As a Florida worker, you may be entitled to workers’ compensation benefits if you are injured in a workplace accident or you become ill as a result of your job. For many workers, the workers’ compensation claim process goes smoothly and benefits begin within a relatively short period of time after a claim is reported. However, for a worker whose claim is initially denied, the appeal process can be frustrating and difficult.
Filing Your Claim – Notice of Denial
The first step toward receiving workers’ compensation benefits is to report the injury to your employer using the “First Report of Injury or Illness” form. Your employer is then required to report the injury or illness to its workers’ compensation carrier. Shortly thereafter you should receive a brochure from the carrier explaining your benefits. If, however, you receive a Notice of Denial instead, this means that your claim for benefits has been denied. If your benefits are denied, you have the right to appeal that denial.
Filing a Petition for Benefits
A worker who has filed a timely notice of injury or illness and received a Notice of Denial has the right to file a Petition for Benefits with the Office of the Judges of Compensation Claims, or OJCC.
Prior to taking this legal step, you and your attorney, if you have counsel, may attempt to resolve the dispute with your employer through informal negotiations. If those efforts are unsuccessful, your next step is filing the Petition for Benefits.
After your petition is filed and a judge assigned, the judge will likely order a mediation conference. In mediation, a neutral party (the mediator) attempts to help both sides reach an amicable solution. Although mediators are often attorneys, they do not represent either side. Mediation is more like an informal meeting than a trial. No evidence is presented nor is testimony given. Instead, the mediator will review documents filed by both sides and consult with both sides before bringing the two parties together to try and reach an agreement.
Appealing to the First District Court of Appeals
If mediation is unsuccessful, your case will be scheduled for a hearing in front of the OJCC. This is akin to a civil trial. Evidence is introduced at this hearing and testimony may be given. After the hearing, the judge will make a decision within 30 days as to whether or not you will be awarded workers’ compensation benefits.
If the decision at this stage of the process is still not in your favor, you have the right to appeal the decision to the First District Court of Appeals. At the appellate level, a claim is reviewed based on the record, meaning you will not be able to present evidence or give testimony. In fact, you will likely never step foot in the courtroom. Your case will be reviewed based on the written record that is sent up from the OJCC and the brief filed by your attorney.
As you can see, if a claim is not approved initially, it becomes harder and more complicated to get it approved as it moves through the appeals process. For this reason, the sooner your claim is approved the better. If you have questions about your claim, consult with an experienced Florida workers’ compensation attorney as early in the claim process as possible to increase the odds of your claim being approved.