If you have been hurt on the job or experienced an occupational illness such as asbestosis, there is a good chance that your employer has workers’ compensation insurance that would cover your claim. Nevertheless, the existence of the insurance
cover is not a guarantee that your claim will be considered valid and subsequently paid. There are many reasons why a claim may be denied. When this happens, you will be formally notified via a letter that will usually include reasons for the denial.
The following are some of the more common reasons for a denied workers’ compensation claim.
Absence of Witnesses
A workers’ compensation claim usually becomes several notches more difficult if there were no witnesses to the incident. The insurance company will interrogate the sequence of events you provide and look for a lack of coherence.
Unwitnessed workplace accidents are not automatically invalid. However, to cover all your bases, immediately report the accident to your colleagues and supervisor as soon as possible. Think through your narration of the incident to ensure it is consistent.
For a workers’ compensation claim to be considered valid, it must be filed within the time frame specified in the law. The rationale is that if someone does not see the need to report their injury quickly, they were probably not that badly hurt on the job in the first place. In Florida, compensation claims must be reported to employers within 30 days.
Even if you are not immediately certain that the injury will prevent you from working, report it to your supervisor and file an accident report. There are some exceptions though since certain work-related conditions may not be apparent immediately. In this case, you must notify the employer within 30 days of receiving the doctor’s report.
Employer Disputes Claim
Your employer may deny the incident ever took place, and if it did, it was not while working. They may maintain that the illness or injury happened elsewhere. When this happens, the claimant has to look for more evidence to support their case. This could be from colleagues, witnesses present when it happened, or a doctor’s statement attributing illness to your workplace.
A claim may also be disputed if it was filed after the worker was laid off. The employer and insurance company see this as a quest for revenge.
If there are contradictions between your medical records and the accident report insurance companies may reject your claim. If your narration of the incident to your colleague, supervisor, and doctor are all different, insurers can use that as grounds to deny compensation. To be safe, write down what happened as soon after the incident as you can when your memories of the event are still fresh. Talk to any witnesses present to confirm your recollection is accurate. This should subsequently be the basis for your description of what happened to other parties.
If witness accounts or your medical records after the incident point to the presence of alcohol or drugs in your system, the claim will be rejected. The insurance company will argue that the injury was due to your recklessness and was therefore avoidable.
Also Read: Common Questions about Workers’ Compensation Cases
Contact an Expert Hardesty, Tyde, Green, Ashton & Clifton, P.A. Jacksonville Workers’ Compensation Attorney
A lot of workers hurt on the job make the unfortunate error of not appealing the initial claim denial and therefore lose out on a financial cushion that would have proved vital for their future. Claim denial does not have to be the end of your fight for compensation. Usually, the letter sent to you notifying you of denial also states the avenues through which you can file an appeal. An experienced Jacksonville workers’ compensation attorney can guide you through the appeals procedure.
The appeal process can be complicated with strict rules of evidence that the court will expect you to be aware of.
A seasoned Jacksonville workers’ compensation lawyer from Hardesty, Tyde, Green, Ashton & Clifton, P.A. would make your task easier and ensure your appeal is not rejected when you have a legitimate claim. Hardesty, Tyde, Green, Ashton & Clifton, P.A. has worked with many Jacksonville workers through the appeals process and successfully obtained payouts from some of Florida’s largest businesses.
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What constitutes a personal injury?
The most common personal injury is an auto accident, but the broad definition encompasses any situation where a person suffers harm due to the negligence of another person or entity. Early identification of a personal injury is important to the legal process. Many serious injuries occur each year involving:
– Auto accidents
– Premises liability accidents such as injuries caused by a slip and fall
– Medical malpractice/nursing home injuries
– Wrongful death
– Work-related accidents
– Animal attacks
– Faulty or malfunctioning products (product liability)