Navigating the workers’ compensation process can be challenging, especially when you’re already dealing with the aftermath of a workplace injury or illness. One of the most frustrating aspects of this process is having your workers' compensation claim denied. If you're in Orlando, FL, and have encountered a denied claim, understanding why this happens is the first step toward resolving the issue.
This blog will break down the common reasons workers' compensation claims are denied and explain how to handle denied claims. If you’re in need of professional assistance, ARL Attorney in Orlando, FL, is here to help.
Workers' compensation is a type of insurance that employers in Florida are required to carry to provide benefits to employees who are injured or become ill while performing their work duties. These benefits often include medical expense coverage, wage replacement, and rehabilitation services. While the system is designed to be supportive, not all claims are approved without questions.
Florida law requires workers to report any workplace injury to their employer within 30 days. Failing to meet this deadline can lead to your claim being denied. If you delay reporting, you're giving the insurer grounds to argue that your injury may not have occurred at work or was not as serious as you claim.
Pro Tip: Always report your injury immediately, even if you’re unsure of its severity. Early reporting ensures that there’s a documented timeline of your injury.
For a workers' compensation claim to be approved, you must prove that your injury or illness occurred as a direct result of your job duties. Claims may be denied if the insurance company believes the injury happened outside of work, was due to a pre-existing condition, or wasn’t linked to your responsibilities at work.
For example:
Pro Tip: Maintain solid documentation, such as witness accounts and medical reports, connecting your injury to work-related activities.
Medical evidence is one of the most critical aspects of a workers' compensation claim. If you fail to attend scheduled medical appointments, or if your doctor’s records do not corroborate your claims, the insurer may reject your application. Insurers often scrutinize medical records for injuries that are inconsistent with the type of accident you’re claiming.
Pro Tip: Seek immediate medical attention after your injury and follow all doctor-recommended treatments. Retain copies of all medical evaluations, treatments, and prescriptions as evidence.
Filing a claim involves a lot of paperwork. Any mistake, such as incorrect details, missing signatures, or incomplete forms, can result in a denial. Insurers frequently deny claims based on minor errors in documentation because it raises doubts about the claim’s validity.
Pro Tip: double-check for accuracy when filling out forms or consider working with a qualified workers’ compensation attorney to ensure you comply with all required steps.
Employers and insurers sometimes question the validity of a claim if they believe it’s exaggerated, fraudulent, or caused by an employee’s negligence. For instance, if substances like alcohol or drugs contributed to the accident, the employer or insurer might use this as grounds to deny your claim.
Additionally, your employer might deny your version of the events leading to the injury. This is more common in cases without witnesses or tangible evidence.
Pro Tip: Collect and preserve as much evidence as possible, such as photos of the accident site, statements from witnesses, and work logs.
Beyond reporting your injury to your employer, Florida law also stipulates that specific claims must be filed within two years from the date of the accident. Missing this deadline can result in an automatic claim denial.
Pro Tip: Act quickly to meet all deadlines. If you’re unsure about the timeline, consult an experienced workers’ compensation attorney to keep you on track.
Florida laws permit insurers to request an Independent Medical Examination (IME) to evaluate the extent of the injury. If the IME doctor’s assessment contradicts your primary doctor’s findings, your claim may be denied.
Pro Tip: Be honest and consistent at your IME. If the doctor's findings are unfavorable, your attorney can challenge the results.
The workers' compensation denial letter will include the reason your claim was denied. This insight is valuable for determining how to contest the decision.
Start collecting any additional documents that can support your case, such as:
If your claim is denied, Florida allows you to file a Petition for Benefits with the Division of Administrative Hearings. The appeal process includes mediation, and if your issue isn’t resolved, it can move to a hearing before a workers' compensation judge.
The appeals process can be complex, especially if you don’t have prior legal experience. A workers’ compensation attorney can help you build a compelling case, so you can focus on recovering from your injury.
Contact ARL Attorney in Orlando, FL
If your workers’ compensation claim has been denied, don’t take on the stress alone. ARL Attorney specializes in workers’ compensation cases in Orlando, FL, and has the experience needed to help you secure the benefits you deserve.
Whether you’re facing a denied claim or simply need guidance through Florida’s workers' compensation system, the right attorney can make all the difference. Here’s why:
At ARL Attorney, we pride ourselves on representing the workers of Orlando, FL, and getting them the compensation they deserve.
Preventing claim denials is always the preferred outcome. Follow these tips:
Dealing with a denied workers’ compensation claim in Orlando, FL, can feel overwhelming. However, understanding the common reasons for denials and arming yourself with the right evidence can help improve the outcome of your case.
If you need professional guidance to get the compensation you’re entitled to, don’t wait—reach out to ARL Attorney today. With our expertise, we’ll help you fight for the benefits you deserve.