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Every day, injured employers who need benefits from workers’ compensation receive a letter denying their claim. This is distressing, as it is often the only chance to avoid financial instability while recovering. These benefits can be substantial and include replacing lost wages and covering medical expenses. Thankfully, injured workers have the right to appeal the denial.
A dedicated and experienced St. Petersburg workers’ compensation lawyer at Kogan & DiSalvo can help you appeal your denied claim. The appeals process can often help you get the benefits you need and deserve. Call today to schedule a free consultation. We are happy to assess your case and answer your questions.
Common reasons for a denied workers’ compensation claim
Workers’ compensation claims can be denied for a variety of reasons. It is not uncommon for an insurance company to reject a claim and approve it upon appeal. There are many instances when providing more detailed information is sufficient.
Some of the reasons a workers’ compensation claim is initially denied include the following:
- Pre-existing conditions. You are not entitled to workers’ compensation benefits for injuries that precede a workplace accident. These benefits are exclusively for injuries that happen on the job. It is worth noting that you could be entitled to benefits if your pre-existing condition has been exacerbated by a workplace accident.
- Missed deadlines. There are several important deadlines that you must comply with throughout the process. If you miss these deadlines, your claim is likely to be denied. One of the most common examples is failing to notify your employer of your workplace injury within 30 days.
- Outside the scope of employment. You might not be entitled to benefits if it is determined that your injuries happened outside the scope of your employment. For example, your employer asked you to go to the store, and on the way back, you stopped for coffee and were rear-ended in the parking lot.
- The injury occurred as a result of the employee’s disregard for safety, as in the case of horseplay or intoxication.
- The employee’s injury was intentional and self-inflicted.
My claim was denied—now what?
After receiving a denial letter, know that 67 percent of claims are initially denied, so it is not the end of the road. Then, read it carefully. It should provide insight into the reason for the denial, although you cannot expect it to provide a comprehensive discussion. The letter will also provide important information about the appeals process, which is in place to ensure that legitimate claims are recognized.
However, there is a limited window of time to formally file, which is 30 days. There is also a filing fee associated with an appeal, although it can be waived in some cases.
In addition, you can do the following:
- Retain a lawyer right away.
- Focus on the reasons for the denial.
- Prepare a Petition for Benefits with all the details of your accident, injuries, lost wages, medical expenses, and the benefits you are requesting.
- Plan for mediation and hearings.
The most important thing for an injured worker to understand about the appeals process is that it is complex, and a seemingly minor error could upend your claim. Your best chance at a successful workers’ comp appeal involves hiring an attorney who thoroughly understands the nuances of Florida Workers’ Compensation Law. Let our firm advocate for you during every stage of your appeal.
Contact Kogan & DiSalvo Today for a Free Consultation
Having your workers’ compensation claim denied is stressful. However, you have options to pursue that could allow you to recover the benefits you deserve. Learn more about how our trusted attorneys at Kogan & DiSalvo will fight for your rights, represent your case, and ensure you are fairly compensated. Let us help you seek justice for your denied workers’ compensation claim. Reach out today for a free consultation
