Law Firm Blog

What Happens if My Workers’ Compensation Claim Is Denied?

Most denied claimants eventually receive the compensation they deserve.

If a lawyer is involved, most denied workers’ compensation claims are paid and paid quickly. 67% of denied claims move to the “paid” column within one year. A paid workers’ compensation claim usually means compensation for lost wages and payment of all reasonably necessary medical expenses.

All too often, job injury victims do not see initial denials as part of the process. Instead, they believe a denial means their claim is weak or meritless. So, a Tampa workers’ compensation lawyer not only shores up denied claims but advocates for job injury victims, as outlined below. Attorneys are also cheerleaders who encourage these victims not to give up until they obtain the compensation they need and deserve.

Understanding and Addressing Flaws

Initial denials are part of the process but Claims Examiners don’t invent reasons for denial. Instead, they must cite a technical or substantive reason for that denial.

The most common technical reasons usually are a failure to submit all required documents at the proper time and in the proper form or a failure to cooperate with the Claims Examiner, usually a failure to attend a medical evaluation appointment.

To address these technical flaws, a meticulous Tampa workers’ compensation lawyer reviews all relevant documents and arranges for make-up appointments, usually with an independent medical examiner. Attorneys know what Claims Examiners want to see and what they do not want to see. Furthermore, an IME doctor is usually more qualified to render an opinion than a company doctor.

Additionally, many workers’ compensation claims benefit from additional witness statements. Leon’s wife cannot testify about the technical or medical aspects of a work-related back injury. However, she can testify about how that injury affects Leon on a daily basis, thus shoring up his claim for lost wages and medical expenses.

ALJ Hearings and Workers’ Compensation Settlements

Another reason the denied-to-paid turnaround rate is so high is that an attorney advocates for job injury victims during settlement negotiations and, if necessary, during an Administrative Law Judge review hearing.

Students who do well on homework assignments usually do well on tests, and attorneys who thoroughly prepare cases prior to settlement negotiations usually resolve these cases on victim-friendly terms. Frequently, insurance companies try to cubbyhole claims (e.g., a broken arm justifies X amount of lost wage payments and Y amount of medical bills). Attorneys must be prepared to counter such low-ball offers with solid evidence.

Speaking of evidence, that is the biggest difference between a Claims Examiner review and an ALJ review. At an initial review, Claims Examiners usually only consider medical documents. At an appeal hearing, the ALJ considers a full range of documentary, testimonial, and other evidence. Additionally, well-prepared lawyers introduce evidence and challenge evidence. Then, they make convincing legal arguments.

For that reason, most workers’ compensation claims are settled prior to the ALJ hearing. Insurance company lawyers know that, because of the format, their backs are against the wall. So, they're motivated to make favorable deals.

Contact a Detail-Oriented Pasco County Lawyer

Victims need and deserve compensation for their serious injuries. For a confidential consultation with a board-certified workers’ compensation lawyer in New Port Richey, contact the Rooth Law Firm. Fewer than 1 percent of Florida lawyers have achieved Board Certified status.