How the Florida Workers’ Compensation Process Works
How the Florida Workers’ Compensation Process WorksFrank Eidson
If you have never filed a worker’s compensation claim before in Florida, the following flow chart should help you to see how the process works – from the moment you are injured to the last stage of an appeal.
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Employee reports the injury to his or her employer within 30 days of knowing that he or she has suffered a job-related injury. (Failure to report can result in a denial of benefits.)
Employee gets medical treatment. The employee must go to a health care provider authorized by the employer and its workers’ compensation insurer (or carrier). However, if it is an emergency, the employee should simply go to the nearest hospital or clinic for treatment.
Employer reports the injury to its workers’ compensation carrier within seven days after the injury is reported. This is called the First Report of Injury or Illness, or accident report.
Workers’ compensation carrier sends information packet to injured employee. The packet should be sent within three days after the injury is reported to the carrier. The packet should contain a copy of the accident report and information about the employee’s rights.
Workers’ compensation carrier accepts claim. The carrier should issue the first benefits check within 21 days after an injury is reported. The amount will depend on whether the employee is entitled to temporary total disability (TT) or temporary partial disability (TP) benefits and whether the injury is “critical.”
The employee should continue to receive checks every two weeks until he or she returns to work or 104 weeks pass. If the employee reaches maximum medical improvement (MMI), he or she must receive a permanent impairment rating.
Workers’ compensation carrier denies claim. The carrier must notify the employee of its decision to deny benefits within 120 days of the injury being reported.
Employee makes a “good-faith effort” to resolve benefits dispute. The employee can talk with the insurance adjuster or administrator. The employee can also contact the Florida Employee Assistance and Ombudsman Office (EAO) for assistance. If the dispute involves medical benefits, the employee
Employee files Petition for Workers’ Compensation Benefits. The employee must file the claim within two years after the injury arose. The Petition is filed with the Office of the Judges of Compensation Claims (OJCC). Copies must be served on the employer and workers’ compensation carrier (and their attorneys).
Workers’ compensation carrier responds to Petition. Within 14 days after the Petition is filed, the carrier must either agree to pay benefits or file and serve a response.
Dispute goes to mediation. In the majority of cases, the OJCC will order a case to go to mediation. This is an informal meeting to resolve a workers’ compensation dispute. The Judge of Compensation Claims (JCC) should issue a mediation order within 40 days after the Petition is filed. The mediation must be held within 130 days after the Petition filing date.
Case is settled. An agreement can be reached at mediation. It may result in a lump sum payment of benefits (including interest) or a schedule of payments.
Case goes to pre-trial hearing. If no settlement is reached through mediation, a pre-trial hearing is scheduled before a JCC. The hearing should be held in the county where the injury arose. All parties should receive a 14-day advance notice of the hearing date.
Final hearing takes place. A hearing to resolve the benefits dispute should be held within 90 days after the mediation conference – and no later than 210 days after the Petition is filed.
JCC issues decision. Within 30 days after the final hearing, the JCC will issue a decision that allows or denies the employee’s benefits claim.
Parties agree with decision. If all parties agree with the JCC’s decision, it becomes “final.” If the JCC allows the employee’s claim, he or she should receive the amount ordered by the court, including a lump sum, interest and penalties, attorney fees and periodic payments.
One or more parties disagree with decision. If either the employee or employer/carrier disagrees with the JCC’s decision, they will have 30 days from the decision date to file notice of appeal. The appeal is filed with the First District Court of Appeal.
JCC transmits record on appeal to First District Court of Appeal. Within 60 days after notice of appeal is filed, the JCC must send the record on appeal to the First District Court of Appeal. (However, additional time may be allowed). After the record on appeal is certified, the party who has appealed (appellant) must file a written argument, or brief. The other party (appellee) may then file a response.
First District Court of Appeal issues a decision. The appellate court will consider the arguments and issue a decision. The decision will affirm the JCC, reverse the JCC or, perhaps, remand the case to the JCC for more findings.
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