How Many Times Can You Appeal a Workers’ Comp Case?

How Many Times Can You Appeal a Workers’ Comp Case?

Workers’ Compensation Is Important

Protecting Your Health and Your Future Is Your Right

Workers’ compensation claims are commonplace both across the United States and in Florida. Every day, workers are injured while on the job, and the benefits from these claims are critical in providing them the financial assistance they need as they recover. Unfortunately, the compensation awarded is not always appropriate for the injuries suffered.

If you were injured on the job and filed a claim, you may wonder how many times you can 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, and an experienced workers’ compensation attorney can assist you with it.

Workers’ Compensation Is Complicated

Submitting Your Claim

One of the most important things you must do if you have been injured at work and want to apply for workers’ compensation benefits is to ensure that you file your claim appropriately. There are a number of important steps to take.

Because the workers’ compensation process can often be contentious, it may be in your best interests to retain a reputable workers’ compensation attorney, one who is established in the state where you are filing and has the experience and knowledge to guide you.

Understanding the Disability Benefits to Which You Are Entitled

How do my disability benefits work? This often-asked question is important. If you have been injured while at work, knowing what to expect with regard to your benefits is critical to managing your future.

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).

Claim Denial: A Common Occurrence

Don’t be surprised if your employer’s workers’ compensation carrier denies your medical or wage claim. This is a common occurrence. A workers’ compensation notice of decision must be sent within 120 days of the report of the injury.

At this point, you (the employee) are 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.

Handling a Workers’ Compensation Appeal

Workers’ compensation law defines a process through which you can appeal the decision of your insurance company. An official appeal in Florida begins with the workers’ compensation appeals board and can extend to the federal U.S. District Courts. You must follow the requirements in order to ensure that your appeal is considered.

First of all, in Florida, you must file your initial appeal within two years of your injury date.

And, 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 includes the following steps:

  • 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 the 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’s 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 the presentation of evidence, the judge will issue a decision within 30 days, either denying or allowing the benefits claim.
  • District Court Appeal – The workers’ comp 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 Appeals 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.
  • Workers’ Comp Judge 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.

Making the Best Choices

A workers’ compensation attorney can provide valuable guidance throughout the claims process. There are a number of decision points where you will receive shared information that may impact your recovery and your life going forward.

But the information provided can be complex and determining what to do can be overwhelming. A workers’ compensation attorney can help evaluate your case, the decisions made and your best options for success. Their guidance can help answer some very important questions.

When Should You Appeal a Workers’ Comp Decision?

Quite honestly, the answer to this questions depends upon a host of things, all unique and personal to your case. What is right for one person, may not be the best decision for another.

Key to determining whether or not you should appeal a workers’ comp insurance company decision are the reasons for the denial.

Your workers’ comp attorney can review both the process you used to file your claim and the resulting insurance company documentation. Depending upon what they learn, they can discuss with you whether they believe it is in your best interests to file an appeal.

How Should You Appeal Your Workers’ Comp Judge’s Decision?

If you have filed an appeal at the district level and are not satisfied with the initial judge’s decision, you have more options, but you must take action within the time constraints as outlined by law. In Florida, you have only 30 days to file a notice of appeal with the District Court. A workers’ comp attorney can prepare the legal brief necessary for the next phase of the process.

Engage Valuable Assistance

Contact the Feldman Legal Group Today

If you have suffered an injury at work, you are under a great deal of pressure. In addition to the pain associated with recovery, you may be concerned regarding the considerable cost of medical care, your time away from your job and the impact both will have on your financial future.

Workers’ compensation can help you during this trying time; however, decisions are not always made in the employee’s favor. If you are wondering how many times you can appeal a workers’ comp case and you need assistance managing the process, reach out to the experienced and well-regarded attorneys of the Feldman Legal Group at 877-946-8293.