- A workers’ compensation denial can hurt you financially, so appealing it can give you the best chance to get back on your feet.
- Workers’ compensation offers medical coverage and some lost wages for injured workers.
- If your claim is denied, you can file an appeal to have your claim reviewed.
- If your first appeal is also denied, you can escalate your appeal to the Workers’ Compensation Commission or the court system.
- An experienced attorney like the team at Werner, Hoffman & Greig can help you navigate the legal system and file the strongest workers’ comp appeal you can.
When you’ve been injured on the job, it’s not just your body that’s damaged. Medical bills and lost wages can harm your financial health too.
In Florida, the workers’ compensation system is there to help. Unfortunately, only about half of all workers’ comp claims are approved. What do you do if your claim is denied?
The Basics of Workers’ Compensation
Workers’ compensation is a type of insurance designed to protect injured workers. Let’s run through the basics of workers’ comp:
- Most employers are required to have workers’ compensation coverage
- Workers’ comp will usually cover your medical bills and 2/3rds of lost wages
- It’s a no-fault system, it doesn’t matter if the accident was caused by you or your employer
- If you’re injured on the job, it’s very easy to receive compensation, but you probably can’t sue your employer
- To receive workers’ comp benefits, report your injury to your employer and they’ll report it to their worker’s compensation insurance carrier
What if I’m Denied Fair Compensation?
Unfortunately, employers and their insurance companies have a lot of reasons they might want to offer you an unfairly low settlement or deny compensation altogether. What do you do if this happens?
Don’t panic–you can appeal the decision and fight for the compensation you deserve.
Key Steps in Appealing a Workers’ Compensation Denial
Understanding the Denial
Claims are denied for many different reasons. For example, the insurance company might argue your injury wasn’t work-related, you haven’t provided enough medical evidence, or you missed important deadlines.
Understanding the justification behind the denial helps you present a focused appeal.
Prepare a strong case by gathering essential documents:
- Medical records: All reports, bills, and treatment plans related to your injury.
- Witness statements: Anyone who saw the accident or can validate your injury claims.
- Accident reports: Official reports filed by your employer or supervisor.
- Paystubs or other wage records: Proof of lost income or reduced earning capacity.
Filing the Appeal
Once you’re ready to file your appeal, you’re looking for a form called the Petition for Benefits. You can file it online, by mail, or in person at the Office of the Judges of Compensation Claims (OJCC).
Make sure you complete this form accurately and completely and attach all supporting evidence. This is your chance to make your case!
Hopefully, you’re working with an experienced workers’ compensation attorney who can help you prepare for any hearings.
A few helpful tips before your hearing:
- Present your case calmly and clearly.
- Answer the judge’s questions honestly and accurately.
- Have your witnesses prepared to testify.
- Dress presentably and arrive on time.
After the hearing, there are two possible outcomes.
If your claim is granted, congrats! You’ll be getting those workers’ comp benefits soon.
However, if your appeal is denied, we’re not giving up yet. You can file a further appeal with the Workers’ Compensation Commission.
Building a Strong Appeal
Here are some tips for a successful appeal:
- Focus on Causation: Make it clear that your work injury requires the medical treatment and lost wages requested in your claim.
- Use Your Medical Records: The records of your injury and treatment are some of the strongest evidence you can have on your side. Doctors can also act as expert witnesses.
- Witness Testimony: Witness testimony from coworkers or clients can corroborate your claims and boost your credibility.
- Legal Representation: Consider seeking help from an experienced workers’ compensation attorney to maximize your chances of success.
Call Werner, Hoffman & Greig
At Werner, Hoffman & Greig, we understand the challenges of navigating a workers’ compensation appeal. Our team of attorneys have plenty of experience winning cases for our clients and securing the compensation they deserve.
Frequently Asked Questions
What happens if I miss the deadline to appeal?
Missing the deadline usually means you won’t be able to proceed with the appeal. However, there may be some allowances for exceptional circumstances.
Consult an attorney for guidance.
What are the costs associated with appealing a workers’ compensation denial?
Workers’ compensation appeals typically require a $300 filing fee.
At Werner, Hoffman & Greig, we work on contingency–we don’t get paid until you get paid. Get in touch with us for more details.
What happens if I lose the appeal?
Don’t give up! You have the right to escalate your appeal to the Workers’ Compensation Commission and, if necessary, the court system.
An experienced workers’ comp attorney can help you review your case and discuss your appeal options.