Five mutual issues that injured workers encounter:
Claim was denied.
Employers too insurance companies oftentimes deny workers’ compensation claims before they ever truly larn started. The exact number of how many claims are filed versus how many claims are denied is unavailable, since the Florida subdivision inwards charge of overseeing claims doesn’t expose information inwards this area.
One must holler upward that insurance companies are a business; a business’s destination is to make a profit. This could manifestly non endure done if everyone’s claim was approved. This does non hateful that entirely invalid claims are denied. Often, perfectly legitimate injury claims are denied every day, amongst the insurance companionship too the employer hoping the injured won’t bother to dispute it.
Insurance companies are also under pressure level from employers who want to keep their premium costs every bit depression every bit possible. Because of this, insurance companies carefully scrutinize claims to find ones they tin deny or cut benefits to. The less claims an insurance companionship pays out, the lower they tin move on their premiums.
Claim procedure is existence dragged out or staled.
A worker’s compensation claim tin have got a long time to move through, specially if something close the claim is contested. If a lawsuit is filed contesting the claim, too then pre-hearing regain too depositions must endure collected too carried out; this tin endure fourth dimension consuming. One may likewise demand to seek additional medical opinions, either because they don’t concur amongst an sentiment that was given or because the insurance companionship requested ane for a similar, albeit, converse reason. Someone may likewise demand to seek additional opinions to establish or contest something called, Maximum Medical Improvement (MMI). All these things tin brand a seemingly elementary procedure have got much longer than expected.
The amount received doesn’t appear similar enough.
One of the biggest complaints regards the amount that someone receives from a village or a judge’s order. This is because workers’ compensation claims are limited to partial wage reimbursement too medical bills. In some extreme cases, compensation may endure awarded for loss of limbs, permanent debilitation, too other cases of severe loss. Workers' compensation laws exercise not usually allow compensation for hurting too suffering. This tin oftentimes brand the monetary figure experience insignificant, since it oftentimes doesn’t fifty-fifty embrace the entire amount of out-of-pocket expenses, much less compensation for everything an injured political party has to move through.
Employee was fired after filing a claim.
It is illegal for an employer to terminate a worker because they filed a workers' compensation claim. The province of affairs becomes less clear when a medico has certified a worker every bit ‘able to render to work’ too the injured party disagrees amongst that doctor's opinion. Once an injured worker is medically cleared yesteryear a doctor to render to work, too they refuse to exercise so, an employer does too then have the correct to terminate their employment.
Despite medical clearance, a claimant is nonetheless inwards pain.
This province of affairs oftentimes arises when hurting too medical conditions/diagnosis don’t match. For example, the medico may diagnosis a patient amongst a youngster dorsum sprain that they claim volition move away inwards a calendar week or two. However, it has been a calendar month too the patient is nonetheless inwards a high score of pain. Therefore, the medico has cleared the patient to render to work, yet the patient finds fifty-fifty walking to endure difficult. These situations are oftentimes the toughest to handle, but it is really possible to move it out inwards exercise goodness of the injured.
Remember, pain is subjective, too therefore, cannot endure measured definitively.
A medico may diagnose an injured worker every bit having reached maximum medical improvement, but the worker may disagree. If someone does non concur amongst the MMI diagnosis or allotted recovery time, the best thing to exercise is seek a second medical opinion.
Filing a Complaint against the Insurance Carrier
If you lot have got credible evidence that your claim was wrongly denied—fraud, administrative error, or another irregularity—you tin file a complaint with the terra firma of Florida. The shape tin endure found here. When you lot file a complaint, it will go through a review process.
If you lot experience that you lot demand to file a complaint amongst the insurance company, it is belike fourth dimension to kickoff thinking close hiring an attorney. Despite what your employer too their insurance companionship powerfulness tell you, an attorney tin endure really beneficial inwards helping to contrary a denied claim and recover much to a greater extent than than what a carrier volition offering on their own.
Common Reasons Workers’ Compensation Claim are Denied
Failure to notify your employer of injury inside fourth dimension limit.
You should immediately—or as before long every bit reasonably possible—notify your supervisor when you lot are injured. Each terra firma is different, but Florida requires that injury is reported to the employer no afterwards than 30 (30) days. You tin read the statute here. Technically, your claim doesn't get until you lot written report your injury to your employer.
Statute of limitations has ran out.
Reporting your injury is non the same every bit filing a workers’ compensation claim. The fourth dimension inwards which you lot must truly file the complaint is known as a ‘statutory bound period.’ Missing this filing time window is grounds for denying your claim.
In Florida, the statute of limitations requires that a claim must endure filed inside two (2) years of the appointment of accident.
Your injury didn’t occur at work.
