Florida Workers’ Comp Complaints, Denials, and Appeals
- “My Claim Was Denied.”
The initial denial of a worker’s compensation claim occurs with greater frequency than most realize. Insurance companies and the adjusters that handle claims are under pressure to pay out as little as possible. Through paying out as little as possible on claims, they ostensibly can keep premium costs lower. The reality is that they increase their profit through claim denials, and denials of both medical care and lost wage payments. Florida worker’s compensation insurance companies have not reduced premiums in well over a decade.
- “It’s Taking Too Long to Process My Claim.”
An entirely denied work comp claim can take up to a year or more to resolve. Benefits you’re entitled to receive but are not receiving due to a work comp carrier’s refusal to authorize necessary medical treatment vary in the length of time taken to resolve. What remedies you have in order to expedite the process of receiving medical care of wage loss benefits is the filing of a Petition for Benefits. A consultation with our office is free. Call us at: (727) 312-3748 or visit www.bettercallbrendan.com We’re conveniently located in downtown New Port Richey on Main Street, at 5435 Main Street, New Port Richey, FL 34652
- “The Settlement Amount Isn’t Fair.”
There is no right to a settlement of a worker’s compensation claim. Settlements occur as a result of mutually voluntary decision between you and the insurance company. Because the insurance company can’t force you to settle your claim, and you can’t force them, there will never be a Judge or Jury to determine the value of your case. Our goal in every work comp case is to obtain as much as possible for our clients. There are many benefits individuals are unaware they’re entitled to, as well as numerous ways in which we can help maximize their settlement amount.
- “My Employer Fired Me Because I Can’t Return To Work.”
An employer cannot legally terminate a worker because he files a workers’ compensation insurance claim. However, because Florida is a right to work state, an employer can fire an employee for many reasons, or no reason. There are exceptions to the freedoms an employer has in regard to terminating an individual. An employer CAN NOT terminate an individual for reporting or filing a work comp claim. An employer has an obligation to make a reasonable accommodation to injured employee after a work accident. If an employer cannot make a reasonable accommodation, the employer can terminate the employee or simply await a change in their medical condition that allows them to return to work in an accommodating position. This is one of the most complicated and detail-oriented areas of worker’s compensation law. A free consultation with our office will help you understand your rights and your employer’s obligations.
5. “I’m Still Suffering from Pain and Discomfort.”
Unfortunately, there is no value attributed to pain and suffering in a worker’s compensation claim. Pain is subjective and impossible to accurately measure. While a doctor may diagnose an injured worker as reaching maximum medical improvement, the worker may disagree. If the MMI diagnosis or allowed recovery time are not acceptable, one option is to seek another medical opinion. The process in doing so is not as simple as most work comp insurance companies lead injured employees to believe.
Filing a Complaint
If you are being denied work comp benefits you’re entitled to, or they’re not being provide timely, you have the option of filing was is called a Petition for Benefits. Our office will file a Petition for Benefits on our client’s behalf based on what we’ve discussed with them in terms of benefits they’re entitled to but not receiving. Once a Petition for Benefits has been filed, the work comp insurance company has 30 days to provide the benefits requested.
Common Reasons for Claim Denials
There are a number of reasons why your claim may be denied. Among the most common are:
- Failure to Promptly Notify Your Employer of Your Injury
You have an obligation to report any work-related injury within 30 days. However, reporting any work-related injury and accident in as quickly a manner a possible is the best means of ensuring that benefits are provided timely and that your claim is not denied. - Failure to File Your Claim within the Statutory Time Period
Reporting your injury and filing your claim are two different processes. There is a statutory time period in which you must formally file your workers’ comp claim, referred to as the filing of a Petition for Benefits within the period known as the Statute of Limitations period. In Florida, a work comp claim must be filed within 2 years of the date of accident. - Your Injury Occurs Outside of Employment
Your injury must occur in the course and scope of your employment or arise out of conditions directly attributable to your work duties. There are exceptions to this requirement wherein an injury that occurs outside of normal working hours and at a location other than your place of work are accident for which work comp benefits are due. Contact our office to determine if your claim is one in which the work comp carrier should provide benefits. - Your Injury Occurs While You Are Under the Influence
Regardless of how hard you work, how long you’ve been employed, or what type of work you’re doing, if you are under the influence of illegal narcotics or alcohol when you’re injured, expect your claim to be denied. Most employers will require that you submit to a post-accident drug screen. If the results of that drug screen are positive, there a presumption that your accident and resulting injuries occurred as a result of the intoxication. - Your Employer Disputes Your Injury Claim
An employer may dispute your claim by stating that your injury is pre-existing, it occurred outside of the scope of your employment, or that your report of your accident and resulting injuries has been fabricated. We encounter such situations on a regular basis and can inform you as to how best to proceed.
Appealing a Denied Claim
Appealing a denied claim occurs when you file a Petition for Benefits. You have a right to dispute any denial. You will likely receive a notice of denial in the mail. If that occurs, contact our office. Again, the consultation is free. Contact us at (727) 312-3748 or visit www.bettercallbrendan.com
Missing the filing deadline for your appeal can end any possibility of getting compensation. Be sure to review the workers’ comp regulations and appellate deadlines in your state.
The Role of Attorneys
The initial filing of most workers’ comp claims can be handled without an attorney. When you believe your claim is being unnecessarily delayed or has been unfairly denied, you may need legal assistance. Most workers’ comp attorneys will not charge for an initial office consultation. You have nothing to lose and everything to gain by visiting with one or more.