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

Filing a workers' compensation claim after a workplace injury is stressful enough, but having your claim denied can add unwelcome frustration and uncertainty. However, a workers’ compensation denial doesn’t mean you are out of options. Many workers' compensation claims are initially denied for various reasons, but with the right steps, our Homestead worker’s compensation lawyers can challenge the decision and zealously pursue the compensation and medical benefits you deserve on account of your on the job injury. At Friedman Rodman Frank & Estrada, we understand how difficult it can be when your workers' compensation claim is denied, and our Homestead workers’ compensation lawyers are here to help you change the decision through our arsenal of legal tools.

There are several reasons why workers' compensation claims are denied, even for valid injuries. For example, below are some of the most common reasons employers and their insurance companies cite when denying claims:

1. Insufficient Medical Evidence: One of the most common reasons for denial is a lack of clear medical documentation linking your injury to your job. Without strong evidence from a medical professional that clearly explains how your job duties led to your injury, the insurance company may reject your claim. Our Homestead worker’s compensation lawyers will work hard to secure the required medical evidence.
2. Missed Deadlines: Workers’ compensation claims are subject to strict deadlines. In Florida, you must report your injury to your employer within 30 days of the incident, and there are additional deadlines for filing your claim. Missing these deadlines can result in an automatic denial. Our worker’s compensation attorneys will conduct an investigation to determine whether the employer was on notice of your injury.
3. Disputed Injury: Your employer or their insurance company may dispute the cause or severity of your injury. For example, they might argue that the injury didn’t happen at work or that it’s not as serious as you claim, which can lead to a denial. Our attorneys will secure evidence to refute that denial.
4. Pre-existing Conditions: If you have a pre-existing condition that is similar to the injury you’re claiming, the insurance company may deny your claim, arguing that the current injury is not work-related or was not caused by your job. Our attorneys will show that even if there were a pre-existing condition that that condition was aggravated by the work related accident which would be compensable under the law.
5. Non-Work-Related Injury: If there’s any indication that your injury occurred outside of work or during a non-work-related activity, your claim could be denied. For instance, if the injury happened while you were commuting to/from work or doing something unrelated to your job, your claim might not be eligible for workers' compensation. However, our attorneys will work hard to create a link between your employment and resulting injury.

If your workers' compensation claim has been denied, you still have options. Florida law allows a claim to be pursued on your behalf and thereby have the worker’s compensation carrier reconsider its denial. The following steps should be taken to increase your chances of success.

1. Review the Denial Letter: The first thing you should do is carefully read the denial letter you received from the insurance company. This letter should explain why your claim was denied and will be important when preparing a claim to fight that decision.
2. Request a Reconsideration: Sometimes, a denial is the result of a simple error or missing information. You may be able to resolve the issue by requesting a reconsideration from the insurance company providing any missing documentation or evidence.
3. File a Petition for Benefits: If reconsideration doesn’t work, you can file a Petition for Benefits with the Florida Office of the Judges of Compensation Claims (OJCC). This formal request starts the litigation process, where your case will eventually (if not resolved sooner) be reviewed by a judge. The judge will hear testimony, review evidence, and make a ruling on whether you are entitled to different types of benefits.
4. Attend Mediation: In many cases, mediation is the next step after filing a petition. Mediation is a meeting between you, your attorney, and the insurance company to see if a settlement can be reached before going to trial. This can be a quicker way to resolve your claim and get the benefits you need. Oftentimes at mediation, settlement may be premature and the outstanding issues are addressed by the parties with a neutral mediator.
5. Prepare for a Hearing: If mediation fails, your case will go to a formal hearing before a workers' compensation judge. At the hearing, medical evidence, witness testimony, and other documentation will need to be presented to support your claim.

Navigating the worker’s compensation process can be complicated, and having an experienced Homestead workers’ compensation lawyer can make the process much easier on you and significantly increase your chances of success.

At Friedman Rodman Frank & Estrada, we know how frustrating it can be to deal with a denied workers' compensation claim, especially while you’re still recovering. Our experienced Homestead workers' compensation attorneys can help you challenge the insurance company’s denial and fight for the benefits you need. With our office located in Homestead for the last 20 years, our team is available to assist you.

While every situation is unique, below are a few of the things we can do to help get you the benefits you are entitled to:

• Analyze the Denial: We will carefully review your denial letter and assess the reasons for the denial. From there, we’ll gather any additional evidence needed to strengthen your claim for benefits on account of your injury.
• Build a Strong Case: Whether it’s medical records, witness statements, or expert testimony, we’ll ensure your claim is supported by solid evidence that directly ties your injury to your job.
• Handle All Communication: We’ll take over communication with the insurance company and represent you in hearings, mediation, or court if necessary so you can focus on your recovery. We will always have your best interest at heart.
• Maximize Your Benefits: We’ll fight to ensure you receive all the workers' compensation benefits you deserve, including medical treatment, lost wages, and, if applicable, vocational rehabilitation or disability benefits.

When your claim is denied, it’s easy to feel defeated. But with the help of a skilled Homestead workers' compensation lawyer, the situation may be able to be turned around and compensation secured that you’re entitled to.

If your workers' compensation claim has been denied, don’t give up hope. The team at Friedman Rodman Frank & Estrada is here to guide you through the workers’ compensation claim process. Contact us today to schedule a free consultation with a knowledgeable Homestead workers’ compensation lawyer and take the first step toward getting your claim back on track. We do not charge a fee unless and until a financial recovery has been secured for you. You can reach us by calling 877-448-8585 or through our secure online contact form.