What to Do After a Denied Workers’ Comp Claim in Florida

Imagine this: you show up regularly for work, where you fulfill your job duties with skill and precision, only to suffer serious workplace injuries one day as a result of faulty equipment.  Knowing Florida law requires most employers to carry workers’ compensation insurance for such workplace injuries, you reported the accident to your employer as soon as you could and followed the steps for filing a workers’ comp claim. You felt confident that due to Florida workers’ compensation law, following the process would give you access to medical treatment and compensation for your lost wages. Instead, you received notice about your denied workers’ comp claim, impacting not only your recovery and wellbeing, but your ability to provide for your family.

Now you’re wondering what to do next.

This blog, from a knowledgeable and experienced Fort Lauderdale workers’ comp lawyer, explains Florida workers’ compensation system and what to do after your workers’ comp claim has been denied. Continue reading to learn more, then contact Lyle B. Masnikoff & Associates at(866) 523-2724(866) 523-2724 for a free case evaluation today.

We will go the extra mile in supporting your workers’ comp case after a denied workers’ comp claim.

Florida Law and Workers’ Compensation

Florida law acknowledges that even the most conscientious employees can sustain workplace accidents. When work-related accidents occur, the resulting medical bills and lost wages can place a significant financial hardship on injured workers and their families. For these reasons, the state maintains a workers’ compensation program for employees dealing with work-related injuries.

Who is Eligible for Workers’ Compensation Benefits?

To qualify for Florida workers’ comp, you must be an employee of a company that carries workers’ compensation insurance. Per state law, construction businesses with one or more employees, including the owner, must have workers’ compensation insurance. Non-construction employers with four or more employees must have workers’ compensation insurance.

Crucial Eligibility Requirements

• Employment Status: In general, contractors do not qualify; however, exceptions exist for subcontractors in construction.
• Injury or Illness: The employee must have sustained a workplace injury or illness, meaning that they suffered injuries while fulfilling their job duties.
• Reporting Time: A worker’s injuries should be reported to the employer within 30 days of the incident or discovery.
• Type of Business: Different rules apply for state and local government employees.

The Rights and Responsibilities of Injured Workers in Florida

After suffering a workplace injury, employees have specific rights and responsibilities under state law.

Injured Workers’ Rights

• Medical Treatment: Injured workers have the right to receive necessary medical attention for work-related injuries from an authorized treating physician.
• Disability Benefits: Injured workers could potentially qualify for temporary partial benefits (which apply when an authorized treating physician releases an employee to return to work but they have not yet achieved maximum medical improvement), or permanent impairment benefits (which apply to situations where a worker has reached maximum medical improvement, yet still suffers from physical, psychological, or functional impairment) based on the severity of the injury.
• Job Protection: The law generally protects injured workers against retaliation from employers for filing a workers’ comp claim.
• Legal Representation: Employees have the right to hire a workers’ compensation lawyer to help them with their claim.

Injured Workers’ Responsibilities

• Report Injuries: Workers who suffer injuries must report them to their employer within 30 days.
• Cooperate with the Insurance Company: Injured workers must comply with requests from the workers’ compensation insurance carrier, including showing up for scheduled medical care with authorized treating physicians, not their own doctor.
• Return to Work: If medically capable, the injured worker should return to work, possibly in a light-duty capacity.

Responsibilities of Florida Employers

Per Florida’s workers’ compensation law, employer must:

• Provide Workers’ Compensation Benefits: Most employers must carry workers’ compensation benefits if they meet specific criteria.
• Post Workers’ Compensation Notice: Employers must display a notice with workers’ comp information in a place where employees can easily view it.
• Report Workplace Injuries: Employers should report the injury to their insurance provider within seven days of notification.
• Offer Alternate Work: If possible, employers may need to provide alternative work consistent with the employee’s physical limitations.

Filing for Workers’ Compensation Benefits in Florida

You must take a series of steps when filing your workers’ compensation claim.

1. Report the Workplace Injury or Illness

   An injured worker must notify their employer of the accident or diagnosed occupational illness within 30 days of the occurrence. The worker should provide detailed written notice, citing the date, time, and circumstances of the injury.

2. Seek Medical Attention from Authorized Treating Physicians

   The injured worker should immediately seek medical treatment from an authorized treating physician listed by the workers’ comp insurance carrier, not their own doctor. Informing the authorized medical provider that the injury is work-related is vital for your workers’ compensation claim.