In social club to endure eligible for coverage yesteryear your employer’s workers’ comp insurance, your injury must have occurred piece performing your move duties on your employer's premises. You volition likewise endure covered if it occurred off-site piece performing duties assigned to you yesteryear your employer or supervisor.
If your injury occurs before or after normal move hours, fifty-fifty if you lot are technically doing something to consummate a move task, your injury may non endure covered. This is why most large companies are extremely strict about non working ‘off the clock.’
Your injury occurred piece you were nether the influence of a substance.
If you lot were injured piece nether the influence of alcohol or illegal narcotics, your claim volition most probable endure denied. It does non matter how hard of a worker you lot are, how long you've been with the company, or what type of move you lot were doing.
Some people think they are prophylactic from this provision, because they would never move to move drunkard or high. However, blood tests are performed after an injury, which tin exhibit alcohol inwards the blood even from the nighttime before. This is oftentimes grounds to deny a claim. If proof exists that fifty-fifty a modest amount is still inwards your system, your claim volition belike endure denied. This is also true for some up-to-date, medico prescribed medications. For example, if you lot were taking a prescribed narcotic painkiller or anxiety medication for completely unrelated reasons, too the insurance companionship tin bear witness they were inwards your arrangement at the fourth dimension of the injury, it is probable your claim volition endure denied.
Your employer has decided to dispute your injury.
As the injured party, you lot are responsible for proving that you lot are injured. An employer does non have got to bear witness that you lot are not injured. This is called the burden of proof. An employer may dispute the claim for whatsoever number of reasons—by claiming that your injury was pre-existing, it occurred exterior of move or piece performing a non-work related task, or that you lot are faking your injury.
The injury or status you lot suffered isn’t covered.
A expert illustration of this psychiatric injuries. Workers’ compensation claims that are based on mental wellness number are almost always initially denied. This is because it is hard to bear witness that the mental wellness number occurred every bit a lawsuit of your work. To endure covered, you lot must endure able to link your mental health issues to a specific, work-related event. For example, if you lot are filing a claim for anxiety after a near-death province of affairs at work, you lot would have got to bear witness that ane is related to the other. Florida does cover psychiatric injuries from specific events, such every bit post-traumatic stress disorder (PTSD). Even weather condition arising over time, such every bit depression too severe anxiety, may endure covered, if it tin endure proven that they are straight related to work. This requires precise and convincing medical evidence from a licensed psychiatrist. Even then, it is probable to endure disputed, at to the lowest degree initially.
Your employer doesn’t consider your injury to endure serious.
As mentioned earlier, at that spot is oftentimes a discrepancy betwixt what someone feels too what their diagnosis is. Everyone is different. You may think that your injury is debilitating, but your employer or their insurance companionship may non consider it to endure all that serious.
In social club to technically qualify for workers’ compensation, your injury must bound or fully prohibit you lot from completing your chore duties. This, similar all the other things related to a personal injury case, volition ultimately endure settled yesteryear a doctor’s—ideally multiple doctors’—opinion. It is these issues that arrive imperative to have got an experienced workers’ compensation attorney on your side. They have got seen all the tricks of denial too know how to grip them. They are likewise oftentimes familiar amongst credible doctors who volition non give a incorrect diagnosis only to assistance out an insurance company.
How to Appeal a Denied Workers’ Compensation Claim
If your claim is initially denied, which is really common, you lot exercise have got options. Although it is frustrating, you lot have the correct to dispute the claim’s denial. Once the insurance carrier decides to deny your claim, they volition ship you lot a denial missive of the alphabet with an explanation of your workers' compensation insurance coverage, your rights to appeal, too the deadline for filing your appeal.
An Experienced Workers’ Comp Attorney
The initial filing of most workers' compensation claims tin endure handled without an attorney. When your claim is existence unnecessarily delayed or has been unfairly denied, it is belike fourth dimension to retain an attorney.
Dolman Law Group represents injured workers inwards the Clearwater-Tampa Bay expanse on a regular basis. We have got a proven rails tape amongst real, credible results. Before you lot hire whatsoever attorney, you lot should query their reputation. The best places to exercise this on attorney ranking website Avvo.com, through Superlawyers.com, the Florida Bar Association, too of course, Google Reviews.
We welcome this sort of scrutiny. We are sure nosotros tin assistance you, too nosotros desire you lot to endure sure you lot made the correct decision. Once you lot retain us, you lot volition endure certain you lot did.
Every customer receives their attorney’s personal jail cellular telephone telephone number too e-mail address. This way, nosotros tin personally serve you lot too solve your workers’ compensation case on an private level.
We sympathise that filing a claim with an insurance companionship is oftentimes hard too frustrating. We are hither to help, every stair of the way.
Contact us today for a gratuitous consultation at (727) 451-6900.
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