Law Firm Blog

How Long Does the Workers’ Compensation Claims Process Take?

It takes time to obtain maximum benefits for a work-related injury or illness.

The average wait time for a workers’ compensation Administrative Law Judge appeal hearing in Florida is over seven months. Wait times at the overworked and understaffed Social Security Administration are even longer.

The seven-month figure is the average wait time between a Claims Examiner review and an Administrative Law Judge appeal. The entire workers’ compensation process, like the entire SSD process, is usually much longer.

Unrepresented victims often get frustrated, give up, and abandon their claims or settle them for pennies on the dollar. But a New Port Richey workers’ compensation lawyer does not quit if things do not go smoothly. Instead, our team doubles down in the face of adversity. We do not settle for anything less than the best possible results under the circumstances.

Choosing the Right Forum

We mention workers’ compensation and SSD together because, in many cases, permanently disabled victims could be eligible for benefits from either program.

Workers’ compensation is available if the victim’s illness or injury was work-related. Florida law broadly defines this phrase. Any activity that benefits the employer in any way is a work-related activity.

If Dre ruptured his Achilles tendon as he ran onto the field during a softball game, that injury is work-related. Healthy and happy employees are beneficial to employers. Furthermore, if Dre wore a jersey that bore the company’s name or logo, the advertising benefited his employer.

An injury of this nature could sideline Dre for over a year. If that is the case, he could be eligible for SSD as well. A New Port Richey workers’ compensation lawyer gives critical advice in such matters.

Initial Determinations

Usually, workers’ compensation claims go through two initial review levels. About 70% of the time, both reviews result in denials.

A few weeks after victims file claims, a Claims Examiner reviews the paperwork in the case, mostly the medical bills, and upholds or denies the claim. Frequently, Claims Examiners use technicalities to deny claims. Other times, they address the merits but reach unfavorable conclusions.

Next, a senior Claims Examiner basically grades the Claims Examiner’s homework. SCEs rarely reverse prior decisions unless the initial examiner made an obvious mistake, like reviewing the wrong person’s medical records.

At this point, the medical records in a workers’ compensation claim are often incomplete or inaccurate. The law is unclear as to what records the CE must take into account. Frequently, they cherry-pick certain records that support a denial of the claim. Furthermore, most Florida job injury victims must see company doctors, whose conclusions are often biased.

Resolving a Case

The first step toward successfully resolving a workers’ compensation case is gathering additional medical evidence. Florida law allows injured workers to seek a second opinion.

Between the claims examiner phase and ALJ review phase, a New Port Richey workers’ compensation lawyer also addresses any holes in the case, such as a work-related connection. Sometimes, Claims Examiners use a pre-existing or non-work condition to support their denial conclusions. These claims are valid as long as a work-related event substantially caused the victim’s illness or injury.

As the ALJ review date nears, if an attorney has built a solid case, most insurance companies agree to favorable out-of-court settlements.

Contact a Pasco County Workers Compensation Lawyer

Victims need and deserve compensation for their injuries. For a free consultation with a board certified workers’ compensation lawyer in New Port Richey, contact the Rooth Law Firm. We routinely handle matters throughout the Tampa Bay area.