Top Reasons Your Workers’ Comp Claim Was Denied
Workers’ compensation claims are denied all the time for a variety of reasons, both valid and otherwise. In these cases, injured workers hire an attorney to litigate the claim and ensure that the insurance company upholds their end of the bargain. It’s important to understand that the workers’ compensation system is governed by Florida State law and it’s part of a legal process. If your claim has been denied, you will only have so much time to appeal the decision and ensure that you are providing the information requested.
In this article, we’ll discuss the most common reasons for denying a workers’ compensation claim.
Missed deadlines
The law requires that both parties in a workers’ compensation dispute provide information in a timely manner so that the dispute can be adjudicated as quickly as possible. For that reason, the law places deadlines on both parties to respond to the complaint or file an appeal. Requests for information also have deadlines. Missing any of these deadlines will result in the insurance company simply denying your claim. Litigants who miss deadlines have little recourse to pursue litigation later.
Really a work-related injury?
Workers’ compensation insurance companies don’t indemnify their policyholders like car insurance or homeowner’s insurance. In other words, it doesn’t matter who’s liable because workers’ compensation is a no-fault system. However, the insurance company is only responsible for injuries that occurred on the job or at least due to work services provided by the employee. When someone is injured on the job and goes to the hospital, it can be very clear how the injury was caused. When the injury is the result of years of cumulative wear and tear, the insurance company generally balks at the request for compensation.
Further, insurance companies will pore over your medical records to find instances of a car accident or a sports-related injury in your past that could account for your current problems. While workers’ compensation is a no-fault system, claims of horseplay or intoxication on the job generally prevent claims from moving forward.
State laws obscure the responsibility of employers
Today, it is more common to see COVID-related claims being filed by workers. However, it can be nearly impossible to prove where you got an infection from. This presents a problem for workers who are required to quarantine by state law and then file workers’ compensation claims during their period of quarantine. Some states have stepped in on behalf of workers to force insurance companies to honor these claims.
The bottom line
If your claim is denied, you will need to speak with a Miami workers’ compensation attorney. Insurance companies sometimes deny claims in bad faith or based on the opinion of supervisors who may have ulterior motives. You will need an advocate who represents your interests to leverage the insurance company to pay. Payer Law can help you litigate your claim. Call today to learn more.
