APPEALING DENIED WORKERS COMP CLAIMS

Our West Palm Beach Workman Compensation Attorneys will Help You Appeal a Denied Claim

A denied claim or a denied benefit makes the Florida workers’ compensation process for compensable accidents and injuries frustrating for injured workers. You have a right to petition for benefits any denied aspect of your workers’ compensation claim. If you’ve tried to fight for workman’s comp benefits unrepresented, it’s not too late to get legal assistance from a West Palm Beach workman compensation attorney. An experienced attorney at the law offices of Vassallo, Bilotta & Davis can review your case and fight any denied claims so that you can get the compensation and medical benefits you need. 

Why Workers’ Comp Claims Get Denied in West Palm Beach

Workers’ compensation claims can be denied for a wide variety of reasons, including on technical grounds such as failing to report an accident and injury within 30 days or simply because the workers compensation insurance adjuster does not want to provide you benefits. Claims may also be denied because of the following: 

Your injury is not work-related. Proving that your injury is work-related and occurred during the course and scope of your employment is required. The work accident must be the major contributing cause of your injury and need for medical treatment. This can be challenging and complicated if you have a pre-existing injury that was aggravated or exacerbated or you were re-injured at work.

Failing to disclose pre-existing injuries. If you fail to tell work comp or the authorized work comp doctor about pre-existing injuries or conditions, that could be considered fraud or misrepresentation and if a Judge of Compensation Claims (JCC) finds you failed to disclose your pre-existing injury for the purposes of securing workers compensation benefits, your case will be dismissed and you will be forever barred from work comp benefits. Even minor inconsistencies can result in allegations of fraud and your workers’ compensation claim being denied. 

You did not seek medical treatment timely. Often, injured workers feel like they may just need time off to heal after suffering a work accident. However, if too much time passes before seeking medical treatment, this leads to claims be denied. The employer/carrier will often allege the work accident is not the major contributing cause of the injuries or the injury was pre-existing. The sooner you seek medical treatment, the better. This will help establish causation through the history you provide and now contained in the medical records. Your medical records are an important part of your claim because they document the cause of your injury and often put limitations and restrictions on your work duties.

Unauthorized medical providers. If you need to medical treatment, you need to request prior authorization under workers’ compensation. This does not apply to emergency situations and urgent need for treatment or treatment necessitated under the self-help provision. As a general rule, workers’ compensation will only cover medical expenses for treatment from an authorized provider.

Pursuing Benefits and Going to Court with a West Palm Beach Workman Compensation Attorney

You have the right to seek and petition for benefits that you are entitled to under the Florida Workers’ Compensation Law. If those benefits are not provided by the employer/carrier, you can have your claims heard by a Judge of Compensation Claims (JCC). Evidence must be presented to secure those benefits at the Merit Hearing and it is vital that you consult with a West Palm Beach workman compensation attorney as soon as possible if you are proceeding to a Final Hearing.  

Attending the Mediation

If you have filed a Petition for Benefits (PFB), the Judge of Compensation Claims (JCC) will schedule a mediation. Mediation is required before proceeding to a Final Hearing and is an informal process that allows the parties to discuss the claims and denied benefits. The Mediation must be attended by both parties within 130 days of the filing of the PFB. If the employee and employer/carrier cannot reach an agreement and resolve the outstanding issues at the Mediation, a Merit Hearing will be required at which time the Judge of Compensation Claims will make a decision on the benefits claimed.

Attending the Merit Hearing

When your work comp benefits have been denied, the Judge of Compensation Claims (JCC) will schedule a Merit hearing within 210 days of the date of your Petition for Benefits (PFB). The Merit Hearing is held in front of the Judge of Compensation Claims and is the opportunity for the employee and the employer/carrier to present evidence to the Judge. This is a trial and formal court proceeding. The JCC decision is final and binding.

Although you are not required to hire an attorney to represent you at the merit hearing, it is strongly represented that you hire an experienced workers’ compensation attorney.  A work comp lawyer will present evidence to prove why you are entitled to workers’ compensation benefits. The workers’ compensation attorney will fight for you and will ask questions, call witnesses, and may object to evidence that should not legally be submitted. To be successful, it is critical to be well-prepared and able to prove your claim. Workers’ compensation attorneys work on contingency so they only get paid if they win and secure you a benefit. For these reasons, your best chance for a successful outcome at a merit hearing is to let a West Palm Beach workmens compensation attorney help you with your case.

You May Appeal the Judge of Compensation Claims’ (JCC) Decision

If you disagree with the JCC decision and have a legal basis to dispute the findings, you may file an appeal to the First District Court of Appeal. The process is lengthy and difficult but a panel of Judges will review the decision and make a determination if there was harmful error. There are attorneys that have experience in this area and they are known as appellate attorneys. An experienced West Palm Beach workman compensation appeals attorney is important and necessary if filing an appeal

of a Judge of Compensation Claims’ Final Order. 

Contact the Law Offices of Vassallo, Bilotta & Davis

The litigation process can be time-consuming and frustrating, let the Vassallo, Bilotta & Davis Law Firm help you get the benefits you deserve. Contact a West Palm Beach workman's compensation attorney who can help by calling 561-471-2800 to discuss your case with an experienced West Palm Beach workers’ compensation lawyer today.