To collect workers’ compensation benefits in Florida, you must give notice of your injury to your employer and make a claim for benefits. (For information on how to do this, see How to File a Workers’ Compensation Claim in Florida.) If your Florida workers’ compensation claim is denied, you have the right to appeal. But there are specific procedures that you will need to follow.
How to File Your Appeal
If your employer’s insurance company denies your claim for benefits, you have the right to challenge that decision. But first, you must try to resolve the dispute informally with the insurance company. If your efforts are unsuccessful, you will need to file a formal appeal.
To start the appeals process, you must mail or fax a Petition for Benefits to the Clerk of the Office of the Judges of Compensation Claims (OJCC). The form asks you to provide information about your claim, including the details of your accident, the nature of your injury, whether you have suffered any wage loss, and what specific benefits you are claiming.
Typically, you must file your petition within two years of your date of injury. However, if you are appealing a specific benefit, such as medical treatment, you must file your petition within one year of your last benefit payment or date of treatment. To avoid missing out on benefits, it’s best to file your petition as soon as your benefits are denied.
Once the OJCC receives your petition, it will notify your employer and its insurance company. The insurance company must either pay your claim or respond to the OJCC within 14 days of receiving your petition.
The Florida Appeal Process
After your appeal is filed, your claim will be assigned a case number and sent to one of the OJCC’s district offices. You can track the status of your appeal online, once you have the case number.
A mediation hearing is the first step in the appeals process. Mediation hearings are informal conferences, during which a neutral third party (called a “mediator”) will try to help you and the insurance company resolve your dispute. Your mediation hearing should be scheduled within 130 days of the filing of your petition.
If mediation is unsuccessful, your case will be assigned to a workers’ compensation judge. The judge will schedule a pretrial hearing to identify the issues in dispute and have you and the insurance company exchange evidence. If both you and the insurance company have lawyers, you may submit written statements instead of attending the hearing. (While you do not need to hire a lawyer, Florida workers' comp appeals are complicated. And, the insurance company will almost certainly be represented by a lawyer. Because of this, many workers hire lawyers to represent them during the appeals process.)
Your final hearing will take place within 90 days of the pretrial hearing. At the hearing, you and the insurance company will have the opportunity to present evidence and testimony from witnesses to the judge. Formal rules of evidence, which govern what evidence can be presented and in what manner, must be followed in workers’ compensation hearings.
After the hearing, the judge will review all of the evidence and issue a written decision. A copy of this decision will be mailed to both parties within 30 days of the final hearing.
Appealing the Judge's Decision
If you do not agree with the judge’s decision, you have the right to appeal to the First District Court of Appeals within 30 days. Appeals to the First District Court of Appeals often take a year or more. Because the court system has even more complicated procedural and filing requirements, most workers are represented by a lawyer at this stage.
Getting Help with Your Workers’ Compensation Appeal
The Florida Division of Workers’ Compensation has an Employee Assistance and Ombudsman (EAO) program that can help you with your workers’ compensation appeal. You can contact the EAO at 1-800-342-1741.
However, if your workers’ compensation claim has been denied, it is probably in your best interest to contact an experienced workers’ compensation lawyer as soon as possible. The appeal process requires extensive knowledge of Florida workers’ compensation law, including what forms to file, how to develop medical and other evidence, and how to present a persuasive case before a judge. (For more information, see Do I Need a Lawyer for My Workers’ Compensation Case?)