Florida Workers’ Compensation
Workers’ Comp Claim Denied in Florida?
A workers’ compensation denial can be frustrating, especially when you are injured, missing work, or waiting for medical care. But a denial does not necessarily mean the dispute is over.
The reason for the denial, the medical evidence, what benefits are being disputed, and what has already happened in the claim can all matter.
What happens if a workers’ compensation claim is denied in Florida?
A denial does not necessarily end a Florida workers’ compensation claim. Florida law provides a process for resolving disputes over workers’ compensation benefits, including a Petition for Benefits when appropriate.
What happens next depends on what was denied, why it was denied, the medical and factual evidence, and the history of the claim.
Prefer to watch instead?
Michelle Chase explains what a denied Florida workers’ compensation claim can mean, why claims are disputed, and why a denial does not necessarily mean the case is over.
Watch on YouTube →What Does a Workers’ Comp Denial Actually Mean?
A denial generally means the employer or insurance carrier is disputing responsibility for some or all of the workers’ compensation benefits being requested.
That does not always mean the entire case has been denied. Sometimes the carrier disputes whether the accident itself is compensable. Other times, the accident is accepted but a particular treatment, body part, period of disability, or other benefit is disputed.
The accident or injury is disputed
The carrier may dispute whether the injury arose out of work or falls within Florida’s workers’ compensation system.
Part of the claim is disputed
The carrier may accept the workplace accident while disputing particular treatment, wage benefits, a medical condition, or another requested benefit.
Understanding exactly what has been denied is often the first step in understanding the dispute.
Why Are Florida Workers’ Comp Claims Denied?
Workers’ compensation claims can be disputed for many different reasons. Some involve what happened at work. Others turn on medical evidence or requirements in Florida’s workers’ compensation law.
The carrier may dispute whether the injury arose out of work performed in the course and scope of employment.
There may be a dispute about whether the workplace accident caused the injury or the need for treatment.
The carrier may raise questions about when the workplace injury was reported to the employer.
The carrier may argue that symptoms or treatment are related to a condition that existed before the workplace accident.
Some disputes involve whether the worker, employer, or employment relationship falls within Florida’s workers’ compensation system.
The carrier may accept the claim while disputing a particular doctor, treatment, period of lost wages, or other benefit.
A denial letter may not tell the entire story. Chase Injury Law can review what was denied and discuss how it fits into the rest of the claim.
An Important Distinction
A Denial Does Not Necessarily Mean the Claim Is Over
Florida workers’ compensation law provides a process for resolving disputes when benefits are not being provided.
Section 440.192, Florida Statutes, provides for a Petition for Benefits for benefits alleged to be ripe, due, and owing.
A Petition for Benefits is a formal legal pleading. Florida law includes requirements concerning the injury, benefits being requested, and other information that must be identified.
The disagreement may involve the entire claim or a particular workers’ compensation benefit.
The accident facts, medical evidence, communications, and claim history may all be relevant.
Florida law provides a formal process for resolving disputed workers’ compensation benefits.
What If I Already Had Problems With the Same Body Part?
A prior injury, arthritis, degenerative changes, or another preexisting condition does not automatically mean that treatment for the same body part cannot be covered after a workplace accident.
It is common for people to have some degree of degeneration or a history of symptoms before a work injury. The important question is not simply whether something existed before the accident. The relationship between the workplace accident, the current condition, and the need for treatment can matter.
A work injury can combine with a preexisting condition.
Florida’s workers’ compensation statute specifically addresses situations in which a workplace injury combines with a preexisting disease or condition to cause or prolong disability or the need for treatment.
In those situations, the statute applies a major contributing cause standard. The work injury must be and remain more than 50 percent responsible, compared with all other causes combined, for the disability or need for treatment at issue.
For example, imaging may show degenerative changes in a worker’s back, shoulder, or knee even though a workplace accident caused new symptoms or created a need for additional medical treatment. The existence of a degenerative finding alone does not answer whether workers’ compensation benefits may be available.
These disputes can depend heavily on the medical evidence and the specific circumstances of the accident and treatment.
Can Reporting or Filing Deadlines Affect a Denied Claim?
Yes. Florida workers’ compensation law contains time requirements that can affect a claim.
The 30-day notice rule
Florida law generally requires an employee to advise the employer of a workplace injury within 30 days after the date or initial manifestation of the injury.
