Injured on the job, but your claim was still denied?
If injured on the job, you are entitled to certain benefits paid by the company providing workers compensation insurance to your employer. These benefits include both wage loss benefits and medical treatment. When you suffer a work injury severe enough to result in you losing time from work, the period of time in which you are undergoing treatment is often considered a painful, frustrating time period.
Receiving a Notice of Denial about your Work Injury Claim
One of the last pieces of mail anyone would want to receive after being injured on the job is a Notice of Denial from the worker’s compensation insurance company.
A Notice of Denial would mean that your entitlement and eligibility for workers’ compensation benefits has ended. You would not be entitled to any additional lost wage checks, nor would you be able to continue treatment with the doctor you were seeing. None of the reasons why a workers’ compensation insurance carrier would deny a claim takes into account the severity of your injury or the condition you’re currently in.
For example, even if you were scheduled to undergo surgery the very next day, your worker’s compensation claim could still be denied. The surgery you were required to undergo within the next 24 hours would be canceled.
Just as the severity of any medical condition is not taken into consideration when denying a claim, the severity of the resulting financial impact is not considered either. Meaning, even if the denial of wage loss benefits means you would end up homeless, the Florida worker’s compensation carrier can still make an attempt to deny paying you benefits.
Any questions concerning your eligibility, entitlement, the amount you should be receiving in wage loss benefits, your medical care, or what options you have, can all be answered.
Why was my Florida workers comp claim denied?
One reason a worker’s compensation claim may be denied is an allegation of fraud. If the worker’s compensation carrier believes they can avoid providing further benefits on the basis of what is called the “fraud defense,” your benefits are in serious jeopardy of being cut off.
Unfortunately, despite your injury and need for treatment being entirely work-related, and even if you had absolutely no intention of engaging in any kind of deceptive or dishonest conduct, the carrier can use the fraud defense as a basis to deny your claim. Reasons that a carrier would believe they could successfully deny a claim for workers’ compensation benefits include such things as finding out you had a prior injury but failed to report it properly.
Not reporting a past injury properly in a worker’s compensation claim is easier to do than most people realize. More often than not, people do not think back to an injury they had years ago at times such as giving a recorded statement to a work comp adjuster, completing paperwork for the work comp insurance company, or when filling out a medical history questionnaire at a doctor’s office. Such times are exactly the instances through which the information you provided can be used against you.
Making sure to list all previous accidents, injuries, hospitalizations, and medical conditions, work-related or not, is important. If your medical history is not complete, the carrier may attempt to argue that your failure to provide such information was done for the purpose of fraudulently obtaining worker’s compensation benefits. A denial of benefits for such a reason may leave you confused; feeling uncertain of what your options are.
Insurance Adjusters may try to Intimidate you Out of Your Work Injury Claim
The carrier may also think it has a shot of you doing nothing in the event you are denied benefits. The adjuster or someone else representing the insurance company may try to scare you out of proceeding with your claim for benefits. The workers’ compensation carrier may provide some reason for denying your benefits that sounds legitimate, but is truly without justification.
You are not expected to understand all the laws and their interpretation as they relate to workers’ compensation cases. That is our job. Don’t let any questions you have about ensuring your work comp benefits continue to go unanswered. Contact us at 727-451-6900 for a free consultation.
Dolman Law Group
800 North Belcher Road
Clearwater, FL 33756