Workers’ compensation insurance was created to provide financial support for employees who have suffered a work-related injury. However, many workers are deprived of these benefits when their claim is denied by their employer’s insurer.
If your claim has been denied or your employer’s insurer refuses to provide you adequate compensation, Gordon & Doner’s worker’s compensation lawyers in Stuart are ready to help. Our attorneys are dedicated to fighting for the rights of the injured and have a strong record of recovering favorable outcomes for our clients. We will provide you with a free, no obligation consultation to review your workplace accident and determine if you were unfairly deprived of the compensation you deserve. All of our services are provided on a contingency fee basis and we never charge upfront for our legal services. We only accept payment if we help you receive the benefits you deserve.
How Our Workers’ Compensation Lawyers Can Help
Employers in Florida are required to carry workers’ compensation insurance to pay for medical expenses and partial lost wages from a work-related injury. However, many claimants are often denied benefits for various reasons or are approved for benefits that do not cover their medical expenses.
If you are unsatisfied with your claim’s results, Gordon & Doner’s skilled workers’ compensation attorneys in Stuart can help you fight for the benefits you deserve. We will use our combined skills and experience to help you navigate Florida’s complicated workers’ compensation system to obtain the benefits you deserve. We will do this by:
We will use evidence to support your claim. This will include:
- Collecting medical documents associated with your workplace injury
- Obtaining medical opinions from qualified physicians
- Consulting with vocational experts to determine if you are able to perform your job’s physical requirements
- Interviewing your loved ones, friends and co-workers about your ability to perform daily activities after suffering your workplace injury
- Investigating your employer for a history of workplace safety violations or lack of employee training to prevent workplace accidents
Handling the Insurance Company
Insurance companies often attempt to undermine a workers’ compensation claim in order to reduce its value or have it denied altogether. This may include an insurer alleging that your injury is not work related or that you waited too long to file a claim. We have witnessed firsthand how these tactics impact a claim and the effect it has on an injured worker’s well-being.
We will use our knowledge and experience to handle your employer’s insurer and help you receive benefits that accurately reflect the losses you have endured. By using the following elements, we can determine how much your claim may be worth:
- The severity of your injury and how it impairs your ability to function
- The cost of past and future medical treatment
- Whether you suffered a total or partial disability
- Your regular wages before the accident
- Your disability rating
This will help us determine the amount of benefits you may be owed through your workers’ compensation claim and could prevent you from accepting too low of an offer.
Helping You File an Appeal
If you are unsatisfied with the insurer’s decision regarding your claim, our attorneys can help you challenge the decision by filing an appeal.
As seasoned Stuart workers’ compensation attorneys, we have helped many injured workers successfully appeal denied claims. Our experience has provided us with the skills and knowledge needed to guide you through this complex legal process. We will use witness testimonies, request your medical records, and prepare you for any upcoming legal proceedings to help you obtain the benefits you need.
We can discuss your legal options during a free, no obligation consultation with one of our dedicated workers’ compensation attorneys in Stuart.
Call 1 (855) 722-2552 to schedule a free consultation with a Stuart workers’ compensation lawyer.
What Workers’ Compensation Covers
Most employers conducting business in the state of Florida are required to provide workers’ compensation insurance for employees who suffer an injury or illness that is work-related.
This benefit is available to all workers and does not require that a worker prove fault for an injury like most personal injury cases. This is because workers’ compensation is a no-fault system, which means you do not have to prove your employer caused your injury to receive benefits.
However, to recover benefits, injured workers must provide evidence that shows that their injury or illness was acquired during the course of their job’s duties. Depending on the requirements of your job, this could include injuries that occur on-site as well as those that occur while traveling on business, running a work-related errand or attending a business-related social function.
Depending on the severity of your injury, workers’ compensation may cover:
- Medical costs to treat immediate injuries and illnesses
- Partial lost wages
- Ongoing medical treatment
- Funeral costs and death benefits to your beneficiaries
What is Not Covered by Workers’ Compensation
However, there are certain workplace injuries that may not be covered by your employer’s workers’ compensation insurance, such as:
- Injuries caused by impairment from drugs or alcohol
- Injuries from a fight started by the employee
- Injuries caused by inappropriate behavior or violation of company policy
- Self-inflicted injuries
- Non-work-related injuries
- Injuries claimed by an employee after he or she has been laid off or terminated
- Injuries suffered by an independent contractor
Steps to Take After a Workplace Accident
If you have been injured in a work-related accident, Florida has a specific process for filing a workers’ compensation claim that you are required to follow:
Report Your Injury
Inform your employer about the accident and your injury as soon as possible.
Florida law requires that you complete a First Report of Illness or Injury form (DCW-1) within 30 days of the accident, or within 30 days of a medical practitioner determining your injury is work-related.
You must return this report to your employer, who will then have seven days after receiving it to inform its workers’ compensation insurer of your injury.
