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Ocala, FL Workers' Comp Appeals

Following a work-related accident, filing a workers’ compensation claim is the next step. Once filed, the claim is reviewed and an employer’s insurance company reaches a determination. If a claim is denied, the option to begin the appeals process is available. Schatt Hesser Mcgraw has more than a decade of experience representing both sides of a workers’ compensation appeal giving us indispensable knowledge to apply to your claim.

Common Reasons Why A Work Comp Appeal Is Denied

Workers’ compensation appeals are denied every day with many rooted in innocent mistakes. The appeals process takes a considerable amount of time and as time moves on, it can be easy to focus on getting back to work rather than recovery. A Florida workers’ comp lawyer with Schatt Hesser Mcgraw has the necessary experience and skills to stay on top of filing deadlines, submitting appropriate paperwork and forms, and ensuring a mistake isn’t the reason for your denied claim.

Missed Reporting Deadline

Your employer must be notified of any workplace-related injury or illness within 30 days of diagnosis. A late notice generally results in a denial of the right to seek medical and wage benefits, even though you have an official diagnosis. Give notice to the employer as soon as possible and keep a copy of the notice for your records.

Visiting An Unauthorized Doctor

Your employer or its insurance company will assign you a doctor to visit for the injury or illness. It’s important to visit this doctor and follow any treatment given to you or face a denial of the claim. You can visit your regular doctor, but the workers’ compensation approved doctor’s orders still stand.

Accepting Or Not Accepting Work

Returning to work, or accepting work, before you’ve recovered from the injury or illness sets up the possibility of a relapse, therefore reopening the claim and need to reestablish benefits. Don’t be afraid to review the job description with the assigned doctor and get a second medical opinion from your own doctor.

Declining work made available can result in a claims denial. Your employer must be made aware of what the assigned doctor says can and can’t be done in a job position until you’ve recovered. If the employer offers a position that matches the doctor’s recommendation as well as your skills and experience, you have to accept the position. Otherwise, the claim and benefits will likely be denied.

Taking A Settlement Too Early

If your workers’ compensation claim begins to lag, it can be tempting to settle and move on. But, the amount you receive may be significantly lower than the amount needed. A workers’ compensation attorney in Ocala, FL with Schatt Hesser Mcgraw will review your claim and work through any sticking points to ensure you receive the full amount necessary.

How The Workers’ Comp Appeals Process Works

Most workers’ compensation cases have a two-year limitation on filing an appeal after a denial. The process begins by mailing or faxing a petition for benefits to the Clerk of the Office of the Judges of Compensation Claims (OJCC). The petition, which is a form, states information about your claim such as:

  • Details of the accident;
  • Type of injury or illness;
  • If wage loss has occurred; and
  • Specific benefits being claimed.

When the petition is received by the OJCC, they notify the employer and the employer’s insurance company. The insurance company then pays the claim or sends a response to OJCC within 14 days of notice. You’ll receive a case number for the specific file and claim.

What To Expect During An Appeal

Mediation is the first step in a workers’ compensation appeal. These informal conferences are between yourself and the mediator whose job it is to resolve the dispute between yourself and the insurance company. If mediation is unsuccessful, the case then goes to a workers’ compensation judge. A pretrial hearing is scheduled to determine issues surrounding the claims dispute; evidence is exchanged between the insurance company and yourself. Due to the complexity of the entire appeals process, it’s suggested to contact a Florida workers’ comp lawyer to assist you with the appeal. A final hearing is then scheduled within 90 days of the pretrial hearing. There you and the insurance company can present evidence and witness testimony to the judge. Once the final hearing is over, the judge will issue a written decision after reviewing all evidence presented. You’ll receive a copy of the decision by mail within 30 days after the final hearing.

Ocala Workers’ Compensation Lawyer

Because of the complexity and time required for a workers’ compensation appeal, having a workers’ compensation lawyer Ocala employees on your side can make all the difference. Schatt Hesser Mcgraw has handled numerous appeals processes, leaning on our years of experience and extensive knowledge of Florida’s workers’ compensation law. You can be assured all deadlines are met, forms and paperwork are filled out, and a present a compelling case during the appeals process. Contact Schatt Hesser Mcgraw today to discuss your workers’ compensation appeal.

(352) 789-6520