What Is the Procedure for Denied Workers’ Comp in Miami?

When an employer denies their employee’s workers’ comp claims, it could seem like the end of the process. But it is far from over. A denied workers’ compensation does not mean you can’t get your benefits, especially if there’s evidence that your injury is work-related.

What you need at that point is to get a Miami workers’ compensation lawyer in your corner. The lawyer will contact your employer and try to find out why they denied your claim. If the employer fails to justify the reason for their decision, your attorney can then initiate the procedure for a denied workers’ comp claim. This article looks at what this procedure is, but first, let’s find out why Miami employers deny claims.

Why Do Miami Employers Deny Work Comp Claims? 

A large number of workers’ compensation claims get denied yearly. While some of these denials are justified, others are excuses used by employers to avoid paying their employees their benefits. In Miami, some of the common reasons for denied work comp claims include:

  • Incomplete application
  • A discrepancy between the official incident report and the documented injuries
  • Failure to meet the deadline by the applicant
  • The applicant failed to seek medical treatment immediately after the injury
  • The medical provider who attended to the applicant is not on the certified list of healthcare providers used by the employer
  • The applicant’s injury did not occur at the workplace or happened outside working hours
  • The injury is not severe enough to warrant workers comp benefits
  • The employer disputes the claim
  • The applicant had a pre-existing injury

Once your employer’s insurance provider denies your claim, your employer will send you a letter. The correspondence will state the exact reason for the denial and provide information on a possible appeal. In Miami, you have two years from the injury date to file an appeal.

This means that the time already started counting while you were still waiting for your employer to approve your claim. However, if your appeal is the denial of one benefit, say lost wages, you have one year. It starts counting from the date of the last payment or treatment date. To ensure you don’t file out of time, work with a Miami workers’ comp lawyer.

What Is the Process of Appealing a Denied Workers’ Comp Benefit? 

When your employer denies your claim, your first step should not be to file a lawsuit. Meet with your employer or their insurance company to find out the reason for the denial. The reason is to enable you to determine if you can correct the reason for the denial or if the court needs to intervene.

If the choice is the latter, then you should contact the Employer Assistance Ombudsman Office (EAO). They assist Florida employees at no cost. If the EAO cannot help you resolve the issue, you need to submit a Petition for Benefits. You have to bring the petition before the Division of Administration.

The administration will then forward it to the Office of the Judge of Compensation Claims (OJCC). The petition should contain the details of your accident, the type of injury suffered, any wage loss, and the benefits you seek. The administration will send you a notice to appear before the OJCC within 40 days from when you filed.

The clerk of the OJCC will notify your employer and their insurance carrier of the petition. The two will then either pay your claim or respond to the OJCC within 14 days. You will receive a case number with which you can track the progress of your appeal online.

Next, the OJCC will arrange for a neutral third party to stand as a mediator between you and your employer. If the mediation is unsuccessful, the workers’ comp judge will schedule a pretrial hearing. During the hearing, both parties will establish the issue and exchange evidence.

Depending on the judge, you might submit a written statement while your work comp lawyer attends the hearing on your behalf. The final hearing will hold within 90 days. Here, both parties present evidence and call witnesses to give testimony. Within 30 days, the judge will give their decision.

If you don’t agree with the judge’s decision, you can appeal to the First District Court of Appeals. You have to do this within 30 days. The Court of Appeal can overturn the OJCC decision, uphold it, or send the case back for more findings.

Miami Lawyers 360 Can Help You Appeal

Just because your employer denied your work comp claim does not mean you should accept defeat. Our attorneys at Miami Lawyers 360 can help you begin the appeal process and get what you deserve. Contact us today to get started.

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