Workplace accidents typically result in personal injuries. For example, an injured worker can seek compensation from an insurance carrier. In case of disagreement, compensation claims lead to disputes revolving around permanent liability, injury management, work capacity decisions, premiums, and benefits.
It is worth mentioning that the employer does not participate in compensation disputes. In Florida, non-construction companies employing four or more workers must buy compensation insurance for their workers. On the other hand, the law requires all construction companies to purchase coverage, no matter how many employees they employ. Hence, the parties to a compensation dispute are an injured worker raising the claim and an insurance carrier, represented by a claims adjuster (an attorney for the insurance company). However, employers decide on accepting or rejecting the claim before the dispute arises.
Compensation insurance covers the costs of surgeries, physical therapy, drugs, rehabilitation, wages, occupational illness, short-term and long-term disabilities compensation, and funeral costs.
Nevertheless, bringing a claim does not guarantee you will receive the benefits. In practice, employers in Florida dispute compensation claims for various reasons. Below is the list of the most common:
The number one reason for disputing compensation claims is the cost of insurance premiums. The more workers bring claims, the higher the cost of the premium. If there is any doubt about the accident or the injuries, the employer and the insurance company will try everything to dispute the claims. By arguing the opposite to claims, an employer hopes to decrease their number to an acceptable level from a premium costs point of view. However, some small claims do not impact the cost of premiums significantly. For example, a sprained ankle claim does not bear the same weight as a leg amputation.
More severe injuries lead to complex medical treatments resulting in higher expenses. Consequently, expensive medical treatment, including surgeries, drugs, and long recovery, increases the premium cost that the employer is paying. Therefore, the employer will dispute the severity of the injuries whenever possible, claiming that the injuries suffered are not severe enough to require medical treatment.
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When the injuries are not severe enough to require expensive medical treatment, the employer can dispute the compensation claim by pointing out that the worker does not need time off from work. Depending on the job, the injuries might not prevent the worker from performing their tasks. However, if the injuries affect the area of the body not needed for everyday job requirements (and your overall health is not compromised), the employer may successfully dispute your compensation claim.
Although there was an accident causing personal injuries, the employer can dispute the claim by alleging that either an accident or injuries do not relate to work. The insurance policy covers only job injuries or injuries that occur while performing duties related to the job. Unlike accidents caused by performing job tasks, other health issues are indirectly related to the job. For example, a hazardous workplace environment can cause lung problems over time, leading to Chronic Obstructive Pulmonary Disease. If your health problems do not fall into these two categories, your employer can successfully dispute your compensation claim.
The underlying medical condition includes chronic illnesses, unhealthy lifestyle, alcoholism, drug abuse, and smoking. Claimant suffering from cancer, diabetes, or having a record of substance abuse will cause an employer to dispute the claim by asserting that the injuries result from such conditions and are not related to work.
Before filing a compensation claim, the worker has a limited time frame to report the accident to the employer. Failing to report the accident in time is a reason for rejecting it outright. Every employer will utilize an opportunity to dispute the compensation claim on formal grounds without opposing it on merit.
Bringing a compensation claim requires you to collect and present evidence to show your allegations are truthful and accurate. That involves medical documentation, receipts, expert opinions, and other proofs of diminished work capacity due to injury resulting from an accident in a workplace. Failing to do so will cause your employer and the insurance carrier to dispute your claim arguing that it is without merits. Filing for benefits without sufficient evidence to corroborate your allegations can even raise the suspicion of a fraudulent claim on your part.
The employer can refuse to believe that the employee suffered an injury due to a workplace accident. But, often, employers are biased against workers, convinced that the workers are just trying to get the money out of the company. That is especially true when the worker suffers from an illness not directly related to performing job tasks. For example, lumbar back injuries, cumulative trauma disorder, and carpal tunnel syndrome occur due to prolonged and repetitive stress. However, it is hard to prove their precise origin and causal connection with workplace conditions. Because of that, many employers think that workers use their chronicle illnesses and other underlying health issues by falsely pointing at workplace conditions as their cause. Although there are examples of such false claims, bias against all workers based on a few isolated instances is not justifiable.
Sometimes, a bias does not come from objective and reasonable presumptions. For example, the personal animus against an employee can cause the employer to view every claim as groundless. Similarly, employers who have a negative opinion of remote working can question each compensation claim for injuries sustained at home. But as mentioned above, some illnesses (such as carpal tunnel syndrome) can develop regardless of the workplace location.
At The Mediation Group, we pride ourselves on taking each worker’s compensation claim with diligence and devotion. Our certified Florida mediators are experts in dealing with workers’ compensation disputes. Knowing what employers and insurance carriers think of individual claims and their biases against workers allows us to advocate for your rights confidently and convincingly.
Do not hesitate to call us today to discuss how we can help.