Why Do Employers in Miami Deny Workers’ Comp Claims?
If you’re injured at work, you expect your employer to have the required workers’ compensation coverage and to cooperate with insurers throughout the claims process. You may be relying on your workers’ comp claim to cover medical bills and lost wages while you recover from your injury.
Unfortunately, many employees have their workers’ comp denied, causing significant financial hardships. Here are several reasons why an employer can deny a workers’ comp claim.
The Injury Is Reported Too Late
Florida law requires injured workers to report a workplace injury or illness to their employer within 30 days of the incident or when the employee becomes aware of the work-related injury. Workmans’ comp can be denied if the worker does not report the injury in time or if they miss the Miami workers’ compensation deadline.
The Injury Is Not Work-Related
An employer can deny workers’ comp claims if the injury did not occur in the workplace or while the employee performed official job duties. In these cases, the injured worker can bring a legal claim against a negligent third party.
No Medical Proof
It’s crucial for injured workers to seek medical care and treatment as soon as possible. Without medical records, there may be no proof of the injury or a way to connect the injury to the workplace. An employer can deny workers’ comp when there is a lack of medical evidence.
The Worker Does Not Qualify for Coverage
Workers’ compensation benefits in Florida generally do not cover independent contractors. If you are self-employed or considered a contractor when the injury occurs, it’s unlikely that you will qualify for workers’ comp coverage.
However, contractors may be entitled to some benefits if the company’s policy specifically includes them. Speak with an experienced Miami workers’ compensation lawyer to learn more about your rights as a worker.
The Worker Was Misbehaving or Intoxicated
Poor conduct or behavior by the employee while on the job can lead to workers’ comp being denied. If you did something or failed to do something, and it contributed to your injuries, it could mean denial of your workers’ comp claim.
Bad Faith Denials
While there are legal reasons to deny a workers’ comp claim, some employees and insurers unfairly deny claims. They may falsely say there are errors in paperwork, that the injury was preexisting, or that the injury did not occur at work. Sometimes, an employer may retaliate against a worker for filing the claim by intentionally sabotaging their ability to receive workers’ comp benefits.
When a Denial Lets You Sue in Miami-Dade Circuit
Under Florida’s exclusive remedy rule, workers’ compensation is typically the only legal option to recover compensation after being injured on the job. Employers are legally protected from being held accountable for a worker’s injury and resulting damages.
However, there are reasons to sue for workers’ comp or bring a lawsuit against your employer when they deny your claim. Here’s how employees can lose immunity or protection from legal action.
Employer Has No Workers’ Comp Coverage
Florida employers with four or more employees are required to have workers’ compensation coverage. In the construction industry, it’s even more strict. Construction companies with one or more employees must have workers’ compensation coverage.
If employers do not have workers’ compensation insurance coverage, employees can sue them directly in Miami-Dade civil court. This is often the clearest path to filing a personal injury lawsuit against an employer.
In these lawsuits, employees may recover a wider range of damages that are not available through workers’ compensation, including:
- Pain and suffering
- Emotional distress
- Loss of enjoyment of life
- Punitive damages
Small businesses often forego workers’ comp coverage to lower expenses. For example, a restaurant with a handful of employees decides to skip the workers’ compensation policy. If a kitchen cook burns his hand while working, he may file a lawsuit to recover damages because the employer failed to carry the required coverage.
Employer Denies Your Injury Is Work-Related
Employers who wrongfully claim your injury is not work-related may lose their immunity from legal action. Equitable estoppel is a legal doctrine that applies to workers’ compensation when an employer denies a claim and falsely represents facts to avoid liability. The employer cannot later say that the employee’s damages fall under workers’ compensation when facing a lawsuit, as it contradicts the initial denial.
For example, a Miami hotel worker is injured while lifting supplies. The employer claims the injury happened while the worker was off the clock and denies workers’ comp. Under equitable estoppel, the hotel is not immune to a negligence claim because it denied the workers’ compensation claim.
This approach can be complex, and a workers’ comp denial doesn’t automatically lead to a lawsuit. A workers’ comp attorney will need to look at the facts of your case to determine if you can move forward with legal action.
Why These Denial Cases Can Be Strong
If workers’ comp denied your claim, it’s possible to build a strong case that holds your employer liable for your damages. These lawsuits may be a favorable approach for injured workers because:
- Miami employers lose legal protections: In some cases, employers lose their immunity from negligence lawsuits when they deny a workers’ compensation claim.
- Miami juries side with workers: When the employer does not take responsibility or unfairly denies a claim, jurors will often side with the injured worker.
Our Miami workers’ compensation lawyers have been successful with cases that started as workers’ comp denials. Although a denial can be discouraging and frustrating, working with our team can help you pursue compensation for your losses and additional non-economic damages.
What If My Denial Was for Another Reason?
Workers’ compensation claims may be denied for other reasons, such as paperwork errors, late notice of the injury, or other technical reasons. If your employer has the required workers’ comp coverage and equitable estoppel does not apply to your claim, denials will likely stay in the workers’ comp appeals process rather than progressing to an employer negligence lawsuit.
To avoid a workers’ comp claim denial, take all the proper steps to file your claim within the Miami workers’ compensation deadline. Learn more about the requirements and deadlines to file a workers’ comp claim by contacting a trusted Miami attorney.
Why Talk to a Miami Work Comp Lawyer After a Denial
When your workers’ compensation claim is denied, your next steps will depend on the reason for the denial. You may qualify to sue an employer who denied your claim and recover additional damages through a civil lawsuit.
It pays to call Payer. Our Miami workers’ compensation attorney can help with your claim by checking whether your employer has the proper coverage, challenging denials, and filing the appropriate case in the right Miami-Dade court.
Call (305) 363-7099 or contact James D. Payer and our skilled team of workers’ comp lawyers online to schedule a free consultation. You pay no fees unless we win your case.
