Ocala Workers’ Compensation Claims Lawyer
In most cases, if you’ve been injured on the job, your only recourse is to file a workers’ compensation claim. You’re not allowed to sue your employer or another worker for negligence; instead, you must rely on workers’ comp to come through for you. The trade-off in exchange for giving up your right to sue is that workers’ compensation benefits are supposed to be guaranteed and easy to get through a simple insurance claims process. Unfortunately, it doesn’t always work out like that in real life. Benefits can be incredibly challenging to get and keep, and employers and their insurance carriers find numerous ways to deny claims.
See below for some of the most common reasons for workers’ compensation claim denials, and contact the Ocala workers’ compensation claim lawyers at Musleh Law Firm for help fighting a denial of benefits.
Main reasons Ocala employers use to deny workers’ compensation claims
Accident was not work-related – Florida workers’ compensation covers injuries or illnesses that arise out of work performed in the course and scope of employment. Employers might claim your injury occurred off-site or outside of work hours, or while you were off duty. It’s important to understand that accidents do not have to occur at the workplace to be compensable, so long as you were working at the time.
The injury was pre-existing – A common reason for denying a claim is that your injury is due to a “pre-existing condition.” However, even if you had a pre-existing condition that was aggravated or accelerated due to a work-related injury or illness, workers’ comp should still cover the expenses related to the aggravation of the injury or acceleration of the disease.
Your injury is nonexistent – If your injury isn’t readily apparent, don’t be surprised if the insurance company challenges your claim that you are injured. They may send you to their own doctor for an examination, and they may conduct surveillance of you to “catch you” doing activities you shouldn’t be able to do. Many different kinds of injuries qualify for workers’ comp, including repetitive stress injuries, soft tissue injuries, and mental impairments related to a physical injury. Part of our job includes obtaining and presenting the medical evidence that proves your disability and entitlement to benefits.
You missed deadlines – Florida workers’ compensation law does have some strict timelines in place, and missing a deadline can lead to a denial of your claim. For instance, you only have 30 days to report the injury to your employer to preserve your right to workers’ compensation. Be sure to report the accident promptly and contact an attorney right away to make sure other crucial deadlines are not missed.
You refused to use proper safety equipment – Your claim can be denied if the employer can prove you willfully intended to injure yourself. If you were injured because you knowingly refused to use a safety appliance or observe a safety rule, you can still recover workers’ compensation, but your benefits can be reduced by 25%.
Other, non-work-related causes contributed to the injury – So long as the workplace accident was the major contributing cause (more than 50%) of the injury, you are entitled to benefits.
You were under the influence of alcohol or drugs – Your employer can legitimately deny your claim if your intoxication was the primary cause of the accident.
Other reasons used to deny claims include: injury was not established to a reasonable degree of medical certainty based on objective relevant medical findings; some other law applies instead of Florida workers’ compensation, such as FELA (railroad workers), LHWCA or Jones Act (maritime, dockworkers and offshore workers), or the Defense Base Act (military workers); or that you knowingly or intentionally engaged in false, fraudulent or misleading conduct to get workers’ comp. At the Musleh Law Firm, we work with the facts and make sure your claim for benefits is strong and supported by evidence so the insurance carrier can’t get away with wrongfully denying your claim.
Our Ocala Workers’ Comp Lawyers are Here for You after a Claim Denial
For help with a workers’ compensation claim denial in Ocala, call the Musleh Law Firm at 352-732-0600 for a free consultation with a team of experienced and successful Ocala workers’ compensation lawyers.
