Key Takeaways: If your workers’ compensation claim was denied in Florida, it is not the final decision. You have the right to appeal by filing a Petition for Benefits. Common reasons for denial include missed deadlines and disputes over whether the injury is work-related. A qualified workers’ compensation attorney can manage the appeals process for you.
Receiving a denial letter for your workers’ compensation claim is disheartening, but it’s crucial to act quickly. The insurance company’s decision is not the final word. Under Florida law, you have the right to appeal a denied claim.
However, navigating the appeals process alone is complex and challenging. This is where an experienced Miami workers’ compensation attorney becomes essential to securing the benefits you deserve.
Why Was My Florida Workers’ Comp Claim Denied?
Insurance companies are businesses focused on protecting their bottom line, which often means finding reasons to deny claims. Based on our experience handling cases in Miami-Dade County, denials typically stem from one of these four issues:
- Disputed Work-Related Injury: The insurer may argue your injury was not work-related or resulted from a pre-existing condition. Your work must be the “major contributing cause” of the injury. We counter this by gathering strong medical evidence and expert testimony to establish a clear link.
- Missed Reporting Deadlines: Florida has a strict 30-day deadline to report your workplace injury to your employer. Failing to report within this window is one of the most common and preventable reasons for an automatic denial.
- Inconsistent or Incomplete Medical Records: The insurer will scrutinize your medical history. If you saw a doctor not authorized by your employer or if your records don’t clearly document the injury’s severity and cause, they may use this as grounds for denial.
- Discrepancies in the Accident Report: Any inconsistency between your account, witness statements, and medical records can be used to question the validity of your claim.
How a Miami Workers’ Comp Attorney Can Help
Facing a large insurance company alone is a significant disadvantage. The Law Offices of Jose M. Francisco has over 30 years of experience exclusively handling Florida workers’ compensation and personal injury cases. We level the playing field by managing every step of the appeals process for you.
Here is how we fight for your rights:
- File a Petition for Benefits: We will immediately file the official petition to formally challenge the insurance company’s denial, ensuring you don’t miss any critical deadlines.
- Gather Crucial Evidence: We collect all necessary documentation, including medical records, witness depositions, and expert opinions, to build a powerful and persuasive case.
- Negotiate with the Insurer: We leverage our understanding of insurance company tactics to negotiate aggressively on your behalf for the full benefits you are owed.
- Represent You in Court: If a fair settlement cannot be reached, we are fully prepared to represent you before a Judge of Compensation Claims.
About the Author: Jose M. Francisco
Jose M. Francisco founded The Law Offices of Jose M. Francisco, P.A. in 1991 to advocate for the rights of individuals against insurance companies and large corporations. A resident of the Miami metropolitan area since 1974, he has deep roots in the community he serves. Mr. Francisco earned his Juris Doctor degree from Nova Southeastern University School of Law and has since dedicated his practice to personal injury matters, including workers’ compensation, automobile accidents, and wrongful death cases. His decades of experience provide clients with the knowledgeable and determined representation they need.
Your Advocate for Work Accidents in South Florida
Don’t let a denied claim discourage you. If you’ve been injured at work in Miami, Hialeah, or the surrounding communities, The Law Offices of Jose M. Francisco is ready to be your advocate.
We operate on a contingency-fee basis. You don’t pay anything unless we successfully recover benefits for you. Contact our office today for a free, no-obligation consultation to discuss your case. Let us handle the legal burden so you can focus on your recovery.