Can I Sue My Employer for Denying Workers’ Comp?

“What can I do if my employer denies my claim for workers’ comp benefits?” This is a question that we frequently receive from injured workers. While Florida law entitles qualifying workers to no-fault benefits when they get injured on the job, employers and their insurance companies routinely deny valid claims.

So what’s next? Can you (or do you need to) sue your employer?

While securing benefits might eventually involve filing a lawsuit against your employer, there are a number of other steps that you will need to take before taking your claim to court.

Why Did Your Employer Deny Your Claim for Workers’ Comp Benefits?

In order to decide what to do about your workers’ comp claim, you need to know why your claim was denied. Employers and their insurance companies deny claims for a variety of reasons. Some of these reasons are legitimate – and some of them are not.

Legitimate reasons for employers to deny workers’ comp claims in Florida include:

• Failure to file your claim on time
• Failure to submit all necessary information
• Failure to see an approved doctor
• Submitting false or misleading information with your claim
• Not being eligible for workers’ comp benefits (i.e., if you are an independent contractor or you got hurt because you were drunk or high on the job)
• Not being able to prove that your injury is work-related

Unfortunately, employers and their insurance companies will often deny claims for illegitimate reasons as well. This is known as “bad faith,” and it is prohibited under Florida law. If your employer or its insurance company has denied your workers’ comp claim in bad faith, you will need to hire a lawyer to fight for benefits on your behalf.

Can You Overcome the Denial?

Sometimes even legitimate denials can be overcome. For example, if you are entitled to benefits but you failed to submit all necessary information, submitting additional information to your employer’s insurance company may be enough to overcome your denial. In order to determine whether this is an option, you will need to discuss your claim with a Florida workers’ comp attorney.

The Process of Challenging a Workers’ Comp Denial in Florida

If it is not possible to overcome your denial by working with your employer or its insurance company directly, then you will need to take formal legal action. The steps involved in challenging a workers’ comp denial in Florida are:

1. File a Petition for Workers’ Compensation Benefits with the OJCC

You will need to file a Petition for Workers’ Compensation Benefits with the Office of the Judges of Compensation Claims (OJCC). When filing your petition with the OJCC, you must also send copies to your employer and its insurance company. The OJCC will review your petition and make an independent determination based on the information provided.

2. Attempt to Resolve Your Claim Through Mediation

In many cases, the OJCC will order the parties to participate in mediation. Mediation is a non-binding process that is designed to help the parties reach an agreement regarding the benefits that will be paid.

If you and your employer (or its insurance company) reach an agreement, then the process will be over. If you are not able to reach an agreement, then your claim will continue to move through the OJCC process.

3. Attend the Pre-Trial Hearing

Following mediation, the next step is to attend a pre-trial hearing before a Judge of Compensation Claims (JCC). You will receive 14 days’ advance notice of the pre-trial hearing, and you will need to work closely with your attorney as he or she prepares to represent you before the JCC.

4. Attend the Final Hearing

After your pre-trial hearing, the next (and final stage) in the OJCC process is the final hearing. At this hearing, your attorney will present your case, your employer (or its insurance company) will present its defense, and then the presiding JCC will render a binding decision.

5. File a Lawsuit Against Your Employer in Court

Finally, if you are dissatisfied with the outcome of the OJCC process, then you can file a lawsuit in court. The purpose of this lawsuit is to challenge the outcome of your final hearing. Your attorney will thoroughly prepare your case, go through all necessary pre-trial procedures, and then argue for the benefits you deserve at trial.

Discuss Your Workers’ Comp Denial with an Attorney

Having a workers’ compensation claim denied can be a devastating experience. Injured workers count on these benefits to cover medical expenses and make up for the income they lose from being out of work. If you receive notice that your claim is denied, it is important to contact a lawyer as soon as possible.

Did your employer deny your claim for workers’ comp benefits? If so, our attorneys can discuss the options available to you.

To schedule a free, no-obligation consultation with a Florida workers’ comp attorney at Colling Gilbert Wright, call (407) 712-7300 today. Our attorneys serve clients in Orlando, Tampa, Miami, and other communities throughout the state.