What to Do When Your Homestead Workers' Compensation Claim Is Denied

If you’ve recently suffered a workplace injury, the last thing you want to deal with is a denied workers' compensation claim. You counted on these benefits to cover your medical expenses and lost wages, and now you’re left wondering how to move forward. While a denied claim can be frustrating, it doesn’t mean your case is over. The Homestead workers’ compensation lawyers at Friedman Rodman Frank & Estrada are here to help guide you through the critical next steps, so you can focus on your recovery without the added stress of handling the claim process alone.

Understanding why your workers' compensation claim was denied is a good place to start when thinking about challenging the insurance company’s decision. While claims get denied for many reasons, some of the most common reasons for denial include:

• Missed Reporting Deadlines: Florida law requires that workplace injuries be reported within 30 days. Missing this deadline can lead to an automatic denial, as insurance companies are quick to argue that the injury isn’t work-related if it wasn’t reported on time.
• Lack of Medical Evidence: Workers' compensation claims rely on clear medical records that show the cause as well as nature and extent of your injury. If your records don’t clearly connect your injury to your job or if the insurance company believes you haven’t provided enough proof, they might deny your claim.
• Disputes Over Work-Related Cause: The insurance company may argue that your injury wasn’t work-related or that it’s a pre-existing condition. They might use any information they can find to cast doubt on whether your injury happened on the job, even if you know it did.
• Failure to Follow Medical Advice: Following the treatment plan recommended by your workers' compensation doctor is essential. Missing appointments or not adhering to prescribed treatments could give the insurer grounds to deny your claim, arguing medical non-compliance or that you’re not as injured as you claim.

While these reasons might feel like roadblocks, it’s important to remember that a denied claim doesn’t have to be the end of the road. With guidance from Friedman Rodman Frank & Estrada, you can take steps to challenge the decision and potentially secure the worker’s compensation benefits you had expected including medical and compensation benefits.

After a denial, you should receive a written notice explaining why your claim was denied. Carefully read through this notice, as it will give you insight into what went wrong. Understanding the insurance company’s reasoning will help you decide on the best way to address the denial.

If your claim was denied due to a lack of medical evidence or doubts about the injury’s cause, now is the time to gather more documentation. Visit your doctor and request more detailed records, and consider getting a second opinion if you believe it will strengthen your case. Detailed medical records, doctor’s notes, photographs and even statements from witnesses can make a significant difference in your claim handling.

Florida workers' compensation law has strict deadlines for filing claims, so it’s essential to act quickly. Once you’ve reviewed the denial notice and gathered additional evidence, you can file a worker’s compensation claim. This will typically involve submitting additional paperwork and documentation to support your case for benefits on account of your work related injury. The process can be complex, but an experienced workers' compensation attorney from Friedman Rodman Frank & Estrada can guide you through each step, ensuring your claim is thorough with all requirements met and timely.

In Florida, many workers' compensation claims result in a mediation conference. During this meeting, you’ll sit down with a mediator, representatives from the insurance company, and your attorney to discuss the claim. Mediation offers a chance to negotiate directly with the insurance company and potentially reach a settlement that meets your needs and/or not settle the case just yet but instead resolve past due issues including entitlement to compensation benefits and authorization of medical attention. An attorney can advocate for you during mediation, working to ensure that your rights are upheld and that any proposed agreement or settlement is fair.

If mediation doesn’t resolve your case, the next step is a formal hearing before a workers' compensation judge. This hearing is similar to a trial, with both sides presenting evidence and arguments. Preparing for a hearing can be challenging, especially when you’re focused on healing from your injury. Friedman Rodman Frank & Estrada will handle the legal work, gathering the evidence, preparing witnesses, and presenting a strong case on your behalf to give you the best possible chance at success under the law.

Dealing with a denied workers' compensation claim on your own can be stressful and overwhelming. Insurance companies often have their own team of attorneys who are trained to minimize claims and protect the company’s bottom line. By working with Friedman Rodman Frank & Estrada, you have dedicated advocates in your corner who understand Florida’s workers' compensation laws and know how to navigate the claim process.

We are immediately available to review your case, identify areas where additional evidence is needed, and handle the legal paperwork and negotiations for you. We’ll also communicate with the insurance company and attend mediations and hearings on your behalf, allowing you to focus on your health and recovery. To learn more and schedule your free consultation, call us at 305-448-8585 or connect with our staff by completing our secure online contact form.