3. File Your Workers’ Compensation Claim

   Once the employer receives your notification, they must report the injury to their workers’ compensation insurance carrier within seven days. As an injured worker, you can additionally file a claim with the Florida Division of Workers’ Compensation within two years of the injury to protect your rights.

4. Follow Up on the Status of Workers’ Compensation Claims

   Injured workers should communicate regularly with their employer and the insurance carrier to monitor the progress of their claim. You should organize and provide easy accessibility to documentation such as claim forms, medical reports, and correspondence. If eligible, you can expect your first temporary total disability (TTD) payment within 21 days of your injury report.

   After completing the initial steps, the insurance company may inform you within the claim processing period if they plan to dispute your claim by questioning its validity and potentially denying workers’ compensation benefits.

What is the Process for Appealing a Denied Workers’ Compensation Claim?

Injured workers can appeal denied workers’ compensation claims via the following process:

1. Notice of Denial: If your workers’ comp claim has been denied, you will
   receive a notice that explains the reasons for the denial.
2. Petition for Benefits: You have the right to file a Petition for Benefits with the Florida Division of Administrative Hearings within two years of the injury. This is the primary means of requesting the involvement of the court to resolve disputes in workers’ compensation claims. Concerning any dispute about injured workers’ benefits, whether medical and/or involving lost wages, the employer and their insurance company will receive a “good faith attempt” to reach an acceptable resolution.
3. Mediation: Before a workers’ compensation claim hearing, mediation often comes first in an effort to resolve the dispute.
4. Pretrial Hearing: If mediation fails to arrive at fair compensation for an injured worker, the next step is a pretrial hearing to exchange evidence and witness lists.
5. Final Hearing: During a final hearing, a judge will evaluate the workers’ comp case and render a decision within 30 days.

What happens if your workers’ compensation claim is denied at a final hearing? You have the right to appeal the decision to the Florida First District Court of Appeal, as long as you fulfill  stringent timelines and legal requirements.

However, consulting a law firm that focuses on workers’ compensation and has extensive experience representing injured clients will protect your rights, properly manage the legal process,  and help you pursue justice.

Have You Been Denied Workers’ Compensation Benefits? Let the Workers’ Compensation Lawyers at Lyle B. Masnikoff & Associates Offer Legal Guidance and Support

Have you suffered injuries on the job only to deal with a denial of workers’ compensation benefits? At Lyle B. Masnikoff & Associates, we understand that coping with the stress of a denied workers’ compensation claim can impede your recovery and create additional stress during an already trying time. You may be struggling to pay for medically necessary treatment, including medical tests, and experiencing financial hardship due to lost wages.

Throughout Broward County, Boca Raton and the entire state of Florida, our Fort Lauderdale workers’ compensation attorneys have collectively represented thousands of clients in workers’ compensation cases, offering informed legal services. We also recognize the tactics insurance companies and their representatives employ to avoid paying money to workers who suffer injuries.

Has your workers’ comp claim been denied? Let us go the extra mile in fighting for your right to fair and appropriate compensation under the law.

Don’t face this alone when a workers’ comp lawyer from our firm can guide you through the process, drawing upon extensive knowledge and experience. Schedule a free case evaluation today at (866) 523-2724(866) 523-2724 or by completing our online form. We’ll provide the legal assistance and advocacy you need, while you focus on your recovery.

Let us go the extra mile for you!

Copyright © 2024. Lyle B. Masnikoff & Associates, P.A. All rights reserved. 

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

Lyle B. Masnikoff & Associates, P.A.

1645 Palm Beach Lakes Blvd #550

West Palm Beach, FL 33401

(866) 523-2724(866) 523-2724

https://workerscompfl.net

Lyle B. Masnikoff & Associates, P.A.

7380 Sandlake Road, Suite 500

Orlando, FL 32819

(866) 523-2724(866) 523-2724

https://workerscompfl.net/

Lyle B. Masnikoff & Associates, P.A.

110 E Broward Blvd #1700

Fort Lauderdale, FL 33301

(866) 523-2724(866) 523-2724

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Lyle B. Masnikoff & Associates, P.A.

543 NW Lake Whitney Place, Suite 106

Port St. Lucie, FL 34986

(866) 523-2724(866) 523-2724

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