In the State of Florida, workers’ compensation law requires most businesses that have four or more employees to carry workers’ compensation coverage (insurance). This coverage is a type of business insurance that provides fixed monetary amounts to cover medical treatment, ongoing care, lost wages, disability benefits (short & long-term), occupational illness, and funeral costs. On behalf of the employer, it is designed to help reduce litigation costs from costly employee lawsuits related to on-the-job injuries.
What Does Workers’ Compensation Cover?
It covers workplace injuries such as:
- Head, knee, shoulder, hand, wrist, eye, ankle, hip, and foot injuries.
- Spinal cord, and back injuries.
- Brain injuries.
- Loss of limbs/amputations.
- Burn injuries.
- Falls from roof, ladders, scaffolding.
- Electrical accidents.
- Power tool/machinery accidents.
- Crane accidents.
- Workplace vehicle accidents (forklift).
- Bring struck by falling objects.
- Slipped disks, carpal tunnel syndrome.
What Does the Claim Process Entail for Workers’ Comp?
If you are recently injured or have never filed a workers’ compensation claim before in the State of Florida, here is how the process works.
1. You Must Report the Injury
You should report the injury to your employer as soon as possible, ideally within 24 hours, but no later than 30-days after you have suffered a job-related injury [Florida Statute 440.185]. If you fail to report the injury, and incident within 30-days, it can result in your workers’ compensation claim being denied (no benefits).
2. You Must Seek Medical Treatment
When you report a workplace injury to your employer, they must recognize and acknowledge the injury. They will have authorized healthcare providers that you can go to for medical treatment. If you need to seek out emergency treatment for your injury, head to the nearest hospital or clinic immediately.
3. Your Employer Will Report the Injury
Your employer must file a First Report of Injury or Illness (accident report), with their workers’ compensation carrier (insurance company) within 7-days after the injury has been reported by you [Florida Statute 440.185].
4. You Will Be Sent an Information Packet/Brochure
Once your employer has filed an accident report, you will receive an information brochure from the workers’ compensation carrier (insurance company), within 3-days after receiving notice of the injury from the employer. This packet will detail the accident report, explain your rights and responsibilities, and provide additional information about workers’ compensation law.
5. An Adjuster Contacts You From the Insurance Company
An adjuster is an individual from your work’s insurance company who will contact you, and ask you a series of questions about the incident, and your injury. Your case will either be accepted or denied.
6. An Accepted Claim
If your claim is accepted, you will begin receiving benefit checks within 21-days after your injury has been reported. The amount is dependent on whether the injury is critical, and if you are entitled to temporary total disability (TT), temporary partial disability (TP), or a combination of the two [Florida Statute, 440.15(2)].
You will receive checks on a bi-weekly basis until you are able to return to work, or until 104 weeks have passed – whichever comes first. If you are unable to return to work and reach “maximum medical improvement” (MMI), you will need to receive a permanent impairment rating. Maximum medical improvement simply means that your authorized workers’ compensation doctor no longer expects that you will have further recovery or improvement in your symptoms from your workplace injury.
What Happens if a Workers’ Compensation Claim is Denied?
If your workers’ compensation claim is denied by your employer’s insurance company, then you must be notified of this denial of benefits within 120 days of the reported injury. You may, at this point in time, make a “good faith effort” to resolve the dispute by either talking with the insurance adjuster, or contacting the Florida Employee Assistance and Ombudsman Office (EAO). If you’d like to move forward, it is recommended that you contact a lawyer, like Frank Eidson, to begin the next step in the process. Here is a general idea of how it works.
- You must file a petition with the Office of the Judges of Compensation Claims within 2-years after the workplace injury. You must serve copies of this petition to the employer and their workers’ compensation carrier (insurance company).
- Their insurance company must respond within 14-days of the filed petition. They can either agree to pay out the benefits to you, or serve a response back.
- The dispute then heads to mediation. A mediation order will be issued within 40-days by the Office of the Judges of Compensation Claims, which must be held within 130 days of the petition file date.
- If an agreement is reached during the mediation period, you will either receive a lump sum payment with interest, or a payment schedule.
- If no agreement is reached during mediation, then a pre-trial hearing will be scheduled in front of the Judges of Compensation Claims. All parties receive a 14-day notice prior to the hearing date.
- The final hearing date will be held within 90-days after mediation, no later than 210 days after the petition is filed. The Judges of Compensation Claims will issue a decision within 30-days after the final hearing that either allows or denies the benefits claim.
- If all parties agree with the Judges of Compensation Claims’ decision, then the decision becomes final. If the benefit claim is approved, you receive a lump sum payment, interest, penalties, legal fees, and periodic payments. If one party does not agree with the decision, a notice of appeal must be filed within 30-days of the decision.
- A record of the appeal is given to the First District Court of Appeal, within 60-days. The party that is appealing, must provide a written argument or brief, while the other party must file a response.
Both sides of the argument will be heard and considered by the First District Court of Appeal. The court will then either agree with the Judges of Compensation Claims’ decision or reverse it.
Not All Injuries Are Covered!
It is important to note that workers’ compensation coverage does not protect employers or employees from legal liability that results in a workplace injury. For example, if an employee gets injured while violating the law, using drugs or alcohol on premise, or is in clear violation of company policy, workers’ compensation benefits are likely to be denied. This is also the case if the injury does not occur in connection with the job itself.
If you have further questions about filing a workers’ compensation claim, please get in contact with us at 407-245-2887 or fill out our contact form for a no obligation case review.