Workmans Comp Denial and Appeal Process
After being injured during the performance of normal work duties, employees will file a Notice of Injury form with their employer and receive compensation from the employer’s insurance company for the medical treatment they receive as a result of that injury. However, upon receiving the initial form, an employer has the ability to contest the employee’s claim and ultimately deny him or her benefits.
When benefits have been denied or delayed by an employer and the insurance company, the injured employee has the opportunity to appeal the denial. However, because employees may not have the specific knowledge of Florida Workers’ Compensation law, he or she may be ill equipped to manage a successful claim for benefits.
This is the point that many workers contact an attorney knowledgeable in Workers’ Compensation claims for help. In doing so, the employee can rest-assured that they will have adequate representation in order to make the best claim for benefits they can.
The Florida Workers’ Compensation Appeals Process
When an injured employee contests his or her denial of benefits, he or she is subject to a specific process mandated by the state to appeal this denial. Below is an overview of that process, of which your attorney will explain to you if you choose to hire counsel.
Upon being denied Workers’ Compensation benefits, an injured worker must first file a petition with the Division of Administrative Hearings. This is the entity that handles any appeals an employee makes against his or her employee. When an appeal is filed, this entity will assign the case to a judge and he or she will schedule a hearing within 40 days.
A hearing is somewhat like what you would expect in a courtroom, except that there is no jury present and the rules of procedure may be more relaxed. At the hearing, the employee or his employer will present any available evidence to the judge explaining why the employee is entitled to Workers’ Compensation benefits. This is your chance to prove that your employer is incorrect in denying your claim.
Types of evidence you or your lawyer can present at a hearing include the circumstances surrounding your accident (where it occurred, what you were doing) and a detailed description of your medical treatment. Specifically, medical records should be used to explain to the judge the extent of your injuries, your work status according to the physician, and how your injuries were the result of performing your work duties. Sometimes, a medical expert may be called in to testify about your ability to return to work or perform work duties in the future.
Your employer and/or the employer’s insurance company will have a chance at the hearing to rebut your evidence and declare that you are not entitled to receive Workers’ Compensation benefits.
The judge makes the ultimate decision regarding your entitlement to benefits after all the evidence and testimony is heard. If your claim is denied again, you must then pursue an appeal with the Florida First District Court of Appeals.
As you can see, pursing an appeal after being initially denied Workers’ Compensation benefits can be a difficult, complicated, and highly technical. Remember that this process is made even more difficult when you are already suffering from physical pain because of your injury and emotional stress because of a sudden lack of income if you are out of work.
Rather than attempt to handle this situation alone, someone who has been injured while on the job needs to obtain the help of experienced Florida Workers’ Compensation lawyers located close in his or her community. At Rue & Ziffra, P.A., we have an entire department dedicated solely to Workers’ Compensation claims so that each client receives the attention and dedication he or she deserves.
Don’t let a complicated process keep you from receiving the benefits that are rightfully yours. Remember you can contact a lawyer at any stage of the process, whether your claim has been accepted or denied, to ensure that you are receiving full compensation for your work-related injuries.