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A Brief Overview of the Workers' Comp Appeals Process in Florida

When you are injured on the job, you will likely try to pursue a workers’ compensation claim. But what happens when your initial claim is rejected or denied? It’s not uncommon for a claim to be refused on the first attempt, particularly if you don’t have enough evidence to support it or your insurance company doesn’t believe they’re entirely liable to cover the injuries you have sustained. When this happens, you will likely turn to the appeals process, which involves submitting your claim to a higher authority for reconsideration and hopefully a better result.

Before you begin this process it’s important that you know what lies ahead so you can anticipate what you’ll need to do, and it’s important that you have legal counsel on your side from a qualified Martin County workers’ compensation attorney. Having a proven and skilled advocate representing your best interests can put the law to work for you and give you a much better chance of obtaining a successful outcome to your claim.

Submitting Your Appeal

The first step in the appeals process is to file your appeal with the Clerk of the Offices of the Judges of Compensation Claims, or the OJCC for short. You’ll need to fill out a Petition for Benefits form and then mail it or fax it to them. Usually you have up to two years from the date of your injury to do this, but appeals for a specific benefit like medical coverage must be filed within just one year. Generally, it’s best to fill out and submit this form as soon as possible to avoid running close to this deadline.

Once the OJCC has received your petition, they’ll notify your employer and their insurance company about your petition. The insurance company will then have two weeks to respond, either by paying your claim or by rejecting it once again and starting the legal process.

The Appeals Process

Once your insurance company refuses your petition, the OJCC will assign a case number to your claim, which you can use to track the status of your appeal online.

The first step of the appeals process is mediation. These are generally informal conferences between both parties which try to resolve the issue outside of the courtroom using the help of a neutral third party, known as a mediator.

If this meeting is unsuccessful at finding a resolution to your case, your case will be assigned to a judge. The judge will then schedule a hearing for your case where you and your insurance company will exchange evidence and submit statements (you may not even have to attend the hearing if you submit a written statement).

Within 90 days of this pre-trial hearing, your case will be heard at the final hearing. You and your insurance company will have your final opportunity to present your evidence and testimony before your judge. This includes the testimony of expert witnesses such as medical personnel, accident reconstruction experts, and many more.

Once the trial hearing has completed, your judge will issue their verdict within 30 days. You’ll receive it in written form by mail.

Appealing the Judge’s Decision

If you don’t receive a favorable outcome to your trial, you can take your case even a step further by escalating it to the First District Court of Appeals within 30 days of receiving the judgement. Be warned, however: these cases can take a year or more to resolve, and have considerably more complicated procedural and filing requirements, which means you shouldn’t undertake this part of the process without having a qualified attorney helping you.

Do you need help with appealing your workers’ compensation decision? Contact Lauri J. Goldstein & Associates, PLLC today by dialing (866) 675-4427!