6 Reasons Workers’ Compensation Claims Are Denied

Workers’ compensation insurance covers any injuries or illnesses you may incur because of your work-related activities. All employers are required to offer workers’ compensation in Florida, with very few reasons as to why workers’ compensation claims can be denied.

If you had an accident and got injured at work, you have to face the medical costs of treatment. You may also go on bed-rest for many days, weeks, and even months resulting in lost wages. Workers’ compensation is designed to cover these losses and help you recover without becoming financially liable.

However, employers or insurers may not always accept workers’ compensation claims. They may raise objections and dispute your claim, in which case you can take your claim to a hearing. Here are some of the common reasons why workers’ compensation claims are typically denied. If you’ve been injured on the job and are planning on filing a workers’ compensation claim or have had one denied contact a workers’ comp attorney to review your best options moving forward.

Late Application For Compensation

Many workers’ compensation applications are turned down by an employer or insurer simply because they are late. If you have suffered a work-related injury in Florida, you must report it to your employer within 30 days. This is typically done by filing an application that includes notes and feedback from your treating physician. If you fail to notify the employer during this time period, it may be used as a reason to turn down your application. You can still legally file for compensation after this period but the insurer may then try to offer you a reduced amount.

Your Injury Is Not Covered

According to Florida Statute 440.02, workers’ compensation covers any injury or death ‘arising out of or in the course of employment, and such diseases or infection as naturally or unavoidably result from such injury.’ This means that your injury must be directly related to your work-related activities. Many compensation claims meet denial when an injury you may think is work-related does not meet this statutory definition. For instance, if you were at work and took some time off to do some private task that resulted in an injury, your injury is not covered.

You Are Responsible For The Injury

Sometimes, an insurance company may argue that you are responsible for the injury. This is most often the case when employee injuries are caused by intoxication. If you consumed alcohol or drugs that caused intoxication, and then ran into an accident, your claim for compensation will likely be denied. Similarly, if you deliberately brought about an injury, your odds of receiving benefits are slim.

The Application Lacks Medical Evidence

One of the most important parts of a compensation claim is medical evidence. This typically includes medical records, doctors’ notes, medical test results, and related documentation. An insurance company will thoroughly examine the medical evidence before deciding on your compensation claim. If the medical evidence is lacking or if it shows that the injury isn’t serious enough, the insurer or employer may deny your claim. You can still counter this by gathering the requisite evidence or working with qualified medical experts to show how your injury is genuine and serious. Once the claim is denied, you can request a hearing with the Workers’ Compensation Commission and then present your evidence at this hearing. However, it is important to get the help of a Florida workers’ compensation lawyer to help you with the hearing.

The Employers Cites Pre-Existing Condition

A pre-existing condition is one that is related to your injury and may have contributed to it. For instance, if you have a limp in your leg, and a slip-and-fall accident makes it worse, the employer may cite your pre-existing limp as the cause of injury. This can be used as a reason by the employer or insurer to refuse your claim. It then remains for you to demonstrate how the limp may have pre-existed but that the accident was not related to it. In many cases, injured workers are able to recover compensation despite the pre-existing condition.

There Were No Witnesses

Witness testimony is important in a workers’ compensation claim. If there are no witnesses, the insurer or employer has to rely on your word and the available medical evidence. If the medical evidence does not clearly support your claim, the employer may use the lack of witnesses as an excuse to refuse the claim. When this is the case, you need to focus on the medical evidence and work with medical experts who can confirm that your narrative is in line with the nature of your injuries.

Finding Reliable Florida Workers’ Comp Lawyers

Many workers’ compensation claims are denied by the employers or insurers and then settled during administrative hearings. When the matter comes to a hearing, an attorney on your side is critically important. It improves your odds of success and helps you get the fair amount of compensation you deserve.

Here at Burnetti P.A., our Florida personal injury attorneys specialize in helping employees who have suffered work-related injuries. If your compensation claim has been denied, we can help you. Call us today to schedule your FREE consultation with our attorneys.