A fairly high percentage of workers’ comp claims are initially denied, but analysis also suggests a significant percentage (up to 70 percent) of denied claims are eventually converted to paid claims. What does that mean? If your claim is initially denied, don’t give up hope. Speaking with an attorney about your options and appealing the denial may result in an eventual approval.

1. Document the incident: Write down exactly what happened and talk with coworkers who may have seen it happen. Their corroborating testimony may be important in your claim filing and appeals. If you can, take pictures of the post-accident scene (like if you were injured by faulty equipment, walkways, spills or some other hazard).
2. Get emergency treatment if necessary: Whether you do this or report to your employer first depends on the severity of your situation. If you require emergency care (like you’re bleeding or potentially suffered a concussion) seek emergency medical care right away.
3. Follow employer reporting procedures: Officially report your injury to your employer and follow all the necessary filing steps. You must do this step within 30 days of your accident or your claim may no longer be valid. Some employers may have unique processes or procedures. Do your best to precisely follow their process.
4. Report the injury to your employer’s workers’ comp insurance provider (this information should be posted somewhere in your workplace, or you can contact human resources). If your employer did not report the injury to the Florida Division of Workers’ Compensation, you should do so via their website. If your employer doesn’t have workers’ comp insurance details posted or they tell you they aren’t insured, you should contact Florida’s Bureau of Employee Assistance and Ombudsman.
5. Fill out the first report of injury or illness form: Your employer should give you this form to fill and sign, after which they’ll submit it to their workers’ comp insurance company. They are required to do this within seven days.
6. You should find out which doctors are approved by your employer or their workers’ comp insurance provider and visit one with the right specializations nearest you. Their assessment of your injuries and recommended treatment may play an important role in your compensation, wage compensation and other benefits.
7. Thoroughly document everything that happens, from your initial injury and medical care to all the forms and communication you get from your employer and their insurance company.
8. Be wary when discussing your case with the insurer. Avoid downplaying or exaggerating your injuries. You are not required to provide a recorded statement to the insurance company even if they request it.
9. Try working with the insurance company on disputes: Calling a lawyer doesn’t necessarily need to be your first step if there are disputes with your claim. In some cases, misunderstandings can be worked out.
10. File a petition: If you can’t negotiate a solution, you should file a petition. You may want to work with an attorney once you arrive at this step as there are a variety of things your petition should include:

• A list of your job responsibilities
• What you were doing on the day the injury occurred
• Exactly what happened and what injuries you sustained
• All the expenses and lost wages you incurred
• A claim for interest on unpaid benefits and attorney fees and costs

11. Claim denial appeal: If your employer or their insurance company is still attempting to deny your claim, you can appeal the denial decision. The appeal process contains three distinct steps: notification of denial, appealing the denial and mediation. The insurer should notify you of a denial within 30 days of your petition. Workers have two years after the injury incident to file a petition of benefits, after which the insurance company can either provide a detailed justification for their denial or approve your claim. The last step, mediation, is a semi-formal negotiation between parties presided over by a judge who will make the final decision on your claim. The judge must issue a decision within 30 days of the mediation hearing. If the judge’s decision goes against you, you and your attorneys still have the option to appeal to the First District Court of Appeals. They can choose to affirm the Judge of Compensation Claim’s decision or reverse it and send it back for additional proceedings.

As you can see from reading through the process, workers’ comp claims are far from simple. Your choice of when to contact an attorney may depend on your comfort with the system and where you run into issues.

Many injured workers first consult with a lawyer when their employer initially denies or disputes their claim or when the insurance company issues the first claim denial. You might also want to speak with an attorney if your employer threatens punitive actions if you file a workers’ comp claim (like threatening to fire you or reduce your hours if you file a formal claim).

Most Florida employers should, by law, carry workers’ comp insurance. If they don’t, you may want to contact Florida’s Division of Workers’ Compensation and the Bureau of Employee Assistance and Ombudsman.