You rely on workers’ compensation benefits when a work-related injury or illness prevents you from working. If your employer or their insurer makes an unfavorable decision regarding your coverage, it could have a big impact on your physical, mental, and financial health.
There are many points in the process where a dispute might arise, but you always have the right to appeal. An Orlando workers’ compensation appeals lawyer from our firm could help. Other lawyers and professionals often recommend our team of attorneys at The Florida Firm to their friends, family members, and clients who need help with a workers’ compensation issue.
Appealable Decisions in a Workers’ Compensation Case
Almost all decisions a workers’ compensation insurer makes are appealable, but there are two important exceptions. If you wait more than 30 days to notify your employer of an injury or a diagnosis of an occupational illness, the insurer can deny your claim. If you were drunk or high when a work-related injury occurred, workers’ compensation can deny you coverage. However, even if your claim was denied for these reasons, our skilled attorneys could argue that a reporting delay was unavoidable or excusable, or that a drug or alcohol test was inaccurate.
If you notified your employer in a timely manner and were not under the influence when you were injured, you might assume everything would proceed smoothly. However, there are many points in the process when you might disagree with a decision the insurer makes. Examples include:
- The insurer denies your initial claim
- You dispute the amount of your indemnity payments
- The insurer denies medical treatments you think would be beneficial
- Your doctor recommends you return to work before you feel ready
- You receive an impairment rating that does not accurately reflect your degree of disability
The insurer will notify you in writing of their decisions, and the letter will contain instructions about how to appeal.
Workers’ compensation appeals procedures can be confusing, and you will need to make a focused presentation to overturn the insurer’s decision. Engaging an experienced Orlando workers’ compensation attorney from our firm to manage the appeal greatly enhances your chances of success.
Initiating an Appeal
Florida Statutes § 440.192 describes the workers’ compensation appeals process. You begin an appeal by filing a petition for benefits that contains specific information set forth in the statute, as our Orlando workers’ compensation attorneys could explain.
The law requires you to certify that you made a good-faith effort to resolve the dispute before filing the appeal petition. If the issue in dispute centers around a medical decision, you can ask the carrier for a second opinion. However, you should contact a legal professional as soon as you receive the insurer’s decision so they can try to resolve the matter informally while also ensuring your petition is filed in a timely manner.
What Happens After Filing an Appeal?
Workers’ compensation insurers may not engage in good-faith negotiations when you first dispute their decision. However, when you work with our Orlando workers’ compensation appeals attorneys to file a petition for benefits, it often spurs the insurer to try to reach a settlement and avoid the expense of litigating the dispute.
When direct negotiations are not successful, the parties must take their dispute to mediation before going to a hearing. At mediation, a neutral third party facilitates the negotiations and tries to help you and the insurance company reach an agreement. When mediation is successful, you and the insurer will each sign a document describing the settlement, and your appeal will be resolved.
If mediation is unsuccessful or you reach a partial settlement where one or more issues remain unresolved, your case will go to a hearing before a judge of compensation claims (JCC). Both sides can present witnesses and evidence to support their position. Further appeals to the First District Court of Appeals are possible if you are dissatisfied with the JCC’s decision.
Talk to Our Orlando Attorneys About Appealing a Workers’ Compensation Decision
You earn your workers’ compensation benefits every day. When your employer’s insurer makes a decision you disagree with, you should take advantage of the opportunity to appeal it. Presenting a strong case against the insurance company is critical, so work with an Orlando workers’ compensation appeals lawyer from our firm. We will use our years of experience to advocate for your desired outcome. We accept no costs or fees unless we win your case. Contact us at Colling Gilbert Wright to discuss your workers’ compensation appeal today.