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When Can an Insurance Company Deny My Workers’ Compensation Claim in Florida?

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If you suffered an on-the-job injury or developed a work-related illness, you may be entitled to workers’ compensation benefits for your medical bills and the loss of income.

However, your employer’s insurance company could deny your workers’ compensation claim for various reasons. If your claim has been denied, you might be able to appeal the denial with the help of a Tampa workers’ compensation attorney at Kobal Law.

Six reasons why your workers’ compensation claim was denied

Below, we will provide a list of reasons why your workers’ compensation claim could be denied in Florida.

You failed to report the injury within the applicable time period

Under Fla. Stat. § 440.185, an injured worker has 30 days to report their accident to their employer. Failure to report the workplace accident within the applicable time period could be grounds to deny your claim.

However, if the insurer denied your workers’ comp claim due to your failure to notify the employer within 30 days, you should consult with an experienced lawyer to discuss your options.

Your injury is not covered

Under Fla. Stat. § 440.02, an employee is covered under workers’ compensation insurance if their injury arose out of and in the course of employment.

In other words, your injury must be directly related to work or job duties in order to be covered under workers’ comp insurance. If your injury does not meet the threshold to be covered, the insurer could refuse to provide coverage.

You were under the influence of alcohol or drugs

While most work-related injuries are covered under workers’ compensation insurance regardless of fault, you may be barred from seeking benefits if your injury was caused by intoxication.

An employer will typically order alcohol and drug testing after being notified of your work-related injury. Pursuant to Fla. Stat. § 440.09, if you test positive for alcohol or drugs, your claim could be denied.

Lack of sufficient medical evidence

Some workers’ compensation claims are denied due to the lack of sufficient medical evidence. If the insurer thinks that you do not have enough medical records and other documentation related to your injury and treatment, it may have grounds to deny your workers’ compensation claim.

When this happens, it is vital to contact a skilled workers’ compensation attorney in Florida to help you build a strong case to obtain benefits.

You had a pre-existing injury

It is not uncommon for insurance companies to turn down workers’ compensation claims arguing that a claimant’s pre-existing condition is related to their alleged work-related injury.

Just because you have a pre-existing injury does not necessarily mean that you will not be able to seek workers’ compensation benefits in Florida. A knowledgeable lawyer will help you receive the compensation you deserve despite the pre-existing condition.

No one witnessed your workplace accident

Sometimes, an insurer may deny your workers’ compensation claim by arguing that there were no witnesses and no one else can back up your claim. However, it may still be possible to obtain workers’ comp benefits even if no one witnessed your accident.

Contact our Tampa workers’ compensation attorney at Kobal Law to help you build a strong claim and seek compensation even if there were no witnesses. Call 813-873-2440 to discuss your situation and determine whether the insurance company had valid grounds to deny your claim.

Resource:

leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.185.html

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