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Our Broward County Law Firm Can Help with Denied Workers Compensation Claims

If you tried to file for workers’ compensation and received a denial, this does not necessarily mean that your claim is over. Unfortunately, while some denials are justified, many are not. Workers compensation insurance companies deny claims for a variety of reasons—including everything from minor technical deficiencies to intentional bad faith.

If you have received a workers’ compensation denial, it will be important for you to speak with a lawyer promptly. There are strict deadlines for filing workers’ compensation appeals; and, if you act quickly, you may still be able to obtain benefits without going through the formal appeals process. Fort Lauderdale workers’ compensation attorney Joseph Maus is experienced in handling claim denials, and he can use his experience to help you seek the benefits you are rightfully owed.

Why Do Workers’ Compensation Claims Get Denied?

When seeking to challenge a workers’ compensation denial, the first question you need to answer is, “Why was my claim denied?” Once you know why the insurance company denied your claim, then you can focus on doing what is necessary in order to overcome the denial. Some of the most common reasons for workers’ compensation denials include:

1. Waiting Longer Than 30 Days

In Florida, you only have 30 days to report a job-related injury or illness to your employer. If you waited longer than 30 days, this may be why your claim got denied.

But, did you really wait more than 30 days? In many cases, injured and sick workers won’t discover their conditions right away. If you filed your claim within 30 days of discovering your condition, you should still be eligible for benefits. Even if you did wait longer than 30 days, a workers’ compensation lawyer may still be able to help you collect at least partial benefits.

2. Seeking Benefits for an Injury or Illness that Isn’t Work-Related

Workers’ compensation benefits are only available to workers who suffer work-related injuries. If you got hurt on personal time, then you aren’t eligible for workers’ compensation benefits (though you may be eligible for other forms of compensation).

But, you don’t necessarily need to be doing your job when you get injured. As long as your injury or illness occurs “within the scope of your employment,” you are eligible for benefits under Florida law. Insurance companies will often deny coverage to workers who are eligible for benefits and who simply fail to provide sufficient documentation of the workplace accident. 

3. Seeking Benefits Without Adequate Medical Records

In order to collect workers’ compensation benefits, you need proof of your injury or illness. This requires medical records that (i) describe the nature and severity of your injury, (ii) link your injury or illness to your employment, and (iii) outline your medical treatment needs.

If you did not submit adequate medical records with your workers’ compensation claim, this could be why your claim was denied. Attorney Joseph Maus can review your claim, review your medical records and help you do what is necessary to secure the benefits you deserve.

4. Having a Pre-Existing Condition

Another common reason for workers’ compensation denials is being diagnosed with a pre-existing condition. If you were already suffering from an illness or injury when you got sick or hurt at work, there is a good chance that this is the reason for your denial.

However, workers’ compensation insurance companies cannot flatly deny claims based on employees’ pre-existing conditions. If your pre-existing condition is now worse than it was, or if your pre-existing condition was a factor in how you got sick or hurt at work, you should still be able to secure benefits. The cost of treating your pre-existing condition won’t be covered, but you should be able to obtain coverage for the costs of recovering from your work-related injury or illness.

5. Submitting an Inaccurate or Incomplete Claim

If your workers’ compensation claim was deficient in any respect, this could be why it got denied. This includes everything from omitting a date or signature to failing to provide documentation that your condition is work-related. If the insurance company found inaccuracies or inconsistencies in your claim, this could be the basis for your denial as well.

These are also issues that can frequently be overcome. As long as you still have time to challenge your denial, workers’ comp attorney Joseph Maus can help you build an accurate and complete claim for benefits, and he can take over dealing with the insurance company.

What Should You Do After Receiving a Workers’ Compensation Denial?

So, you filed a claim for workers’ compensation and your claim got denied. What should you do now?

At this point, you need to discuss your situation with an experienced workers’ compensation attorney. You need to understand why your claim was denied, what (if anything) you can do to address the issue, and how to challenge your denial in the most effective way possible. Each of these steps requires a thorough understanding of Florida’s workers’ compensation laws and the workers’ compensation system.

Depending on why your claim was denied, it may still be possible to obtain benefits without filing a formal appeal. Attorney Joseph Maus may be able to deal with your employer’s insurance company directly to resolve any outstanding issues. But, if the insurance company is still unwilling to pay, then it may be time to take your claim to Florida’s Office of the Judges of Compensation Claims (OJCC).

Regardless of the steps that need to be taken, acting quickly will give you the best chance of collecting benefits for your work-related injury or illness. You can contact us 24/7 to get started with a free consultation.

Schedule a Free Consultation with Broward County Workers’ Compensation Attorney Joseph Maus

Are you entitled to workers’ compensation benefits even though your claim was denied? To find out, schedule a free consultation at Maus Law Firm. Call 855-908-4379 or tell us how we can reach you online to speak with workers’ compensation attorney Joseph Maus as soon as possible.

 

 

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Posted By: Teresa Meadows