The statute also contains exceptions and circumstances that can affect the notice analysis, so a “late reporting” denial may require a closer look.
Statute of limitations
Florida law also contains time limits for pursuing workers’ compensation benefits.
Prior authorized treatment, benefit payments, the type of dispute, and other circumstances can affect the applicable analysis.
The history of the individual claim matters. When a denial raises a reporting or filing issue, a workers’ compensation lawyer can review the timeline and the circumstances surrounding the claim.
Looking Beyond the Denial Letter
What Can a Workers’ Compensation Lawyer Review?
A short denial notice may involve a much larger medical and legal picture.
Reviewing a denied workers’ compensation claim can involve looking at the accident, the stated reason for the denial, the medical evidence, prior treatment, disputed benefits, and timing issues.
What did the carrier actually deny, and what reason was given?
What happened at work and how was the injury reported?
What diagnoses, testing, treatment recommendations, and medical opinions exist?
Is the carrier relying on a prior injury or degenerative condition to dispute treatment?
Is the entire claim denied, or is the dispute limited to medical care, lost wages, or another benefit?
Are notice requirements, filing deadlines, or prior benefits relevant to the dispute?
You do not need to know whether the insurance company is right before calling us.
Tell us what happened and what the insurance company denied. We can discuss the circumstances of your claim and whether Chase Injury Law may be able to help.
Common Questions
Florida Denied Workers’ Comp Claim FAQs
Does a workers’ comp denial mean my claim is over?
Not necessarily. Florida law provides a process for resolving disputes over workers’ compensation benefits. Whether a particular denial can be challenged depends on the facts, medical evidence, and legal issues involved.
Why would a workers’ compensation claim be denied?
Claims may be disputed for many reasons, including whether the injury is work-related, medical causation, accident reporting, a prior medical condition, employment or coverage issues, or entitlement to a particular benefit.
Can I still have a workers’ comp claim if I already had problems with that body part?
A prior injury or degenerative condition does not automatically prevent workers’ compensation benefits for the same body part. Florida law specifically addresses situations where a workplace injury combines with a preexisting condition, and medical causation and the major-contributing-cause standard may become important.
What if only my medical treatment was denied?
The carrier can dispute a particular benefit even when other parts of the workers’ compensation claim are accepted. The denial should be evaluated based on the reason given, the medical evidence, and the history of the claim.
What if the insurance company says I reported the injury too late?
Florida generally has a 30-day notice requirement, but the statute contains exceptions and circumstances that can affect whether a notice defense applies. The particular facts surrounding the accident and notice matter.
What is a Petition for Benefits?
A Petition for Benefits is a formal pleading used in Florida’s workers’ compensation system to pursue disputed benefits. Florida law contains requirements concerning the information and specific benefits identified in the petition.
Do I have to hire a lawyer after a workers’ comp denial?
No. An injured worker can proceed without an attorney. A workers’ compensation lawyer can provide legal advice and representation, evaluate the denial and evidence, identify disputed benefits, and handle litigation when appropriate.
Michelle Chase, Esq.
Michelle Chase represents injured workers throughout Florida. Before focusing her practice on workers’ compensation, she served as a prosecutor. She has more than 10 years of legal experience and founded Chase Injury Law to provide injured workers with direct, knowledgeable representation.
Learn more about Michelle →Florida Workers’ Compensation Resources
This guide is based on Florida’s workers’ compensation statutes and information published by the Florida Division of Workers’ Compensation.
Your claim was denied. That does not mean you have to accept the explanation at face value.
Chase Injury Law represents injured workers throughout Florida. If your claim, medical treatment, or wage benefits have been denied, we can review what happened and discuss how Florida workers’ compensation law may apply.
Legal information disclaimer: This page is provided for general educational information only and is not legal advice. Florida workers’ compensation claims are fact-specific, and the law may apply differently depending on the circumstances, medical evidence, prior treatment, communications between the parties, deadlines, and other issues. Nothing on this page should be relied upon to make decisions about medical care, employment, filing deadlines, litigation, or the handling of a particular workers’ compensation claim. Reading this page, submitting a contact form, or speaking with Chase Injury Law does not create an attorney-client relationship. An attorney-client relationship is established only through a signed representation agreement.