Some workers compensation insurance companies will try anything to deny your work comp claim. Thus, it is important to know your rights and responsibilities after being injured at work. Over the decades of handling workers’ compensation cases, I have found that these are some of the main reasons the carriers use to deny claims:
The Workers Compensation Claim Was Not Timely Reported to Employer
Florida Statute 440.185 states that an employee shall advise his or her employer of a workers’ compensation injury within thirty (30) days after the date of injury. Failure to do so shall bar a work comp claim. However, there are exceptions to this law including the employer having actual knowledge of the injury and failing to know an injury was work-related. Therefore, it is important that you talk with an attorney who understands Florida workers’ compensation law if this argument is raised.
The Statute of Limitation Has Run on the Workers Compensation Claim
Some carriers will deny a claim because they believe the statute of limitation has run on the case. Under Florida Statute 440.19, an employee has “two years after the date on which the employee knew of should have known that the injury arose out of work performed on the course and scope of employment” to file a petition for benefits. This period is tolled (extended) for one year from the date of payment of any indemnity benefit or authorized medical care after the two year initial period. There are a lot of cases on what is considered a basis for the tolling of the statute. If the insurance company denies your case because of the statute of limitation, make sure you talk with an attorney before accepting that they are correct.
The Workers Compensation Claim is Denied Because of the Employee’s Horseplay
The general rule is found at Florida Statute 440.092(3) which states that if an employee suffers an injury while engaged in a deviation from the job duties, the employee is not eligible for work comp benefits. Some insurance companies will argue that if an employee is injured during horseplay, this is a deviation from the job duties and therefore no work comp benefits are payable. However, that’s not always correct. The test in deviation cases is the distinction between a small deviation and a large deviation. Usually, the courts do not deny workers’ compensation benefits if the horseplay involves fooling around for only a momentary deviation without obvious danger. However, if the horseplay involves outrageous conduct that amounts of a complete abandonment of the employee’s job duties, then the case may be denied.
Employee Misrepresentation on Job Application/Post Job Offer Questionnaire or Exam
In Florida, if an employee lies about their physical condition when applying for a job, they are not eligible for workers’ compensation benefits for an otherwise compensation injury if (1) there is a causal relationship between the injury and the false representation; (2) the employee knew it was false; the employee relied on the false representation; and (4) such reliance resulted in hiring the employee. There is a lot of litigation in this area including what is a misrepresentation and what is a misstatement; the meaning of blank answers; and other legal arguments. If the workers compensation carrier raises this defense known as the Martin v. Carpenter defense, consult with an attorney about your rights before walking away from the medical treatment and wages you may be entitled under the law.
These are just a few of the many reasons why a workers compensation carrier may deny a work comp claim. If you get injured at work, remember that although you have rights, you also have responsibilities under the Florida law. Be sure to talk to an attorney who understands Florida workers’ compensation law before assuming the adjuster is correct.
About the Author
Attorney Matthew Noyes helps injured workers fight for workers’ compensation benefits. As the prior Director of Perenich, Caulfield, Avril & Noyes, P.A.’s Workers’ Compensation Department, Attorney Noyes understands what is required of both the insurance company and the injured worker. He has compiled his own “Top Ten Things to Know About Workers’ Compensation.” If you would like a copy of his Top 10 or have questions regarding your rights and responsibilities after a Florida work comp claim, call his office at 727-796-8282 or simply click here to schedule a free case consultation.