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
  • 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.

Florida workers comp claim 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.

Florida’s Many Agricultural Workers

Florida has among the highest levels of employment in the agriculture industry nationally. This presents some potential problems in filing successful workers comp claims.

Between 37% to 47% of Florida’s agriculture workers are undocumented. Even though Florida law allows for these workers to qualify for workers’ compensation, their circumstances may prevent them from satisfying the requirements of a successful claim.

For example, if an undocumented worker has no healthcare insurance, they may be unable to provide sufficient documentation of their medical history. Additionally, fear of adverse consequences may cause these workers to leave out certain identifying information in their claims, which will also lead to a denial.

Notably, the laws describing which workers count as “employees” that employers are required to provide workers’ compensation insurance for are complex when it comes to agriculture workers. Because of this, an employer may deny that you are eligible for benefits due to the specific circumstances of your employment.

Florida’s High Proportion of Independent Contractors

Reports from 2020 have shown that Florida has the highest proportion of “gig workers” nationally, at 22%.
Similar to the agriculture industry, employers whose workers fall under the definition of “independent contractor” are not required to provide workers’ comp coverage to employees, excluding those in the construction industry.

So while an employer may offer workers’ compensation to other non-contractor employees, they may deny your claim if they believe you do not meet the qualifications of an “employee.” In this situation, you should contact an attorney to find out if you may be eligible for benefits.

Contact Us for Help With Your Case!

While high rates of workers’ compensation denials may seem discouraging, our skilled attorneys will work with you to make sure your case has the best chance of success. Our Florida workers’ compensation lawyers will assist you by:

  • Reviewing your claim
  • Filling out forms completely and accurately
  • Handling disputes with employers and insurance companies
  • Filing appeals after a denial.

Reach out today! An initial consultation is offered at no cost for new clients. We have skilled bilingual attorneys, making our firm accessible to Florida’s Spanish-speaking workers.

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