What Does It Mean to “Appeal” Your Workers’ Compensation Claim in Florida?

According to the Collins Dictionary, the definition of “appeal” is “to ask earnestly for help or support.” This might be the definition that most Tampa residents are familiar with, but the term “appeal” has a much more specific meaning in the legal world. When you appeal a decision, you ask a higher court to examine it. The goal of an appeal is to change the initial decision and experience a more favorable ruling. How exactly does this work in the context of workers’ compensation?

The Appeals Process in Workers’ Comp: What You Need to Know 

The first thing you need to know about appealing a workers’ comp claim decision is that it is possible. In other words, there is no need to give up hope if your initial claim is denied by your employer and their insurance company. The appeals process allows you to push back against this denial and strive for optimal results.

You should also know that a high number of claims are denied each year. Often, insurance companies deny claims for reasons that are incorrect or nonsensical. The good news is that the insurance company is legally required to provide you with a clear reason for their denial of your claim. You should receive an explanation in an official denial of coverage letter.

Your First Steps in Appealing Your Claim 

The first step should be to determine exactly why your claim has been denied. This might not be immediately clear – even if the insurance company explains their reasoning in a letter. Although the insurer is required to use wording that is easily understandable in layman’s terms, denial letters are nonetheless filled with complex “legalese” in many cases.

In order to make sense of it all, you might need to consult with a qualified, experienced workers’ comp attorney in Tampa. These legal professionals can examine your situation and determine whether the reason for denial makes sense. If there is an opportunity to appeal the denial, your lawyer will let you know.

From there, your best bet is to speak directly with your employer and their insurer. Attempt to resolve the situation without going to court if at all possible. If the error is obvious enough, all parties should agree that settling the issue without resorting to litigation is the most mutually beneficial option.

Your Next Steps for Appealing a Denied Claim in Florida 

If the insurer insists on denying your workers’ comp claim even after these discussions, you still have the option to officially appeal the decision in court. This process involves several specific steps:

• File a Petition for Benefits with the clerk of the Office of the Judges of Compensation Claims
• Wait 14 days for your employer and their insurer to either respond in writing or pay your claim
• Attend mediation sessions if necessary
• Attend a pretrial hearing if negotiations fail
• Attend a final hearing
• Wait 30 days for the court to issue a decision
• File another appeal with the First District Court of Appeal if necessary

Find a Workers’ Comp Lawyer in Tampa 

If you’ve been searching for a qualified, experienced Tampa workers’ comp attorney, look no further than the Franco Law Firm. We know that workers’ compensation claims may seem complex to the average employee in Florida. These complexities can be heightened even further if you need to appeal a denied claim. Book your consultation today to get started with an effective action plan.

Sources: 

1dca.flcourts.gov/

jcc.state.fl.us/JCC/