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Common Reasons for Denial of Workers’ Compensation Claim

Workers' Compensation Claim

Why Was a Workers’ Compensation Claim Denied?

Workers’ Compensation insurance is required for most Florida employers and provides an important financial safety net for workers who are injured or contract occupational diseases at their jobs. Since workers’ compensation benefits are available, employees are generally not allowed to file personal injury lawsuits. The only good side of that equation is employees do not have to prove negligence in order to recover benefits; workers’ compensation is a no fault system. Generally speaking, that means even if the accident is your fault, you would still be covered. Despite the availability of this type of protection, some workers’ compensation claims are often delayed and denied. Before filing a workers compensation claim, here are some common reasons why and how to avoid denials or delays from Coral Springs Workers’ Compensation attorney Evan M. Ostfeld, Esquire.

Exposure Cases

Not all workplace injuries and illnesses will be covered by workers’ compensation. For example, if you contract a common communicable disease such as COVID, your claim for benefits will likely be denied. One must be able to prove that you were in fact made sick due to circumstances at the place of employment. Unfortunately that burden is almost impossible to overcome.

Missing Deadlines

Under § 440.185, Fla. Stat. (2022), you must notify your employer about your workplace injury or illness immediately after an injury. That or no later than 30 days after it occurs or the date that you learn the illness or injury was work-related. If you don’t notify work timely, your claim for benefits will likely be denied.

There are other deadlines for filing documentation you must strictly follow. To avoid claim delays or a denial, report your injury or illness to your supervisor immediately and file am incident report. If they refuse, write up your own and give them a copy. Additionally, seek medical treatment at once. Just make sure that you give a history that the incident occurred on the job. If you find it difficult to file any required paperwork or documentation, you should retain Evan M. Ostfeld, Esq. at The Law Offices of Evan M. Ostfeld, P.A. for help (866) I SUE YOU (866) 478-3968 immediately. He firm will fight to protect your rights under the Florida Workers’ Compensation Act.

Non-Work Injury or Illness

The insurance company might classify your injury or illness as non-work related and thus ineligible for benefits in the following situations:

  • No one witnessed your accident and injury.
  • You sustained an injury while engaging in a recreational activity even if it occurred in the workplace.
  • Your injury or illness resulted from a pre-existing condition instead of your job.
  • Your accident happened while you were traveling from home to work or from work to home or while you were on a break; there are however several exceptions such as the personal comfort docrtine.
  • You didn’t notify your employer about your injury when it occurred.

Typically you can’t recover benefits if you were injured in an accident while traveling from home to work or vice versa, however there are certain exceptions. Contact our law office to learn more about the law regarding travelling employees and or special errands.  Since COVID, many people now work from home. As such, injuries that occur there may still be covered if you were in the course and scope of your employment.

Companies oftentimes try to claim that injuries and illnesses were caused by pre-existing conditions. Even if that is true, it does not automatically disqualify a person to receive workers’ compensation benefits. The most important thing to do is to promptly report your injury or illness to your employer and get legal representation ASAP! Our office provides a free case consultation. The more information you learn, the better protected you’ll be from the “Big Bad” insurance companies!

You Were Injured While Engaging in Horseplay Or A Fight

If you were injured at work while engaging in horseplay or a fight, the insurance company may not cover the claim. To avoid this type of problem, refrain from roughhousing or fighting on the job. On the other hand, if you were simply attacked at your place of employment, the victim may be covered but not the aggressor. Just file a police report and or try to have the state attorney’s office file charges against the defendant. That will likely help strengthen the case.

Your Injury Occurred While Intoxicated or On Drugs

Some employees suffer workplace accidents and injuries because they were under the influence of drugs or alcohol. If so, the injury may not be covered by workers’ compensation. If your employer believes that your accident happened because of your use of alcohol or drugs, they can require you to submit to a drug test. Make sure you follow your company’s drug-free workplace policies to reduce the risks of accidents and avoid claim delays or denials. That being said, lawyers can still fight to protect your workers’ compensation rights if the employer and or insurance company failed to follow correct protocol during the testing procedures.

You Failed To Seek Medical Treatment

If one suffers an injury at work but fails to see a doctor, they might have trouble recovering any workers’ compensation benefits. That’s because the whole system is based on medical care. Accordingly, you cannot collect lost wages unless a doctor specifies work restrictions. So, ask for medical treatment from your employer right away! If they refuse, simply go to an emergency room or visit your own physician. Just make sure you explain how the accident occurred at the place of employment. Once you see a doctor, get your work restrictions, recommendations and present a copy to your employer.

You Refused the Doctor Selected by Your Employer

Under Florida law, generally the employer and their insurance carrier has the right to choose your physicians. If you refuse to do so, your own doctor may not be able to testify in court.
Plus any work restrictions and medical recommendations may be ignored since they did not come from an authorized medical provider approved by workers compensation.

Talk to a Coral Springs Workers Compensation Attorney

If you’ve been injured at work and or have learned that your illness is work-related, immediately report it to the job. Before filing a workers’ compensation claim your next step should be to consult with an experienced Coral Springs Workers’ compensation lawyer like Evan M. Ostfeld and his legal team. The Law Offices of Evan M. Ostfeld, P.A. has more than 29 years of experience and provides a free, no-obligation case evaluation. You will not have to pay attorney’s fees or costs unless there is a court award or settlement. Please contact us today at (866) I SUE YOU, (866) 478-3968, (954) 227-7529, (954) 998-0075or evan@attorney4life.com; we are here to help!

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