A denial is not the end of your workers’ comp claim. In Florida, injured workers have the right to challenge a denied claim through a formal dispute process, and many denials that initially seem final are successfully overturned. If you received a denial letter after filing a workers’ comp claim in Orlando, the most important thing to understand is that you have options and a deadline to act on them.
Why Workers’ Comp Claims Get Denied in Florida
Insurance carriers deny claims for a range of reasons, and not all of them hold up under scrutiny. Common reasons for denial include:
- The injury was reported after a delay, and the carrier is arguing that the timing undermines credibility
- The employer disputes that the injury happened at work or during a work-related activity
- A pre-existing condition is being used to argue that the injury is not work-related
- The carrier claims the medical treatment sought was not authorized or not related to the workplace injury
- There was no witness to the accident, and the carrier is treating the account as unverifiable
- A missed procedural deadline during the claims process
Some of these are legitimate disputes that require additional documentation to resolve. Others are carrier tactics designed to reduce payouts, and they can be challenged, especially with help from the right workers’ compensation attorney.
The Florida Workers’ Comp Dispute Process
Florida’s workers’ compensation disputes are handled through the Office of the Judges of Compensation Claims under Florida Statutes § 440.25. Here is how the process generally works after a denial:
- Petition for Benefits: The injured worker files a Petition for Benefits with the Office of the Judges of Compensation Claims, formally identifying what benefits are being disputed.
- Mediation: Most disputes go through mandatory mediation before reaching a hearing, giving both sides a chance to resolve the issue without a judge.
- Pretrial hearing: If mediation does not resolve the dispute, a pretrial conference is scheduled to narrow the issues before a formal hearing.
- Merits hearing: A judge of compensation claims hears testimony and reviews evidence, then issues a ruling on the disputed benefits.
The deadline to file a Petition for Benefits in Florida is generally two years from the date of the injury or the date benefits were last provided, under Florida Statutes § 440.19. Missing that window can permanently bar your claim.
What to Do Right After a Denial
Do not wait to see if the situation resolves on its own. Gather your denial letter, all medical records related to the injury, any written communication from your employer or their carrier, and a record of any treatment you have had or been denied. The stronger your documentation going into a dispute, the better positioned you are.
A denied claim in Orlando is not a closed door. At Smith, Feddeler & Smith, P.A., our Orlando workers’ compensation lawyers offer free case evaluations for injured workers throughout Orange County who are ready to challenge a denial. Call (407) 848-5178 or contact us online to go over what happened and what comes next.
