Find out the reasoning for why your workers compensations claim was denied.
If you are injured on the job, whether in a work-related injury or by a cumulative trauma (like carpal tunnel) or occupational disease (like asbestosis), you most likely have a workers’ compensation claim in your state. However, workers’ compensation claims may be denied for many reasons, as described below. If you workers’ compensation claim is denied, you will receive a letter stating the claim was denied. The letter will likely state the reasons your claim was denied.
Common Reasons for Claim Denial
One of the most common reasons that workers’ compensation claims are denied is that the claim was not reported or filed on time. The law requires that a worker report the claim immediately, sometimes within a matter of days. And the employer must inform the state and/or their workers’ compensation insurance carrier just as quickly.
Another common reason is that the employer disputes the claim. This can be because the employer disputes the accident ever happened at work, or disputes that your current injury/illness is a result of the accident (or exposure or overuse). If this is the case with your claim, you will need to gather additional evidence to support your workers’ compensation claim. This can be witness accounts that the accident occurred or a statement from your doctor attributing your condition to your workplace.
The employer or its insurance company will sometimes look for whatever reason possible to deny a workers’ compensation claim. For an employer, denying a claim means decreasing insurance expenses and liability.
There are several other reasons a claim may be denied. Some states preclude certain conditions as workers’ compensation claims, such as stress-related conditions. Or, your injuries might not be severe enough to amount to a workers’ compensation claim. Look at your claim denial letter for the reason(s) your claim was denied, and talk to an attorney if you are still uncertain why your claim was denied.
Appealing a Workers’ Compensation Claim Denial
The letter you received stating your workers’ compensation claim was denied may also describe how you can appeal the denial of your claim. Make sure you read the letter carefully, and note any appeal deadlines.
The first step to consider is contacting your employer or its workers’ compensation insurance carrier to discuss your claim denial. If the denial was simply a matter of mistaken paperwork or other similar problems, the mistake could be cleared up and your claim allowed. But this route is unlikely to be successful unless your claim denial was a bona fide mistake on the part of your employer or its insurance company. If your employer still refuses to allow your claim, you may want to appeal the claim denial.
The appeals process varies in each state. Often, the first level of appeal will be at an administrative hearing before an administrative law judge. The hearing can be through a state labor department or a state board of workers’ compensation. There are additional levels of appeal beyond the initial administrative levels as well, which vary depending on the state.
At the appeal hearing, you will be required to present medical and other factual evidence to support the existence of your workers’ compensation claim, whether it is a work-related injury or occupational disease. Make sure that your appeal is filed within the time limits, and that you have plenty of medical evidence to support your claim.
Talk to an Attorney
Do not give up your right to workers’ compensation benefits simply because your claim is denied initially.
Talk to a workers’ comp lawyer as soon as possible. An attorney can help you determine whether an appeal of your workers’ compensation claim denial is the best course of action for you. Appeal deadlines are short and strict, and you do not want to lose your rights to your workers’ compensation claim.
And you should talk to an attorney before filing any appeal yourself. Appeals are complicated legal processes, involving rules of evidence and civil procedure that the judge will expect you to know. If you do not prevail at the initial levels, you may not be able to present additional evidence at subsequent appeal levels. One of the reasons that many people lose their workers’ comp claim appeals is because they did not have an experienced workers’ compensation attorney at their side to help them prepare a strong case.
John is a Jacksonville native who grew up on the First Coast. He graduated from Bishop Kenny High School in 1975 and went to college at Florida State University where he completed a 4-year program in 3 years. John graduated from the Florida State University College of Business in 1978 and went straight into Florida State University College of Law. While in law school, John earned a position on the prestigious Law Review Board serving as its Business Editor. As a law student, John studied in the Oxford program. He also interned with the Florida Legislature working in the Florida House of Representatives Criminal Justice Committee. John was admitted to the Florida Bar in 1981.
John began his legal career as a law school intern in the State Attorney's Office in Jacksonville in 1981. After his internship, legendary State Attorney Ed Austin hired John as a full-time Assistant State Attorney for the Fourth Judicial Circuit (Clay, Duval, and Nassau Counties). As a prosecutor, John tried jury and non-jury trial on charges ranging from DUI to Murder.
In 1983, John moved from the State Attorney's Office to begin his career in private practice. He has practiced law for 30 years on the First Coast. For the last 20 years, John and his family have made Clay County their home.
John limits his practice to personal injury and disability cases. While there are many fine attorneys in Clay County, John is one of only a few Clay County attorneys who limit their practice to personal injury and disability cases. John takes pride in helping clients resolve injury claims in ways that avoid the stress, uncertainty, and the expense of unnecessary litigation.
John is the past President of the Clay County Bar Association and has served on the Board of the Clay County Bar Association from 2009-2013. He is an active member of the Florida Bar, and the Federal Bar of the Middle and Southern Districts of Florida. He is also a member of the American Association of Justice, the Florida Association of Justice, the National Organization of Social Security Claimants' Representatives, and the National Organization of Veterans' Advocates.
Service to the Community
John is involved in the Clay County Community serving as a member and Director of the Rotary Club of Orange Park, of the Clay County Bar Association, and the Putnam County Bar Association.
The information provided on this web site is provided for general informational purposes only and should not be interpreted as legal advice. Every case is different and requires individual attention before such advice can be given. Neither the transmission nor receipt of general advice to or from our website will constitute an attorney-client relationship.