Common Reasons Workers’ Compensation Claims Are Denied
Every employer in Florida has a duty to ensure that their employees are operating in a safe environment. When an operating environment is inherently unsafe, a number of rules and regulations apply. These extra rules could result in mandatory breaks, shortened shifts, and/or for employees to possess and properly maintain specified safety items or clothing.
While all of these safety measures can be valuable in safeguarding the well-being of employees, work-related accidents still happen all around the country every single day. Sometimes, accidents just happen. In recognition of this, the majority of employers in Florida are required to carry workers’ compensation insurance. If an employee is injured or becomes ill because of their job, they can file a workers’ compensation claim against their employer’s insurance in order to try to recoup funds to cover medical costs or lost wages as a result of the injury. Simple, right?
Well…as too many injured workers have come to know, a workers’ compensation claim is not guaranteed to be paid out. Many injured workers file a claim only to find out that the insurance company reviewed and denied their claim. How is that possible? While it is easy to blame the system and simply write-off the denial as a money-saving ploy, that is not always the answer. There are a number of valid reasons that a workers’ compensation claim might be initially denied. This article will outline three of the most common reasons that an insurance company may cite as the reason that a Florida employee’s workers’ compensation claim was denied.
- Missed Deadline
Injuries must be reported to your employer within thirty days. An Insurance Company may see your failure to do so or a late filing as an easy way to dismiss your claim. It is good practice to advise your employer of your injury and intent to file as soon as practicable.
- Insufficient Medical Proof
When you file a workers’ compensation claim you should expect that the insurance company will require sufficient medical documentation to support a work injury. Insurance companies are wary of fraud and are unlikely to pay out a claim for an injury that they believe is insufficiently documented.
- You are (allegedly) at Fault
Workers’ Compensation Insurance is meant to cover the cost of injuries that are sustained by an employee of a business while carrying out the normal or expected course of business for their job position. Therefore, a window-washer who falls from scaffolding while cleaning a third story window would likely be successful in a workers’ compensation claim. They were performing a normal job duty, in a seemingly ordinary fashion, when the accident occurred.
In contrast, consider if a different category of employee – such as an accountant – climbed that same scaffolding after being dared to by his co-workers. Even if this stunt occurred in the physical office place of employment, the accountant was acting well outside the boundaries of their traditional job duties. If the accountant fell from that third story scaffolding, they would likely have a much more difficult time getting a workers’ compensation claim approved.
Contact the Musleh Law Firm
Fortunately, Floridians generally have the right to challenge such a denial of a workers’ compensation claim. If you are preparing to bring a workers’ compensation claim, or to fight the denial of your claim, contact the experienced Ocala workers’ compensation attorneys at the Musleh Law Firm. Our dedicated team can help you navigate your claim and come to the best possible conclusion.
