What to Do When Your Employer Denies Medical Treatment Requests in a Workers’ Comp Case

Suffering a workplace injury is stressful enough, but discovering that your employer or their insurance carrier has denied your request for medical treatment can feel overwhelming. Unfortunately, this situation is more common than many workers realize. The good news is that you have rights, and there are clear steps you can take to fight back.

Understand Why the Denial Happened

Before taking any legal action, find out the specific reason for the denial. Under Florida’s workers’ compensation system, insurers are required to provide written notice explaining why a treatment request was rejected. Common reasons include claims that the treatment is not “medically necessary,” disputes over whether the injury is work-related, or administrative errors such as missing documentation. Knowing the reason shapes your next move.

File a Petition for Benefits

If your treating physician has recommended a procedure or treatment that was denied, you can file a Petition for Benefits with the Florida Office of the Judges of Compensation Claims (OJCC to seek the Court’s assistance in ordering the procedure or treatment. You need legal representation at this stage in the process prior to filing a Petition. The formalities of the process need to followed and documentation to support the claims needs to be provided to the Employer and Carrier.

This is the most powerful formal tool. This legal document formally requests that the court order the insurer to provide the disputed medical treatment. Once a petition is filed, the insurer is required to respond, and the matter moves into the dispute resolution process. There are strict deadlines under Florida law, so it is important to act quickly.

Mediation

Before a formal hearing, ALL workers’ comp disputes in Florida go through a mediation. This is a structured negotiation process overseen by a neutral mediator. Mediation is often faster and less adversarial than a full hearing, and many cases are resolved at this stage. Coming prepared with medical records, physician statements, and documentation of your injury will give you the best chance of a favorable outcome.

Attend the Merits Hearing

If mediation does not resolve the dispute, your case proceeds to a merits hearing before a Judge of Compensation Claims. At this hearing, both sides present evidence and arguments.

Do Not Wait to Get Legal Help

Delays can hurt your case. Florida imposes filing deadlines that, if missed, can permanently bar you from recovering certain benefits.

If you have been injured on the job, you do not have to face the claims process alone. At De Cardenas Freixas Stein & Zachary, P.A., we are here to help you understand your rights and pursue the benefits you need. Call us at 305-377-1505 for a complimentary consultation. Our bilingual team is ready to guide you through each step of your case.