If a workers’ compensation claim is denied, in part, or in whole, a notice of denial is filed with the State of Florida. The appropriate form is a DWC-12, which looks like this in format.
Once a denial is filed, there are generally two ways the denial is rescinded. 1) the employer/carrier rescinds the denial on it’s own with evidence, or 2) an injured worker/ claimant files a petition for benefits to challenge the denial through the Judge of Compensation Claims.
Denied workers’ compensation claims in Florida can be a devastating and difficult experience for an injured worker. Workers’ compensation is a system designed to provide financial assistance to workers who suffer an injury or illness on the job, but claims in Florida may be denied for a myriad of reasons. Reasons for a denied claim may include a lack of evidence that the injury occurred at work, pre-existing conditions, or failure to follow proper reporting procedures. When a claim is denied, the injured worker may be left without financial support to cover medical bills, treatments, lost wages, and other expenses related to their injury. However, denials can be challenged, and an experienced attorney can provide guidance and support through the process.
There are several common reasons for denials of workers’ compensation claims in Florida:
- Lack of medical evidence: If an injured worker fails to provide sufficient medical evidence to support their claim, their workers’ compensation claim may be denied. This can include medical records, doctors’ reports, and other documentation that demonstrates the extent and severity of the injury.
- Pre-existing conditions: If an injured worker had a pre-existing condition that contributed to their injury, their workers’ compensation claim may be denied or reduced. The employer or insurance company may argue that the pre-existing condition was the primary cause of the injury, or the major contributing cause (51%), which is the standard in Florida workers’ compensation claims.
- Failure to report the injury in a timely manner: In Florida, injured workers must report their injuries to their employer within 30 days of the incident. If an injured worker fails to report the injury in a timely manner, their workers’ compensation claim may be denied.
- Employer disputes the claim: In some cases, employers may dispute an injured worker’s claim for workers’ compensation benefits. This can occur if the employer believes that the injury did not occur at work or if they believe that the injury is not as severe as the worker claims.
- Intoxication: If an injured worker was under the influence of drugs or alcohol at the time of the injury, their workers’ compensation claim may be denied.
Filing a petition for benefits in Florida is the process injured workers can pursue if their workers’ compensation claim has been denied or if they are not receiving the benefits they are entitled to. To file a petition for benefits, the injured worker or their representative must complete and submit the appropriate forms to the Florida Division of Administrative Hearings. After the petition is filed (an injured worker is promised a hearing within 210 days pending delays outside the control of the injured worker or employer/carrier), a hearing will be scheduled where the injured worker can present their case and any relevant evidence.
If your Work Comp Claim is Denied and you have questions, feel free to reach out to our workers’ compensation attorney for a free consultation.