If you’ve been injured at work in Florida, you may be entitled to workers’ compensation benefits. But what if your employer’s insurance company denies your claim or won't pay for all the benefits you believe you deserve? You have the right to appeal any decision that’s not in your favor. This article explains common reasons insurers deny claims and how to file an appeal with the Florida Division of Workers’ Compensation (DWC), which oversees the state’s workers’ comp system and reviews claim disputes.
You could lose your right to workers’ comp benefits if you don’t give your employer notice within 30 days after you’re hurt at work or after a doctor tells you that your injury or illness is work related. (See How to File a Workers’ Compensation Claim in Florida for more details on the claims process.)
Your employer’s insurance company could also reject your claim if:
If the accident happened because you refused to use an employer-provided safety device or follow safety regulations, your benefits will be reduced by 25%.
Learn more about the rules for deciding whether injuries or illnesses are work related and for workers’ comp claims filed after you’ve left your job.
You have the right to appeal if the insurer denies your injury claim or refuses to pay some Florida workers' comp benefits like medical bills or temporary disability. However, the state requires that you go through several steps first:
If you’re unhappy with the results of the administrative hearing, you may appeal to the Florida’s District Court of Appeals, First District. You must file your appeal within 30 days after the workers’ comp judge’s order
Instead of going through these steps, you and the insurance company may agree to binding arbitration. You must request approval for this step from a workers’ comp judge. You wouldn’t be able to appeal the arbitrator’s decision except in certain limited circumstances, so you should always speak to an attorney before you agree to binding arbitration.
It’s frustrating when the insurance company denies your workers’ comp claim, balks at paying some benefits, or refuses to authorize medical treatment that you need. It’s also difficult to navigate the Florida workers’ comp system on your own—especially when it comes to appeals. If you don’t have an attorney, you can reach out to the EAO for information and assistance. You can also ask to have an ombudsman help you prepare a petition for benefits that meets all the legal requirements. However, EAO ombudsmen may not represent you at a workers’ comp hearing. And it wouldn’t be wise to go to a hearing without legal representation. So you should consider speaking to a workers’ comp attorney if you’re having disagreements with your employer’s insurance company—especially when you may need to request a hearing. If you haven’t decided whether to hire an attorney, see Should I Hire a Workers’ Comp Attorney, or Can I Handle My Own Case?