If a worker suffers an injury while on the job, the employer has a responsibility to cover related expenses through workers’ compensation insurance. Unfortunately, an employee who files a worker’s compensation claim may receive a denial letter. There are different reasons for a claim denial, and there is an appeal process for denials.
According to the Florida Legislature, an employer must compensate for accidental injury or death if they occur during the course of employment. However, the employee must be able to show proof of the injury and its occurrence on the job. This includes letting a supervisor know right away when the accident happens and seeing a doctor to get objective medical findings related to the injury.
For employees who are filing a claim for repetitive exposure or occupational disease, he or she must present evidence showing both sufficient exposure and how this exposure caused the disease.
According to FindLaw, the insurance company may deny a workers’ compensation claim for a variety of reasons. Common ones include
- Failure to report the accident or file the claim in a timely manner
- Lack of medical evidence
- Lack of medical treatment
- Lack of evidence that the injury occurred at the workplace
- Involvement of drugs or alcohol
If an employee wants to file an appeal, he or she must do so before the stated deadline, which the denial letter includes. The appeals process may include various steps. Prepare to submit evidence in the form of initial medical records, additional medical exams and proof of being on the clock during the time of injury.