Miami, FL—After an employee has been involved in a work-related accident and they notified their employer that injuries were sustained, their employer is expected to notify their insurer of the injury within seven days.1If the employee had to seek immediate medical attention, their medical bills should be forwarded to their employer’s insurer for processing. Given the employee is eligible to receive workers’ comp benefits and their work incident is covered, their claim should be approved, and they should be entitled to receive medical care that is rendered by an authorized physician.
What if the insurer denies the claim?
Unfortunately, there are times when an insurance company may deny a workers’ compensation claim alleging the incident didn’t happen at work. When this happens, an employee can contact a workers’ compensation lawyer in Miami, FL to help resolve the issue or try and find out what evidence the insurer needs to get the decision reversed. Some forms of evidence that may be able to convince an insurance company that the injury did, in fact, occur while an individual was on the clock include:
- Photos from the accident scene, if the employee was able to take any.
- Witness statements. If another employee was present when the incident occurred, a statement from them would be beneficial to have.
- Written documentation from the physician who provided the initial treatment.
- Proof the individual was clocked in and working on the day the incident occurred.
When an insurance company attempts to use any of the following excuses to deny a workers’ comp claim, the employee should consider retaining a legal expert:
- There isn’t enough evidence to support the approval of the claim.
- The employee’s pre-exisiting condition is what caused them to suffer the injury.
- The work injury happened outside of the workplace or when the employee was off the clock.
In addition, an employee also has the option of contacting the Employee Assistance and Ombudsman Office, which aims to resolve disagreements without having to take the matter to court.2 In some cases, employees and their employer’s insurer may be able to find a way to get the matter resolved, but in others, employees may need to take a few additional steps in order to obtain the benefits they are entitled to.
If an employee in Miami, FL is having trouble getting their employer’s insurer to approve their workers’ comp claim, they can contact Mario Trespalacios P.A. for legal advice. The Miami, FL workers’ compensation lawyers at Mario Trespalacios P.A. are ready and available to help an injured worker understand their legal rights and what options they have when the insurer refuses to approve their claim.
Mario Trespalacios P.A. can be contacted at:
9495 SW 72 Street, Suite B-275
Miami, FL 33173