What to do if your Florida workers compensation claim is denied

Workers Compensation Notice of Denial

Imagine this scenario: you're a stellar employee who always goes above and beyond at work. You pick up extra shifts and do all your work without complaint. Then one day, through no fault of your own, you get injured at work. You report your accident to your employer and  you're thinking, "Ok, I'll be fine, my employer has workers compensation insurance." Then you receive a Notice of Denial stating that all your benefits are cut off. How will you get by and...

provide for your family? 

This situation occurs more often than you think. While most insurance companies play by the rules, some are hoping you'll give up and walk away. It saves them money if they don't provide you the medical attention you deserve. 

In general if you don't have an attorney at this point it is highly recommended that you speak with an experienced Florida workers comp lawyer. A Notice of Denial means that the insurance company has denied your claim. This isn't the end of it. There are countless times when the insurance company sends a Notice of Denial only to backtrack once an attorney is involved. 

Reasons for a Notice of Denial:
There are many reasons a claim can be denied. On the Notice of Denial it should state why your claim was denied. Some of the more common reasons include:

1. Pre-existing Injury: The insurance company is claiming that you were injured before the workplace accident.
2. Untimely Reporting: Workers compensation accident must be reported within 30 days of the accident. See more.
3. Major Contributing Cause: The insurance company is claiming that the accident did not cause the injury.
4. Intoxication: The insurance company is claiming that you were under the influence of drugs or alcohol. 
5. Fraud: The insurance company is claiming that you are trying to commit insurance fraud.

These are some among many reasons that the insurance company could be denying your benefits. 

The most important take away here is the insurance company does not have final say over a denied claim - that is left up to the judge.

If you receive a Notice of Denial, the next step is to file a Petition for Benefits. A Petition for Benefits is a legal document used to request benefits from your workers comp insurance. These benefits may include: appointments with doctors, prescriptions, surgeries, lost wages, in home care, and disability payments, among others. 

Once a Petition for Benefits is filed, the litigation process starts. The general timeline is:

1. Notice of Denial: The insurance company denies your claim for benefits.
2. Petition for Benefits: You formally file a Petition seeking benefits under workers compensation and requesting the court to resolve the dispute. 
3. Mediation: You meet with the insurance company, the employer, and the mediator. The mediator will try to resolve the dispute.
4. PreTrial Hearing: This occurs about a month before the Final Hearing. At the PreTrial Hearing the parties exchange exhibit and witness lists and agree to some specifics about the case. 
5. Final Hearing: The Final Hearing is your opportunity to be heard by the Judge. The Judge will examine the submitted evidence and enter an order within 30 days. 

If the judge doesn't rule in your favor, you can still appeal the decision if you meet the timeline and very specific appellate requirements.

Workers compensation is a complex area of law with many pitfalls and deadlines. If you received a Notice of Denial it’s important to hire an experienced Florida workers comp lawyer, such as Attorney Andrew Graves. Your lawyer will be able to gather evidence, negotiate with the insurance company, protect your rights, and secure maximum compensation for your Florida workers comp accident.

Call Attorney Andrew Graves at (407) 308-0327 or fill out the free case consultation form ​so we can start working today.