When you are injured while on the job, workers’ compensation should cover at least a portion of your medical expenses and provide disability benefits while you recuperate. However, for various reasons, workers comp claims are sometimes denied. If you received a Notice of Denial regarding your workers’ compensation benefits, do not despair. You have options to appeal the decision and receive the medical care and wage benefits you deserve for your injury.
A Tampa workers’ compensation attorney at Kogan & DiSalvo can guide you through the Florida workers comp appeals process and represent you in court. While it is possible to represent yourself during the appeals process, it is not advisable. It is a complicated process with firm deadlines. It is easy for those unfamiliar with the workers’ comp appeal process to make mistakes jeopardizing their ability to have the denial overturned.
The workers’ comp appeals process consists of precise steps. The first step involves having your attorney try to resolve the issue with your employer’s insurer privately. The insurance company will have an attorney present, so it is wise for you to also have legal counsel.
If there is no resolution, the next step is filing a Petition for Workers’ Compensation benefits with the Office of the Judges of Compensation Claims (OJCC). The petition must include all details of your accident and injuries, as well as wage loss. It must also include the exact types of benefits you seek.
An OJCC judge will probably order mediation. During mediation, a neutral mediator works to come up with a solution amenable to all parties. These mediators are often former judges or workers’ comp attorneys.
Your attorney represents you at mediation, and the insurer will have its attorney representing them. The bulk of workers comp appeals are decided at mediation. However, if mediation does not work out, a workers’ comp judge schedules a pretrial hearing with the OJCC.
During this hearing, the judge reviews evidence from all parties and makes a decision regarding your claim. If the judge denies your claim, you can take the next step and appeal to the First District Court of Appeals. This is your final chance to appeal.
Following the timelines and deadlines for the workers’ compensation appeal process is critical. Miss a deadline, and you may invalidate your claim.
You have two years from the date of your injury, or in the case of illness, from your diagnosis in which to file a Petition for Workers’ Compensation benefits. It is wise to file the petition as soon as possible.
Once your petition is filed, your employer’s insurance company must respond within 14 days. The insurer can either agree to pay your claim within that timeframe or respond to the OJCC.
If your employer’s insurer does not respond, the insurer should pay your claim. However, most insurers will respond to the petition.
A mediation must be held within 130 days of the petition filing. If the mediation is unsuccessful and you pursue a pretrial hearing, the hearing must take place within 90 days of the mediation meeting.
If you disagree with the judge’s decision, you must appeal to the First District Court of Appeals within 30 days. Keep in mind that it could take a year or more for the FDCA to make a decision.
Your denial letter states the reason your workers’ comp application was denied. Your attorney strategizes to develop the most effective arguments for you to win your appeal. We work to present relevant evidence that the reason given for denial is factually inaccurate.
For instance, if your claim was denied because the insurer believes the injury was not work-related, your lawyer must prove that your injury took place while you were on the job. This is often the case with back and neck injuries, which may occur over time but are caused by heavy lifting and other work-related tasks.
There are also situations in which the employer denies claims routinely because they want to wear workers down, hoping they will drop pursuit of their workers’ comp claim. We work hard so that you may receive the benefits you are entitled to.
If you were denied workers comp, you need the services of the experienced workers’ compensation attorneys at Kogan & DiSalvo. Schedule a free, no-obligation consultation to discuss your workers’ comp denial. We serve Tampa and all of Hillsborough County.