a successful claim.

• The employer/insurance company says the injury is not work-related.
  • Accidents on a lunch break or during your commute usually aren’t covered.
• You aren’t eligible if you got hurt because you were under the influence of alcohol or drugs.
• Failure to seek medical treatment
• Medical care that is out-of-network is generally not covered by your employer’s workers’ compensation insurance.
  • You must also comply with medical requests made by the insurance company.
• Missed deadlines
  • You must report your injury to your employer within 30 days of the accident or the time when you noticed the injury. Your employer is required to report the claim to the insurance company within 7 days of learning about your injury.
• Insufficient/incomplete information on the application
• Your injury is not considered severe enough.
  • Mental health is not generally covered unless the mental condition is directly linked to a work-related physical injury or illness.
• The employer/insurance company disputes the amount of benefits owed.

Reasons for Florida’s High Denial Rate

There are specific circumstances behind the especially high denial rate for workers’ compensation in Florida.

Strict Workers Comp Fraud Provisions

Any misrepresentation in the claim for workers’ compensation benefits can denied, and the employee can be reported for workers’ comp fraud. It is essential that your claim is as detailed as possible, including any pre-existing conditions you may have.

If you have a preexisting injury, you must have sufficient documentation to prove that it was made significantly worse by the work-related injury. Some claims may be rejected because the insurance company or employer believes that the pre-existing injury was the main cause of the current injury.

If your employer gives inaccurate or insufficient information on the claim, they can also be reported for fraud, and the claim can be denied.

Employer-Friendly Workers Comp Laws

The employer is required to supply medically necessary treatment, which requires the employee to attend many doctor visits on the employer’s timeline. The scheduling may not be convenient for you and could cause you to miss appointments/deadlines after reporting your injury to your employer.