Getting injured at work is tough and a denied workers’ compensation claim will make it even worse.
Let’s admit it. Not all injured workers are lucky to have employers willing to pay for workers comp. Most compensation claims get routinely denied without thorough evaluation. Some employers will even go as far as to threaten or fire those who file a workers comp claim.
If your employer or insurance company denies your work injury claim, know that you can still appeal their decision. But to effectively do that, you first need to know the reason behind the denial.
Top Reasons Why a Workers Comp Claim is Denied
Aside from your employer or insurance company not wanting to pay compensation, here are some common reasons why a workers comp claim is denied:
- There is doubt that the injury is work-related. One of the most important requirements in any workers comp case is that the injury must be work-related. It doesn’t necessarily mean that you got injured in the workplace. But you must establish that you suffered the injury while doing your job. Check out this post to know what is considered work-related injuries.
- You missed the filing deadline. Most states have a prescription period for workers comp claims. In Florida, for instance, you need to report your injury to your employer within 30 days after the accident or when you’ve known of your injury.
- Your medical condition doesn’t meet the state’s requirements. In most states, a work injury is only compensable if it affects your ability to work or do any kind of work. For instance, stress isn’t really a valid medical condition for workers comp benefits in most states.
- You received no medical treatment. In certain states, you must undergo medical treatment to receive compensation.
Appealing a Denied Workers Comp Claim
Since each state has different workers comp laws, the steps in appealing a denied workers comp can vary across the country.
In Florida, the appeal process starts with filing a Petition for Benefits at the Office of Judges of Compensation Claims. It must be filed within two years from the date of the accident or when the employee has known of the injury.
The judge will then schedule a mediation between you and the insurance provider. While waiting, you may be asked to submit more evidence of your injury or undergo a medical exam. If a settlement agreement isn’t reached at this point, you will proceed to a pretrial hearing.
During this hearing, you will need to prove why you deserve the compensation benefits. After hearing the arguments from both sides, the judge will then make a decision.
If you want your appeal to go in your favor, here are the things you need to know.
What to Do Before Filing an Appeal
Hire a Reliable Doctor
The extent of your injury is a major factor in determining how much compensation you’ll get. This is why you need a reliable doctor. They will conduct a medical examination on you and testify about your injury in court. They must be able to reliably assess your medical condition so you won’t be short-changed.
File an Appeal ASAP
Florida’s workers’ compensation law can be complicated. The Office of the Judges of Compensation also receives a lot of appeals a day. This is why your case can take months before a final decision is reached.
During this waiting period, you most probably are out of work. But you still need to provide for your medications, pay your bills and buy groceries. Thus, it’s best to file an appeal as early as possible so as to avoid missing out on benefits.
Hire a Workers Comp Lawyer
Appealing your denied worker’s comp claim will be an uphill battle. You need to prepare the right evidence and make a solid argument to win your case. Not to mention all the legal and bureaucratic processes that you have to hurdle.
This is why having an experienced workers’ compensation lawyer like Victor Malca is essential. He’s been in the practice for over 27 years so he knows the system like the back of his hand. The expertise of a workers comp lawyer will surely turn the tides in your favor.
Besides, your employer and the insurance company will have their own legal them. Thus, it just makes sense that you’ll also have yours to level out the playing field.
Filing Your Appeal
As mentioned above, the first step to filing a workers comp appeal is to submit a Petition for Workers Compensation Benefits to the Office of Judges of Compensation Claims (OJCC). If you have a lawyer, they can help you file the appeal. Otherwise, you can submit the form yourself by mail or through their online portal.
After you’ve filed the appeal, you will receive a case number assigned to your claim. What few people know though, is that they can actually track their application’s status online. Just go to the OJCC website and enter your case number. You can also search the case attributes such as the accident date, claimant’s name, and employer.
Once they receive your appeal, the deputy chief judge will forward it and all attachments to the presiding judge of compensation claims who will then review them.
If the points raised in your petition meet the statute’s requirements, the judge will then schedule a mediation. You and your employer will receive a written notice 5 days before the scheduled mediation.
What Happens During a Mediation?
Unlike a full-on court trial, a workers comp mediation is an informal negotiation event. This is where you and your employer will work out the terms of your workers’ comp settlement.
Since it’s an informal event, you don’t have to testify under oath and present witnesses. It’s just you, your employer or insurance company, and the mediator who is a trained, neutral third party. If you have a lawyer, they can negotiate with your employer on your behalf.
You, your employer, and your insurance company are legally prohibited from divulging any information disclosed during mediation. So you can discuss sensitive medical or personal issues without worrying about it becoming public knowledge.
If you reach an agreement after the mediation process, both parties will then sign an agreement settlement and you can get your workers comp benefits. If not, your appeal will proceed to the next stage of the process which is the pretrial hearing.
What Happens During a Pretrial Hearing?
As its name suggests, a pretrial hearing is where the two parties and the judge meet before the formal court trial. During this, documents and evidence may be presented. The judge will then decide which evidence may be presented or excluded during the formal hearing.
The purpose of pretrial hearings is to clear up any administrative issues that may arise during the actual hearing. Some of the things that happen during a pretrial hearing are:
- the judge decides if there’s a fair cause for trial
- filing necessary pretrial motions
- settling undisputed facts
- agreeing or denying claims
If the date of the final hearing isn’t yet set, the judge will also set its date during the pretrial hearing. After the pretrial hearing is concluded, the judge will issue both parties a 14-day notice of the final trial by mail.
What if Your Claim is Denied by the Judge?
During the final hearing, the presiding judge will evaluate the evidence and testimonies from both sides and issue a final decision. If your claim is denied, you will receive a denial letter after 30 to 90 days.
If you have any objections to the jury’s decision, you can file an appeal at your state’s court of appeals. The deadline for filing of appeal varies from state to state. In Florida, you need to file it within 30 days of receiving the jury’s decision. But in some states, it can be as short as a week or two. In most cases, the court of appeal’s decision is final.
If you have some questions about your compensation benefits, you need to seek advice from an experienced workers’ compensation attorney. It’s important to make sure that you will get all the benefits that you deserve.
Victor Malca Law P.A. has been defending the rights of Florida’s workers for more than 27 years. We specialize in workers’ compensation and social security benefits. We’ve helped thousands of workers to fight for their rights and get what they deserve.If you need help with your workers’ compensation benefits, contact us and get a free consultation.
VICTOR MALCA LAW – A TRUSTED NAME IN FLORIDA
Victor Malca P.A. has over 25 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success in fighting for his clients puts among the most trusted workers’ compensation lawyers in Florida. Our area of expertise is in representing injured workers on compensation benefit cases and disabled individuals claim social security disability benefits.
Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida. Book a free consultation today.
ABOUT THE AUTHOR
Judy Ponio is a writer for Victor Malca Law P.A. and enjoys helping people with questions about social security, workers compensation, and other serious matters involving people’s livelihood. She is not an attorney and her writing should not be considered legal advice.