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Workers' Comp Appeal Lawyers

Workers’ compensation is designed to protect injured workers from unexpected expenses, but what happens when a settlement is insufficient or denied? Some workers might be able to negotiate an agreement with their employer’s insurance company, but others might not be so lucky. When insurance companies refuse to cooperate, as they often do, employees have the option to escalate the case to trial. Unfortunately, taking a workers’ compensation case to court is not a guarantee for a reasonable settlement. Without any legal support from a Gainesville & Ocala law firm to protect their best interests, injured workers are likely to receive lousy offers inside and outside the courtroom.

If a court has decided unfavorably on your case, there are still steps you can take to get the compensation you deserve. At Hesser & Kipke, we are dedicated to doing what’s right for workers and getting them the compensation they need. Contact our workers’ compensation attorney in Gainesville and Ocala, FL, today to request a case consultation.

Why Workers’ Comp Claims Are Denied

A workers’ compensation claim may be challenged by either the insurance company or the employer. Some of the most common grounds on which claims are denied include the following:

  • The injury was not reported in time: In Florida, workers must report most injuries to their employer within 30 days of the accident. For conditions or illnesses developed over time, workers must notify their employers within 30 days of discovering the illness’ relation to their work.
  • The claim was filed before the deadline: In Florida, workers’ compensation claims must be filed within two years of the date of injury.
  • Employer disputes the claim: Employers may try to challenge a case by claiming the accident happened outside of work, was the result of horseplay, or another reason that may disqualify the employer from obtaining compensation.
  • Insufficient evidence: Injured workers must often prove that the accident happened while at work or was somehow related to their work. Evidence in the form of medical exams and witness testimonies can help clients build a stronger case.
  • No need for medical treatment: In most cases, only injuries requiring medical treatment are eligible for workers’ compensation.
  • Injury is not compensable: Some injuries may not be covered by the employer’s workers’ comp policy. Also, Florida does not guarantee workers’ compensation for stress-related injuries.

Workers’ Comp Appeal Process

When their employer’s insurer denies their claim for benefits, workers have the right to challenge that decision. Before submitting an appeal, however, employees should try to resolve the dispute informally by contacting the insurance company. If the insurer is unwilling to cooperate, workers may then file a formal appeal. Contact our office to learn more about filing an appeal.

Appealing The Insurer’s Decision

Injured workers in Florida can file a workers’ compensation appeal by submitting a completed Petition for Benefits form to the Office of the Judges of Compensation Claims (OJCC). In the form, claimants are required to list what benefits they are seeking. They must also provide information regarding any accidents, injuries, and lost wages relevant to the case. In most cases, workers must file a petition for benefits within two years of the date of injury. However, some courts may require workers to file within one year since the worker last received benefits. Once the OJCC receives the petition, it will notify the worker’s employer and the insurance company. The insurance company must then either agree to pay the claim or respond to the OJCC within 14 days.

If the insurer still decides not to award workers’ compensation, then the injured workers and their lawyers, the insurance company lawyers, and, sometimes, the employer, all engage in a series of mediated negotiation meetings. These meetings are, for the most part, informal. The first is typically scheduled within 130 days since workers filed the petition for benefits. Negotiations are mediated by a third-party and end once all parties reach an agreement.

If mediation is unsuccessful, the case assigned to a workers’ compensation court. At this point, workers must hire an experienced workers’ compensation lawyer to represent them during any court hearings. Once the judge reviews all of the evidence, they will then issue a written decision.

Appealing The Judge’s Decision

If workers do not agree with the judge’s decision, they have the right to appeal the court’s ruling to Florida’s First District Court of Appeals within 30 days. Unfortunately, most appeals to this court take longer than a year. Because of complicated procedural and filing requirements at this stage in the appeal process, legal representation is crucial to getting a workers’ compensation appeal approved.