Seek Medical Attention
After you have informed your employer of your injury, you will be provided with a medical practitioner who has been approved by your employer or its workers’ compensation insurer.
During your initial medical examination, you should provide the approved medical practitioner with a detailed description of the accident, including how you were injured and any pain or symptoms you have experienced since the accident. You should also inform your treating physician of any past or current medical conditions or injuries you may have suffered.
If your physician prescribes you a treatment plan or medication, it is important that you follow through with it. This will show that your injury is serious and requires compensation for medical treatment.
After each medical appointment, provide your employer with a copy of the Medical Treatment/Status Report form (DWC25).
Additionally, if your physician determines that your injury limits your ability to work, inform your employer of any restrictions you have.
Wait for Your Employer’s Insurer to Contact You
After your employer has reported the claim to your employer’s workers’ compensation insurer, an adjuster should contact you within 24 hours to explain your rights and obligations.
When you speak to your employer’s insurer, report wages from all sources of employment if you had more than one employer in the 13 weeks before the date of the accident. This will help it determine the proper amount of wage replacement, if necessary.
Within three to five business days after your injury has been reported, you will receive an informational brochure explaining your rights and obligations, as well as a notification letter detailing the services provided by the Employee Assistance Office of the Division of Workers’ Compensation.
Document Your Injury
Following a workplace accident, you should carefully document everything related to your injury. This includes:
- The details of the accident that caused your injury, such as the time, date and location where it took place
- The progress of your injury, including the amount of pain or restrictions you experience
- Any meetings you have with your approved medical practitioner
Have this information ready for when you are contacted by an insurance adjuster.
Additionally, our Stuart workers’ compensation attorneys may be able to use this information to show an insurer the true extent of pain and suffering caused by your injury, as well as how it has restricted your ability to work.
Complete our Free Case Evaluation form.
Why Are Workers’ Compensation Claims Denied?
Although workers’ compensation is a no-fault system, the process of filing a claim can be difficult and, unfortunately, claims are often disputed or denied by insurance companies.
Our Stuart workers’ compensation attorneys have handled numerous claim disputes with insurance companies and have seen claims denied because:
- The injury is not serious and does not require medical attention or wage compensation
- The claim was improperly filed
- The worker missed the deadline to report the injury or file a claim
- The injury is not work related
- The claim was improperly filed
- The physician that examined the worker was not “approved” by his or her employer or its insurer
- The worker did not follow through with the prescribed medical treatment plan
Call 1 (855) 722-2552 if your workers’ compensation claim has been denied.
Appealing a Denied Workers’ Compensation Claim
If your employer’s workers’ compensation insurer has denied your claim, you have the right to challenge the decision.
However, you should initially try to resolve the dispute internally with your employer or its insurance company. If your attempt at an informal resolution is unsuccessful, you should contact the nearest Division of Workers’ Compensation, Employment Assistance Office (EAO) for help resolving your dispute.
If you are still unable to reach a resolution with your employer’s insurer, you will need to file a formal appeal.
Filing the Appeal
In Florida, the process to appeal a workers’ compensation claim begins when you mail or fax a Petition for Benefits to the Clerk of the Office of the Judges of Compensation Claims (OJCC). This form will ask you to provide information about your claim, including details about your accident, the condition and symptoms of your injury, any wages you have lost, and what benefits you are claiming.
You must file your petition within two years of the date of your injury. However, if you are appealing a certain benefit, such as medical treatment, you must file your petition within one year of your last benefit payment or date of treatment. However, it is best to file the petition as soon as your benefits are denied.
Once the OJCC receives your petition, it will notify your employer and its insurance company. The insurance company will have 14 days to either pay your claim or respond to the OJCC.
The Appeals Process
After your appeal has been filed, the OJCC will assign your claim a case number and send it to one of its district offices. Once your claim is assigned a case number, you can track its progress online.
The first step in the appeals process is to attend an informal mediation hearing. During this hearing, a third-party mediator will try to help resolve your dispute with the insurance company. Generally, the mediation hearing is scheduled within 130 days after filing your petition.
If the mediator is unable to resolve your dispute, your case will be assigned to a workers’ compensation judge. The judge will schedule a pretrial hearing to discuss the cause of the dispute and will require you and the insurance company to exchange evidence. If both you and the insurance company have legal representation, the attorneys will submit written statements instead of attending the meeting.
Your final hearing will take place within 90 days of the pretrial hearing. At the hearing, you and the insurance company will present evidence and testimony from witnesses to the judge. After the hearing, the judge will review all of the evidence and issue a written decision to both parties within 30 days.
Appealing the Judge’s Decision
If you do not agree with the judge’s decision, you can appeal to the First District Court of Appeals within 30 days. Appeals to the First District Court of Appeals often take one year or more. Because of the lengthy process and complex procedure of Florida’s court system, we highly recommend you contact a skilled workers’ compensation lawyer in Stuart to represent your claim during this time.
