Workers’ Compensation Lawyers in Miami Beach, FL

 

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When a worker endures an on-the-job injury, they not only have to worry about the aches and pains associated with their accident, but they also have the stress of not knowing how they are going to pay their bills and support their family while out of work. The good news is that these workers have the right to file a workers comp claim in Florida. Unfortunately, not every employee receives approval for workers compensation benefits.

Workers compensation is an insurance plan that an employer or a business will take out to ensure that their workers receive compensation for their work-related injuries. This helps both parties involved because the employer is not liable for paying their worker’s medical bills, and the employee receives the support that they need to get back on their feet once they recover.

Many workers comp claims filed in Florida are simple and straightforward. The worker has an injury, they report it to their supervisor or boss, and then they file a claim. Within a few days, they start to receive benefits based on the severity of their injuries.

However, not every workers comp claim in Florida ends that well. There are some circumstances where an injured employee has their claim denied. When that happens, the victim will usually hire a workers comp lawyer to assist them with filing an appeal.

Reasons for a Denied Workers Comp Claim in Miami Beach, Florida

There are many reasons why a workers comp claim doesn’t get approved. It could be due to a simple mistake or because the insurance company doesn’t agree with your case. Having solid evidence of your accident will help improve your odds of getting approved and receiving the benefits that you deserve. If your case is very complex, meaning that you will require a significant amount of money for your injuries, or the accident caused you to become permanently disabled, the defense will do whatever they can to prevent paying out a hefty sum.

Each workers compensation case is different. However, there are a few common reasons for a denied workers comp claim in Florida such as those listed below:

Questions About the Severity of Your Injury: Workers comp insurance only pays for the medical care and the loss of wages that are a result of the employee’s recent injury. If the employer or the insurance company believes that the employee is attempting to get benefits for an old injury, or a health issue that doesn’t exist, that have the right to refuse to provide benefits for anything they feel is unnecessary.

Procedural Mistakes: Even though the employee may become injured and unable to take care of filing a claim or filling out paperwork, there is no extended deadline for filing a workers comp claim. Those who fail to file their claim in time could have their benefits denied simply because they waited too long. Since the claims process requires a lot of paperwork, every injured employee should allow themselves time for correcting errors and resubmitting forms. That is why most lawyers recommend that injured workers file their claims as soon as possible to ensure the best outcome.

Unanswered Questions about the Cause of the Injury

To qualify for workers compensation benefits in Florida, the employee’s injury must be related to their job duties. If there is any reason for the employer or the insurance company to believe that the accident may have occurred outside of work, it is highly likely that they will deny the claim.  To avoid this problem, victims should have as much evidence as possible regarding their claim and make sure that any witnesses that were present will provide their testimony.

The Process of Filing a Workers Compensation Appeal in Florida

If the employer or insurance company denies the workers comp claim, the employee has the right to challenge their denial by filing an appeal. Initially, the injured worker should try to resolve their dispute with the insurance company by speaking with them directly and learning their exact reason for the denial. If resolving the dispute informally doesn’t work, the employee will need to file a formal appeal instead.

To begin a workers comp appeal in Florida, the injured victim should either mail or fax a Petition for Benefits to the Office of the Judges of Compensation Claims or OJCC. This form will require various details about the claim, such as a detailed description of the accident, information about the injury if the employee has endured any loss of wages because of their injury, and what benefits the employee is claiming.

Florida law states that all injured workers must file their claim for workers compensation benefits within two years of their injury. However, if the victim is appealing their denied claim for a specific benefit, such as they require additional medical treatment, they will need to file their petition for appeal within one year of their last benefit payment or their last date of treatment for their injury. To avoid a relapse in benefits, employees must file their petition as soon as possible after they receive news of their denial.

When the Office of the Judges of Compensation Claims receives the petition, they will notify your employer as well as the insurance company handling the claim. The insurance company will need to either pay the claim or provide a response to the OJCC within days after receiving the petition for an appeal.  

If after the appeal, the worker is still unsatisfied with the judge’s decision, they have the right to appeal their claim to the First District Court of Appeals within 30 days. These appeals will usually take at least a year or longer to review. That is because the court system has stricter filing requirements and a complex process. At this stage, a workers compensation lawyer represents most injured workers.

Appealing a Denied Workers Compensation Claim in Miami Beach, Florida

Once the victim files their appeal, the workers comp claim has a case number assigned and goes to the closest OJCC district office. There is a mediation hearing scheduled which is the initial step in the appeals process. These hearings are informal and include a mediator or third-party individual who attempts to help both parties resolve their problem to provide everyone with a fair compromise. The mediation hearing usually takes places around 130 days after the date when the employee filed their petition.

If the employer, the insurance company, and the employee can’t agree on the terms suggested by the mediator, afterward a workers comp judge takes over the case. The judge schedules a pretrial hearing where the judge will listen to all sides of the story so that they may come up with a viable solution. If the insurance company and the employee both hire workers comp attorneys, the injured employee has the option to submit their case in writing.

Even though it is not a requirement for an injured worker to hire a legal representative to file an appeal, the process can be very complicated, especially for those who do not have much knowledge concerning Florida’s workers compensation laws. Insurance companies will always have a lawyer representing them. Therefore it is best for the employee who filed the claim to hire a workers comp lawyer to represent them in court as well.

The final hearing occurs in less than 90 days following the pretrial hearing. At this meeting, the employee and the insurance company have the chance to present their evidence and testimonies gathered from witnesses to the judge. There are restrictions on what type of evidence the plaintiff or defense may use in a workers compensation hearing, and failure to follow these rules could result in claim denial.

Once the hearing ends, the judge will review the evidence provided to them and give their written decision. Both parties will receive a copy in the mail within 30 days of the hearing.

When to Contact a Workers Compensation Lawyer in Miami Beach, Florida

If you have suffered an injury  during the time spent at work, and have any doubts about the process, you need to consult with a workers comp attorney who understands the laws of the state of Florida. Those who have experience working on similar cases to your own will have the knowledge to build a compelling case on your behalf.

The key to having your workers comp claim approved is the amount of evidence that you have at your disposal. If you have very little evidence to back up your claim, your employer or the insurance company could use your lack of proof to their advantage. A workers compensation attorney who understands the current laws for the state will have access to evidence, reports, and testimonies that could help turn your case around.

You didn’t ask to become injured at work, and now that you are trying to get help with medical bills and a loss of income, you end up dealing with a workers compensation denial. Make sure you get the fair compensation that you deserve by hiring one of our workers compensation lawyers in the Miami Beach area today.