Having your workers’ compensation claim denied is a frustrating and frightening experience. You are injured, possibly unable to work, and the very system designed to help you has just slammed the door. But a denial is not the end of the road. Understanding why claims get denied and what you can do about it is the first step toward getting the benefits you deserve.
Common Reasons for Claim Denial
Insurance companies in Florida deny workers’ compensation claims for a variety of reasons, some legitimate and many not.
Late reporting is a frequent basis for denial. Florida requires you to notify your employer within 30 days of your injury. If you miss that window, the carrier may use it against you.
Pre-existing conditions are another common excuse. Insurers often argue that your injury is related to a prior condition rather than your job duties. This is not always a valid reason to deny a claim, but they use it anyway.
Disputes about whether the injury is work-related arise frequently. The insurance company may claim you were not actually performing your job duties when the injury occurred, or that your injury happened outside of work.
Lack of witnesses or documentation can make a claim easier to challenge. If there is no record of how your injury happened, the carrier may argue there is no proof it occurred at work.
Missing or inconsistent medical records give insurers room to question your treatment and the severity of your condition.
Your Right to Appeal
If your claim is denied, you have the right to challenge that decision. Florida’s workers’ compensation system has a formal dispute resolution process that includes mediation and hearings before a judge of compensation claims.
Do Not Go It Alone
Insurance carriers have teams of adjusters and attorneys working to protect their bottom line. You deserve an advocate who is equally focused and experienced. Attorney William Heller has been fighting denied claims for over 35 years and knows how to build a strong case on behalf of injured workers.
Whether your claim was denied at the outset or benefits were cut off mid-stream, Bill is not afraid to take on insurance companies and go to trial if necessary.
If you are dealing with a denied workers’ compensation claim in South Florida, call William Heller today for a free consultation at (954) 921-7171.