The appeals process is often difficult and complex for people who are unfamiliar with Florida’s workers’ compensation laws. Our Stuart workers’ compensation lawyers are familiar with the requirements for appealing a denied claim and can guide you every step of the way.
Workers' Compensation Benefits
Workers’ compensation provides injured or sick employees with crucial financial support after a work-related accident. Depending on the severity of the worker’s injury or illness, he or she may be eligible for one of the following types of workers’ compensation benefits:
Workers’ compensation is designed to pay for all authorized necessary medical expenses associated with the treatment of a work-related injury. This includes:
- Medical transportation to the hospital after the accident
- Initial medical treatment with your approved medical practitioner
- Physical therapy
- Medical tests
- Prescription medication
- Corrective surgeries
- Medical equipment, such as a wheelchair or crutches
- Transportation costs to and from your doctor visits
- Medical treatment
Temporary Disability Benefits
If your injury or illness prevents you from working, your employer’s workers’ compensation insurance may reimburse you for partial lost wages. In total, you can receive up to 104 weeks of temporary disability benefits.
There are two types of temporary disability benefits in Florida that injured workers may be able to receive:
Temporary Total (TT) Disability
If your doctor determines that you cannot work because of a work-related injury or illness, you should receive payments equaling 66 and two-thirds percent of your regular wages at the time the injury occurred.
However, you will not receive TT payments for the first seven days of disability, unless you are disabled more than 21 days due to your work-related injury. All payments must be authorized by an approved doctor.
Furthermore, certain injuries may entitle you to 80 percent of your regular wages for up to six months after the accident. You can estimate your TTD benefits online to get a better understanding of the amount you may be owed.
Temporary Partial (TP) Disability
If your doctor determines that you are able to return to work and perform limited duties, you may be eligible to receive TP disability benefits if you are unable to earn 80 percent of the wages you were earning at the time of your accident.
If you believe you are eligible for TP disability benefits, you can estimate your benefits online to determine what you may be owed.
Impairment Benefits (IB)
If your doctor determines that you have reached maximum medical improvement (MMI), meaning your condition is not expected to improve, you will be evaluated for possible permanent work restrictions.
You will then be provided an impairment rating based on your ability to perform work-related tasks. Your IB payments will be based on your level of impairment if you receive a rating higher than zero percent. To find out what you may be owed, you can check online and receive an accurate estimation.
Permanent Total (PT) Disability Benefits
If you have reached MMI and your condition is so severe that you are left permanently disabled and unable to work, you may receive PT disability benefits. You will be provided 66 and two-thirds percent of your regular monthly wages for the duration of your disability.
If a work-related death occurs within one year of the date of the accident or five years of continuous disability, the following benefits may be provided and payable up to a maximum total of $150,000:
- Funeral expenses up to $5,700
- Compensation to dependents
- Educational benefits to the surviving spouse
Our workers’ compensation lawyers in Stuart are well-versed in Florida’s workers’ compensation laws and will be able to determine which benefits you may be eligible for.
Third Party Lawsuit
Under certain circumstances, you may also be able to file a personal injury lawsuit against a third party that caused your work-related injury.
Because Florida’s compensation laws prevent workers from taking legal action against their employer, a work-related personal injury lawsuit can only be brought against an outside party that caused your accident. This can include:
- The at-fault driver of a work-related auto accident
- Architects or engineers that designed a flawed building or structure
- Manufacturers of dangerous or defective products
- Manufacturers or sellers of dangerous chemicals
- Vendors responsible for installing or maintaining equipment or machinery
- The owner or party in control of a dangerous worksite
To bring a successful lawsuit against a third party, you must be able to prove the other party is liable for your injury.
For example, if you were injured in a construction site accident, we may be able to hold the site’s owner liable for your damages. However, we will need to prove your injury was caused by a dangerous hazard that formed because the owner failed to maintain the property.
Our Stuart workers’ compensation lawyers will investigate your claim to determine if an outside party was associated with your accident and review its level of involvement. If we can establish a link between your accident and a third party’s negligence, we may be able to pursue additional compensation.
Complete our Free Case Evaluation form for a no obligation review.
Contact Our Stuart Workers’ Compensation Lawyers
A work-related injury can cause many complications in your life, which are worsened if your workers’ compensation claim is denied or you receive less benefits than you deserve.
At Gordon & Doner, we have decades of combined experience helping injury victims fight for their rights after a serious accident. We understand that insurance companies are only focused on their best interests. For this reason, we are committed to working for our client’s best interests to help them receive the compensation they deserve.
If your workers’ compensation claim has been denied or you were provided inadequate benefits, contact Gordon & Doner’s workers’ compensation lawyers in Stuart for a free, no obligation review of your claim. We work only on a contingency fee basis, which means we never charge our clients upfront for legal services. You only have to pay us if we win your case and you receive the benefits you deserve.