What To Do if My Workers’ Compensation Claim Is Denied

If you are injured on the job and your workers’ compensation claim is denied, you have the right to dispute a refusal by filing an appeal. Being injured at work is stressful enough. Having your workers’ compensation claim denied on top of everything else only adds more stress, but you have legal options to pursue the funds you need.

If you are not sure what to do if your workers’ compensation claim is denied, our legal team can help. Our workers’ compensation lawyer can help you file your appeal.

How Do I Appeal a Denied Workers’ Compensation Claim?

You can appeal the denied workers’ compensation claim with the help of our team. We can guide you through the appeals process, which, according to the Florida Department of Financial Services may include:

• Speaking with the insurance company or your employer
• Filing a Petition for Benefits
• Attending mediation
• Attending a hearing with a Workers’ Compensation Judge
• Filing an appeal with the 1st District Court of Appeal

The process of petitioning a denied workers’ compensation claim can be complex and confusing. You do not need to handle this process on your own. Our team will advocate for you throughout the claims process.

Why Was My Workers’ Compensation Claim Denied?

If you are injured at work, you will typically need to inform your employer within 30 days. As such, it is always better to report an injury to your employer as soon as possible to avoid unnecessary complications.

Once notified, your employer must file a report with their workers’ compensation insurance carrier about the accident within seven days. The insurer is then responsible for organizing an assessment of your injury and arranging your medical treatment. Unfortunately, while this process sounds straightforward, many legitimate claims are still refused. Let’s examine why your workers’ compensation claim might have been denied:

Your Employer Failed To Report a Work Injury

Your employer might not report a work injury if you did not require medical treatment or if you did not take sick leave. They could also say your injury happened outside the workplace or that you did not notify them in time. There is also the possibility your employer does not have workers’ compensation insurance.

To avoid this, be sure to report your injury as soon as possible and ask your employer to confirm they know about the accident and your need for medical attention. You can also ask who provides your employer’s workers’ comp insurance or find the information posted about this in the workplace. If your employer is slow to report an accident, you can notify the insurer yourself.

If your employer fails to report the accident to their insurer, does not have accident insurance when they ought to, argues the accident did not happen at work, or claims you did not notify them in time, you can always discuss your situation with our workers’ compensation lawyers for free. We will help you check if your employer treated you fairly. If not, we will fight for the benefits you are entitled to receive.

Denials Based on Pre-Existing Health Conditions or Non-Work-Related Injuries

Your employer’s insurer may try to deny a legitimate claim or use a pre-existing health condition as a basis to reduce the benefits available to you. They can also dispute that you sustained your injury outside the scope of your employment or work hours.

You can file an appeal against your denied claim. However, the process can be complex, especially while recovering from your injuries. Our team can help you gather the evidence required to prove you are entitled to benefits and guide you through the appeal process so you provide the correct information at the right time. We also protect your rights, so you are treated fairly during the appeal.

Denials Due to Missing Information or Lack of Medical Evidence

Perhaps the easiest to resolve, missing information or lack of supporting evidence can result in claim denial.

Check in with your employer’s insurer to see if your claim was denied due to something relatively simple to resolve, such as a mistake on the initial application form or missing information. Having a lawyer involved early on can help you to avoid mistakes during your initial application.

Find Out More About Appealing a Denied Workers’ Compensation Claim for Free

If you are struggling with your workers’ compensation claim, the team at Dismuke Law is here for you. Whether you need help filing your initial claim or want to appeal a denial, we can help you. Contact us for a free consultation where you can discuss your situation without obligation.