If you were injured on the job and filed a claim, you may wonder how many times can you appeal a workers’ comp case. Workers’ compensation is a fundamental right for most U.S. employees, and if your injury claim is denied, there is ample opportunity to challenge the decision. So, how many times can you appeal a decision? There are several potential layers to the appeals process. An official appeal in Florida begins with the workers’ compensation appeals board and can extend to the U.S. federal (district) court system.
Disability Benefits to Which You Are Entitled
If all goes well after a temporary disability claim is reported, you can expect your first workers’ compensation check within 21 days. The amount of wage replacement benefits you receive depends upon the authorized medical provider’s assessment and whether you are classified with temporary partial disability (TPD) or temporary total disability (TTD). Benefits can continue for up to 260 weeks or until you are (1) released to return to work or (2) declared to be at maximum medical improvement (MMI).
If the workers’ compensation carrier decides to deny your medical or wage claim, they must do so within 120 days of report of injury. At that point, the employee is responsible for making a “good-faith effort” to resolve the dispute, meaning you should call and discuss the matter with the insurance company. The Florida Employee Assistance and Ombudsman Office (EAO) is available to assist you with efforts to obtain denied benefits. If your claim is still unreasonably denied, you can begin an official appeal.
Workers’ Compensation Appeal
In Florida, you must file your initial appeal within two years of your injury date. If the appeal is for medical treatment, you must file within a year of your last benefit payment (or treatment date.) While you do not have to use an attorney to help you with an appeal, the process is complicated, and it is to your benefit to seek representation by an experienced workers’ compensation lawyer.
Appealing a Florida workers’ comp claim denial proceeds as follows:
- Petition — A Petition for Workers’ Compensation Benefits is filed with the Office of the Judges of Compensation Claims (OJCC), with copies provided to the employer and insurance carrier. A response should be received within 14 days.
- Mediation — If benefits are still denied, the OJCC will order an informal mediation meeting between the disputing parties. This mediation should be held within 130 days of the Petition filing.
- Pre-Trial Hearing — If an acceptable agreement is not reached at mediation (potentially to include a lump sum or schedule of payments, including interest) a pre-trial hearing is scheduled. At this hearing, the issues are further defined and evidence is exchanged.
- Final Hearing — Next will be the OJCC final hearing, which is held within 90 days of the mediation, or no later than 210 days post-Petition. Following presentation of evidence, the judge will issue a decision within 30 days, either denying or allowing the benefits claim.
- District Court Appeal – The OJCC judge’s decision is final only if both parties agree with it. If not, a Notice of Appeal can be filed with the First District Court of Appeal within 30 days. The party filing the appeal must then argue the facts of the case in a written legal brief, and the opposing party will file a subsequent response.
- Decision — The District Court judge’s decision will either affirm or reverse the OJCC decision. Or, the case may be remanded back to the OJCC and the process can begin again.
Should You Appeal Your Workers’ Comp Case Decision?
For help determining the best steps to take in your individual case, talk to the lawyers at Feldman Williams.