Imagine working in a retail store as a stocker. You are in the back bay pulling product when a tower of improperly stacked boxes falls on top of you. After getting to the emergency room, you find out you have a concussion and some cracked ribs. Now, you are facing a high emergency room bill, multiple other medical expenses and you will have to miss work for more than a week.
It seems like it should be relatively easy to file a claim and receive workers' compensation benefits. You were injured while on the clock and on the store premises. Why would the insurance provider deny your claim? Unfortunately, even in cases that seem very simple, an insurer can deny a workers' compensation claim. However, a claim denial does not have to be a final ruling.
An experienced personal injury attorney in Florida can help you through the initial filing and the appeals process. Read further for what to do after an insurer denies your workers' compensation claim.
Reasons for a denial
After receiving a claim denial, the first thing you should do is try to understand why the insurer did not approve it. The insurance provider should send you a letter that explains why they denied your claim. One of the most common reasons why claims are denied is because the employee did not report the injury in time. Not filing the claim within prescribed time limits can also cause an insurer to deny it.
If your employer disputes the claim, the provider will more than likely deny it. For example, your boss may tell the insurance company that your accident happened outside of work. There are many reasons an employer can cite that will disqualify you from receiving workers' compensation benefits.
After you receive a letter of denial, you have the right to appeal the insurer's decision. Included in the denial should be instructions for appealing the decision, including where and when to file the appeal. Before you begin the appeals process, you may want to consider meeting with your boss and the insurance carrier to discuss the denial. It could be that your received the denial by accident and a simple conversation can clear up the matter.
If you choose to move forward with the appeals process, be prepared for very complicated legal proceedings. You may have to attend a hearing with an administrative law judge, meet with Florida Department of Labor officials, and possibly go through many levels of appeal.
If an insurer has denied your workers' compensation claim, it is important to remember that you have options.