If your workers’ compensation claim has been denied in Florida, it is not the end of the world. There are often simple reasons why a denial has been decided and it may be able to reverse the decision quite quickly. In other cases, it will mean an appeal with Florida’s Division of Disability Determinations. It is advisable to get legal help from a workers’ comp. attorney if it gets to the appeal stage as the process can get quite complicated. Workers Compensation Law in Florida In Florida, the Division of Disability Determinations (DDD) makes decisions about medical disability caused by workplace injuries and illnesses. Most employers in Florida, barring those with few employees, contractors and agricultural employers are required to have workers’ comp. insurance with a commercial carrier. Compensation is not based on fault which removes the obligation by the injured or sick employee from having to prove that their employer was at fault. If compensation is granted, then this also precludes the employee from seeking a private lawsuit against the employer, so the state’s workers’ comp. laws work in favor of both the employer and employee. In the first instance, you should notify your employer within 30 days of the incident and make a claim within two years. Compensation, when awarded, should pay all medical costs and a percentage of lost earnings depending on how long you were absent from work and the degree of seriousness of the injury. As is the case in many other states, compensation for mental health problems is not permitted. Why Your Claim Could be Denied Your WC claim is not automatic. You could lose out on a claim if you don’t stick to the time limits imposed on the claim process. Insurers do not generally bend over backwards to help you get compensation. Apart from missing time limits, another common reason is a misunderstanding about when you were at work. This can happen quite by mistake if the wrong dates are given over by your employer to the insurer. It is unlikely you will have to challenge this and it can be relatively easily corrected. More serious allegations may be made by the insurer to justify a denied claim including: alleging that you were not at work when the injury occurred; claiming that you became sick before you started working for your present employer; stating that you self-inflicted an injury in order to obtain compensation; that you didn’t follow your employer’s safety procedures, even though you knew what they were. The Florida Workers' Comp Appeals Process Appeals against a decision to refuse a claim should be made by petition to the state’s Division of Disability Determinations. The petition should result in a hearing administered by an Administrative Law Judge (ALJ). The judge will hear all sides of the dispute, and this is where having an attorney to help you or represent you would be of real value. The hearing may take up to a year before it is held. If you are still dissatisfied with the ALJ’s decision, even after you and your attorney have presented all the evidence that you have available, you can still appeal further. There are two higher levels of appeal, although in many cases the decision will have already been made to the satisfaction of both the employee and the insurer. Why a Workers' Comp Attorney May be of Help You are not required to use an attorney if you appeal a claim denial, but it will certainly help you if you do. Workers’ comp. attorneys understand the state laws and will be able to brief you on the documentation that will help you support your case. Attending hearings can be quite intimidating and confusing without an attorney to represent you. Additional Resources What is the Workers’ Compensation Filing Process in Florida? Hurt Working At Miller's Ale House Hurt Working At Rib City
