Why Your Workers’ Compensation Claim May Have Been Denied

Reasons why workers' compensation claims are deniedIf you suffered an injury or developed an illness due to your job, workers’ compensation is a no-fault system in Florida that should entitle you to benefits, regardless of how the incident occurred.

Once you file a claim with your employer’s insurance company, that should start the process and give you access to medical care and financial support for your recovery.

 

However, sometimes the insurer denies claims—even legitimate ones. Here's what you should know.

Major Reasons Workers’ Comp Claims Are Denied

Workers' compensation claims are denied for a number of reasons. If you feel these don't apply to your case, it may be time to secure legal representation to help you receive benefits that are rightfully yours.

  • Failure to report accident. Under Florida law, you're required to report your injury or illness to your employer within 30 days. If you fail to do so, your claim could be denied.
  • Injury not-work related. In order to be eligible for benefits, your injury must be job-related. This means if you were injured at a restaurant or while doing errands on your lunch hour, you probably won't be entitled to benefits. However, if you were at a business meeting or traveling between job sites, your injury should be covered.
  • Not seeking medical care. Some conditions, such as neck, back, and traumatic brain injury, may not be apparent until days or longer after your accident when symptoms emerge. However, if you fail to obtain prompt medical care, the insurance company could use this fact to dispute that a job-related incident caused your injuries—even when the opposite is true. In addition, you must be treated by a physician approved by the insurance company. If you fail to do so, your claim may not be paid.
  • Pre-existing injuries. If you had a pre-existing injury to the same body part hurt in your current accident, the insurance company could try to base a denial on this. However, a pre-existing injury shouldn't disqualify you from receiving benefits.
  • Intoxication. If you were intoxicated due to drug or alcohol use, this may be a legitimate reason to deny your claim.
  • No eyewitness. In some cases, the insurance company may reject a claim if there were no eyewitnesses. If this is the basis of your denial, an experienced workers’ compensation attorney can help prove you sustained injuries at work.
  • Other disputes. The insurance company can raise a variety of disputes to deny or reduce a claim depending on the facts of a case. Your lawyer will have strategies to defeat these invalid arguments so your claim is resolved.

If your claim was denied, or you're not sure the workers' compensation benefits are accurate, call our Ormond Beach office using the numbers on this page. We'll arrange for a free consultation with one of our experienced workers’ compensation attorneys to review your case.