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What To Do If Your Workers’ Compensation Claim Is Denied


Workers’ compensation claims are denied for various reasons. If your claim is denied, you may not be aware of what the next steps you should take are. This article will provide information regarding some of the reasons why workers’ compensation claims are denied, as well as some steps you could take if your claim is denied.

Why are some workers’ compensation claims denied?

Workers’ compensation claims can be denied for any number of reasons. Some of these reasons include the following:

  1. You failed to meet an applicable deadline. With workers’ compensation claims, timing is of the essence. If you miss a specified deadline, such as the deadline for notifying your employer of your accident, your claim may be denied.
  2. Your accident report and medical records are inconsistent. If the accident report that you gave your employer does not match your medical records, your claim is likely to be denied.
  3. Your injury was not work related. Your injury must occur within the course and scope of your employment to be compensated.
  4. You failed to seek medical care for your injuries. If you never received medical care for your injuries, employers and insurance companies may question the significance of your injuries and refuse to provide compensation for them.
  5. You were injured while under the influence of drugs or alcohol. In Florida, employers and insurance companies can deem an injury as uncovered by workers’ compensation if testing reveals that the employee had high amounts of drugs or alcohol in his system when he was injured.

What are some steps I can take if my workers’ compensation claim was denied?

If your workers’ compensation claim is denied, you should consider taking some of the following steps:

  1. Closely review the denial letter. Though it may initially be frustrating to receive a denial of your claim, you should ensure that you closely review the denial letter at some point to fully understand the reason(s) why you were denied. It could be that either you or the insurance company made a simple error that could be rectified by a phone call or email. If you notice any errors on the denial letter, contact the insurance company right away to see if the problem can be fixed.
  2. Consider reaching out to a workers’ compensation attorney. If there was a substantive basis for your denial, you should consider contacting a workers’ compensation attorney. This attorney will let you know whether you should file an appeal and will ensure that you meet any applicable deadlines. Alternatively, if you decide to opt out of the workers’ compensation process altogether and file a personal injury lawsuit against your employer instead, an attorney can initiate and provide assistance throughout that process.
  3. File a petition. This process involves filing a petition with the office of the Judge of compensation claims. The case will be set for a hearing to determine whether you have a valid claim for benefits.

Was Your Workers’ Compensation Claim Denied? Our Firm Can Help

If you recently filed a workers’ compensation claim that was subsequently denied and you would like to file a personal injury lawsuit against the employer instead, The Musleh Law Firm is prepared to assist you through the process. Our experienced Ocala workers’ compensation attorneys will fight to ensure that you receive compensation for your injuries.

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