My Workers' Compensation Claim Was Denied – What Now?
Brian O Sutter
Workers’ Compensation
Not all worker’s compensation claims in Ft. Myers, Port Charlotte, North Port, or any area of southwest Florida are approved right away. For those who have been injured on the job, these benefits are a necessity, and a denial is just one more wrench thrown into an already stressful situation. The good news is that a denial is not the end of the road, you do have options when it comes to appealing the decision. Your First Steps
After a workers' compensation denial anywhere in southwest Florida, you don’t have to go into the appeals process straight away. You may be able to avoid appeals if you’re able to negotiate with the insurance company providing the worker’s compensation insurance. Opening up a conversation with the adjuster allows you to go through the simpler internal appeals process, bringing about negotiations that may result in a satisfactory resolution.
However, if a satisfactory resolution cannot be reached, you will need to escalate the situation to get the benefits you need. When going through an internal appeals process, it helps to have negotiations overseen and handled by a skilled Florida worker’s compensation lawyer. They’ll be able to best appeal the decision, work through negotiations, and determine if the situation should be escalated.
Filing A Formal Appeal
Not all internal appeals processes are successful, and this isn’t the end of the road quite yet. The next step should be filing a formal appeal with the Florida Division of Workers' Compensation. This is a more complex process, but one that is well worth it.
The first step in the formal appeals process is filing a petition with the clerk of court in the Office of the Judges of Compensation Claims, or OJCC. In this filing, you should provide:
• A mention of the specific benefits you’re looking for
• Proof of wages lost from the accident
• A description of all injuries sustained
• A detailed description of how the accident occurred, and what injuries resulted from it.
In the state of Florida, there is a 1-year statute of limitations placed on filing a formal appeal in worker’s compensation cases. After your petition has been filed, the OJCC appeals board will review your petition and a judge will notify your place of employment and their worker’s compensation insurance provider. The employer has up to 2 weeks to file a response after being notified of the petition.
It’s most likely that the employer’s insurance provider will be the one responding to the claim, not the employer. If the insurance provider or employer fail to respond to the petition within 2 weeks, the insurance provider must pay the claim.
If the insurance provider does not agree with the benefits being sought, a formal hearing will be set to hear both arguments before a judge.
Why You Need A Worker’s Compensation Lawyer Through This Process
Insurance providers will have teams of lawyers on their side, making sure they’re taking every step possible to save their bottom line. When going up against these companies yourself, you’re facing a far more skilled and experienced opponent and you may not be able to get the compensation you deserve.
An equally skilled worker’s compensation lawyer can see you through the entire appeals process, from internal appeals all the way to filing a formal petition and bringing this argument before a judge. There is no need to be intimidated when you know that you have the law on your side.