Few things are more frustrating than being injured on the job and then receiving a denial letter from the workers’ compensation insurance carrier. A denial does not mean the case is over. It often means the next step requires a closer look at why the claim was rejected and what can be done to challenge it.
After an accident investigation, an insurance company may deny that the injury occurred on the job or was work-related. Florida allows workers up to 30 days to report an injury, but insurers may deny claims not reported within the first day or two unless an eyewitness can immediately corroborate the accident. Insurers frequently deny repetitive-stress conditions, in which the employee reports symptoms that have been building over time rather than appearing after a single event. Some denials stem from paperwork issues rather than the merits of the case. Incomplete forms, inconsistent statements between the injured worker and treating physicians, or gaps in the medical record can all trigger a denial.
Oftentimes, the insurance company agrees that a workplace accident occurred, but denies that it actually resulted in any disabling injury. It often cuts the injured worker’s benefits after sending them to a company-favored clinic or doctor who may downplay the injury, rush them back to work, or claim that their disability and need for medical treatment are because of a preexisting condition rather than the accident. This tactic disproportionately affects older workers, whose age-appropriate arthritis or degenerative changes are blamed for their symptoms and used as a pretext to deny benefits.
To challenge a denial of benefits, injured workers have the right to present medical records, expert opinions, and witness testimony at a hearing before a Judge of Compensation Claims. By meticulously gathering medical evidence and securing an Independent Medical Examination (IME) through an attorney to counter the insurance doctor’s findings, a favorable outcome can often be negotiated before a full hearing takes place—or, if necessary, obtained through a formal ruling by the Judge.
Ultimately, a denial is a starting point for investigation, negotiation, and—if necessary—a hearing before the Judge of Compensation Claims. Attorney William A. Heller represents injured workers throughout South Florida whose claims have been denied or delayed, helping them gather the essential medical evidence and documentation needed to successfully pursue the benefits they are owed.