When you get ready for work in the morning, the last thing you expect is to end up injured while performing your duties. However, this is an all too common occurrence for many. However, workers’ compensation can help provide compensation for medical treatment and a portion of lost wages for those injured while on the job. Unfortunately, you may file a workers’ compensation claim only to find that it has been denied. If this reflects our circumstances, the following blog explores what you must know about these circumstances and how a Broward County work injury lawyer can help you appeal your workers’ compensation decision.
What Is Workers’ Compensation?
Workers’ compensation is a form of insurance that employers carry that generally prevents them from facing a lawsuit from injured employees. This helps pay for the expenses a worker can incur if they are hurt or fall ill while performing their job duties. These benefits can cover medical costs, lost wages an employee endures while they take time off to heal, and funeral expenses.
In Florida, workers’ compensation is mandatory for most employers. However, the minimum number of employees required to carry the insurance will vary across industries. In general, all construction companies with one employee must have this insurance, while non-construction companies with more than four employees are required to hold workers’ compensation insurance.
If you wish to pursue compensation following a Broward County work injury, you must take the proper steps. This includes alerting your supervisor, completing a report, and seeking medical attention from a company-approved doctor. However, if it is an emergency situation, you may seek immediate medical treatment at the nearest hospital, regardless of whether or not it is approved.
Why Workers’ Compensation Claims Get Denied or Reduced in Florida
A denial or reduced award does not always mean that a worker is not eligible. In many instances, disputes over workers’ compensation are the result of documentation errors, employer challenges, or procedural issues.
Common Reasons Claims Are Denied
- Injury reported outside of employer deadlines
- Employer disputes the circumstances of the injury (outside of work hours or outside of the scope of employment)
- Alleged pre-existing condition
- Lack of medical documentation
- Treatment from an unauthorized provider
- Missed or incomplete documentation
Reasons a Benefit Award May Be Lower Than Expected
- The average weekly wage calculation was incorrect
- Errors in impairment rating
- There may be disputes about work restrictions
- Limited authorization for ongoing care or therapy
Steps to Take After a Workers’ Compensation Denial in FL
If your workers’ compensation claim has been denied in Broward County or across Florida, it’s important to understand how to appeal. The first thing you should do is discover why your claim was denied and gather documentation to support your dispute.
Actions to Take Immediately
- Request a written copy of your denial decision if you were not given one
- Confirm that the stated reason for the denial is accurate
- Ask your physician for updated medical notes
- Gather all documentation of the accident, including witness statements, incident reports, and employer records
- Verify that you reported the injury before the 30-day deadline
- Confirm all forms and documents are correct and were submitted on time
How to Challenge a Workers’ Compensation Decision in Florida
In some states, when workers’ compensation is denied, most appeals will proceed through an appeals board. However, in Florida, these disputes are handled through a petition for benefits before a hearing with the Office of the Judges of Compensation Claims (OJCC).
Florida Workers’ Compensation Dispute Process
- File a petition for benefits with the OJCC
- Wait for the employer or their insurer to respond to the petition
- A mandatory mediation hearing will be set
- If the case cannot be resolved, a pre-trial hearing will occur
- A compensation claims judge will hear the case and issue a final order
When a Case May Be Appealed Further
- Legal error in the application of the Florida workers’ compensation law
- Evidence was improperly excluded from consideration
- The judge was incorrect in their legal interpretation of the law
Mediation vs. Final Hearing: What Workers Can Expect
While hearings can and do occur, the large majority of workers’ compensation claims are resolved during the mandatory mediation hearing.
Mediation May Help Resolve Disputes Regarding:
- Temporary vs. permanent disability status
- Work restrictions
- Denied medical treatment
- Wage calculations or back-pay
Issues More Likely to Proceed to Hearing
- Employer claims the injury did not occur at work
- There are allegations of fraud or misrepresentation of injuries
- There are complex medical disputes
Deadlines and Time Limits Workers Should Know
Unfortunately, the workers’ compensation timeline can be incredibly overwhelming, which is why familiarizing yourself with the timelines is critical to avoiding a denial or dispute based on this reason.
Common Florida Workers’ Compensation Timeframes
- Injuries are typically required to be reported within 30 days of when the worker knew or should have known about the injuries
- Most Petitions for Benefits must be filed within two years
- Depending on the type of benefit, the disputes may have shorter requirement windows
Connect With Our Broward County Injury Attorneys Today
At the Finizio Law Group, we understand the complexities of workers’ compensation and the impact that these injuries can have on your life. As such, we will do everything possible to assist you through these challenging times. Contact us today to learn more about how we will fight for you.
