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How to Appeal a Denied Workers’ Compensation Claim in Florida

WorkComp

Not all insurance claims make it through the adjuster as expected. It can be frustrating to discover that your valid needs are not being met. Not to mention that arguing your merits with an insurance company can be intimidating.

When your claim has been denied, you have the right to appeal the decision. You can represent yourself during the process. However, injured people fighting workers’ compensation boards and insurance companies generally experience better results when working with a licensed Florida workers’ compensation attorney.

Filing a Workers’ Compensation Appeal in Florida

Before launching a formal appeal, it is possible to negotiate with the insurance company beforehand. Upon receiving the denial, you can open up a dialogue with the adjuster and file an internal appeal. However, if that does not yield desirable results, then you should file a formal appeal with the Florida Division of Workers’ Compensation.

In order to initiate an appeal, you are required to file a petition with the clerk of court in the Office of the Judges of Compensation Claims (OJCC). The petition requires you to provide specific details regarding your appeal. Be prepared to provide the following:

  • how the accident occurred
  • a description of all injuries
  • the amount of money you have lost
  • a mention of specific benefits you want

In Florida, a statute of limitations exists on appeals. There is a one year time limit starting from the date of your last treatment. Consider working with a licensed Florida workers’ compensation attorney to ensure that you meet the proper deadlines.

What Happens After You File an Appeal

The OJCC appeals board will review your petition. The judge panel notifies your employer and the workers’ compensation insurer. The employer has up to 14 days to respond to your claim after receiving notice of your filing. If no response is provided, then implied consent takes effect. The insurance company must pay the claim.

The employer’s insurance company will more than likely respond to your appeal. If there is still a disagreement over which benefits should be paid, then a formal hearing is held to discuss it in a judicial setting. Having an aggressive Florida workers’ compensation attorney on your side is comforting in this situation.

Get Legal Advice for Your Workers’ Compensation Claim

While it is true that you can contact the Florida Workers’ Compensation Commission to ask general questions, they cannot offer legal advice. For example, you can ask their administrators if you can demand certain benefits, but they cannot tell you what or how much you should ask for. At this point, you are pointed in the direction of a lawyer.

When your workers’ compensation claim has been denied, consider contacting Payer Law Group to assist you in getting coverage for your work-related injuries. Our team of experienced Orlando workers’ compensation lawyers have been serving Florida families and workers for 20 years. Schedule a free consultation with our office.

Resource:

jcc.state.fl.us/jcc/

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