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Why Is My Workers’ Compensation Claim Being Denied?

Typically, when a Florida resident is injured at work, workers compensation insurance is in place to cover their injuries and other damages. In Florida, employers are required to provide adequate coverage in relation to the risk level of their particular industry, thus covering most common injuries seen on the job in the event an employee gets hurt. However, not all workers compensation claims are simple, and some injured workers may even find themselves with an unexpected denial.

Having a workers compensation claim denied can be a harrowing and stressful experience. Workers may find themselves out of work with mounting medical bills, and left wondering how they’re going to catch up to stay afloat while they recover. Workers compensation claims may be denied for any number of reasons, but the most common are:

Untimely reporting – Ideally, a workplace injury will be reported straight away, but this isn’t always possible. Sometimes, workplace injuries may not be obvious or the direct result of an accident, like in cases of carpal tunnel syndrome or strain injuries caused by repeated simple movements. In the state of Florida, a person must report their injury within 30 days of suffering the injury or having a doctor determine their injury is work-related. Reporting outside of this timeframe can lead to claim denial.

Employer disputes – In some cases, an employer may dispute your claim, and claim themselves that your injury did not occur due to work-related activities. For instance, if a person claims to have sprained an ankle at work, but their employer suggests it was actually an injury suffered during an out-of-work activity or due to their own negligence on the job.

Refusing medical treatment – If an employee refuses to seek medical treatment after an accident, doesn’t follow follow-up medical advice, or fails to attend appointments related to their workplace injury, their workers compensation claim may be denied. The thought process behind this is that the injury is not severe enough to warrant compensation if medical advice goes unfollowed, and therefore the claim is invalid.

Insufficient evidence – If there is insufficient evidence of the circumstances surrounding the injury, a claim may be denied. In workers compensation cases, an injury must be proved to be work-related, and evidence can go a long way in building a strong foundation for your case. Witnesses are not always present in all cases, but medical professional testimony will often do the job.

What To Do Next

If your workers compensation claim has been denied, it doesn’t have to be the end of the road. The letter received detailing your denial of compensation should include your deadline for filing an appeal to the decision, which should be done as soon as possible. In Florida, one will typically have 30 days to file an appeal of their denied claim.

The appeals process can be a complicated and lengthy one, and even with all necessary evidence, it is still possible to unknowingly self-sabotage your case. For this reason, it’s always recommended to handle the workers compensation appeals process with an experienced Florida workers compensation attorney by your side. Your attorney will make sure you have all necessary evidence, listen to all details of your case, and guide you in the best steps to take in order to get the compensation you need and deserve.

Daniel Murphy's passionate belief in upholding the Florida justice system by defending the rights of the public against corporate interests, has lead him to become one of Florida's most effective young attorneys. Daniel Murphy carries his enthusiasm for fighting for the rights of the injured outside the courtroom by staying involved in legal and community organizations.

Why Is My Workers’ Compensation Claim Being Denied?

Goldman Babboni Fernandez
Murphy & Walsh

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