Getting injured at work is never a pleasant experience, especially if you have the unfortunate circumstance of a less than agreeable employer. At Aaron Delgado & Associates, our workers’ compensation lawyers frequently receive questions from people who have been hurt on the job and are looking to get the care they need but are unsure about their options. If you or a loved one have been injured at work or hurt while performing a job-related task, we recommend taking a few minutes to go over the following list of workers’ compensation FAQs and their answers.
Workers’ compensation is a no fault system which pays a portion of covered employees’ medical expenses and lost wages which result from on-the-job accidents. In most circumstances, to make a workers’ compensation claim, it does not matter whether the accident was caused primarily by actions of the employee or actions of someone else. Depending on who caused the accident, injured workers can commonly pursue separate claims against the actor who caused the accident, as long as the actor is not a coworker. We can help explain when it is, and when it is not, possible or prudent to bring a claim against a third party.
Workers’ compensation insurance is the coverage businesses must carry to provide medical, rehabilitation, and lost wage benefits to employees who are injured or fall ill due to a work-related cause. With a few exceptions, all businesses throughout the U.S. that have employees who are not owners are required to carry workers’ compensation insurance. Fortunately for Florida-based workers, the Sunshine State requires most businesses to carry workers’ comp insurance for employees.
If an employee is injured on the job or develops a work-related illness, workers’ compensation will pay for the most reasonable and necessary medical care they need for their injuries, with the expectation that the injured employee will return to work as soon as they are deemed able by their doctor.
The most common answer in Florida is that the employer has secured insurance to pay workers’ compensation claims, meaning once the accident happens, the burden doesn’t fall on the employer, but instead on the insurance carrier with whom they have contracted and paid premiums in the past.
The other possibility is that the employer is self-insured, meaning they put aside money on a recurring basis to pay out claims as they arise. Either way, the net outcome should be the same, but, in reality, employers who are paying from self-retained funds are at times more scrutinous and resistant to providing benefits to injured workers.
Typically, if all goes as it should, simply notifying your employer about an on-the-job accident is sufficient to have your employer notify their workers’ compensation carrier, which should begin the process. Unfortunately, it is common in Florida for employers to ignore or delay the reporting of an accident by an employee. If you are injured on the job and have not heard from an insurance carrier within a week or two, there is a strong possibility the claim was not reported by the employer. Employees may report an injury directly to a carrier, but, if you suspect your employer is trying to ignore or bury the claim, it may be prudent to ask a workers’ comp lawyer for assistance.
It is your duty as an injured worker to report a point source injury to your employer within 30 days of the incident in order to qualify for benefits. Occupational diseases, on the other hand, can be reported up to 90 days after an occurrence. However, the sooner you report your injury, the better.
Unfortunately, in most circumstances, you may not select your own doctor for treatment if you want your care to be covered by your employer’s workers’ compensation insurance. Unless you’re experiencing a true medical emergency, you should seek treatment through your employer’s workers’ compensation carrier before seeing your regular doctor. Keep in mind, if you choose to see your own doctor afterwards, that the visit will not be covered by workers’ compensation benefits.
Typically workers’ compensation will pay two thirds (66 and ⅔%) of the employee’s average weekly wage during the time the employee is wholly unable to work, and up to 64% of the employee’s average weekly wage during periods that work limitations related to the injury prevent the employee from earning at least 80% of their pre-injury wages. The weekly benefit is also capped, based on an annual index you can find here.
Workers’ compensation can provide the following benefits to injured employees:
In most cases, TTD, PPD, and PTD benefits will be equal to 66⅔% (66.67%) of your regular wages. If you are able to return to work, but are unable to earn the same wages that you were earning before your injury, TPD benefits will pay you 80% of the difference between 80% of what you earned before your injury and what you are able to earn now. If your injury left you permanently disabled, impairment benefits will pay you based on your average weekly wage, impairment rating, and other factors.
Under Florida law, when you start receiving workers’ compensation benefits depends on how long you are deemed unable to work by your medical provider. If you are disabled for 21 days or less, you will not receive benefits until the eighth day you miss work due to your injury. However, if you are disabled for 22 days or more, you may receive benefits for the first seven days you missed work. Keep in mind that these benefits will be sent out at a later date, after you have already passed day 22 of disability.
No. However, if you are still receiving care from your authorized doctor and return to work on light or limited duty, you will have to pay taxes on the wages you earn while working.
Your employer must report your injury to their insurance company no later than seven days after receiving notification about your injury. Then, within three days of notifying their insurance company, you should receive an informational brochure from the insurance company that outlines your rights, responsibilities, and other information about Florida workers’ compensation laws.
No. All of your medical visits related to your work injury should be billed directly to your employer’s insurance company, but once you heal as well as you can (reach maximum medical improvement) you must then make a $10 copayment for future doctors’ appointments.
It definitely can. Commonly employees need to show that a work accident is the major contributing cause of the need for treatment, however, some types of issues including repetitive trauma and psychiatric needs must be shown by clear and convincing evidence. Depending on your situation, your employer’s insurance company may choose to begin providing medical coverage while simultaneously launching a 120 day investigatory period to determine whether or not your work injury is the largest cause of your need for treatment. If you have a preexisting condition, give us a call at 386-222-6677 to discuss how you should navigate this complex and uncertain legal issue with a workers’ compensation lawyer.
Surprisingly, workers’ compensation cases settle only upon agreement of all the parties involved. Unlike typical civil cases, which culminate in a trial before a judge and/or jury, the future value of workers’ compensation cases is not determined by the Administrative Law Judge who presides over workers’ compensation cases. That said, employers and their carriers are commonly motivated to settle cases early, at times even before the injured worker reaches maximum medical improvement. A workers’ compensation lawyer can help an injured worker decide on the timing that makes the most sense for the worker’s unique situation, and can help to motivate an employer and their carrier to settle at or near the best time for the employee.
If your workers’ comp benefits have been denied, or if you have experienced any other issues with receiving them, you should consider contacting a workers’ compensation lawyer to help you file a workers’ compensation claim. Workers’ compensation lawyers can help you gather evidence, negotiate with the workers’ comp insurance company, write your settlement agreement in a way that helps you avoid any unintended consequences, and meet all of the critical deadlines for your legal paperwork. In some cases, they can also help you change which doctor you see for your medical treatments. In addition, if an agreement cannot be made with the insurance company, a workers’ comp lawyer can help you prepare for and represent you at trial to pursue the benefits you deserve.
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Our personal injury and workers’ compensation cases are always contingency-based, meaning you will pay no fees or costs unless we recover for you. We use the standard contingency fee agreements approved by the Florida Supreme Court wherever applicable. That being said, our legal fees are often payable over and above what our clients’ awards are, and clients are typically able to pocket their entire award while we recover our fees and costs (in addition to the award) from the defendant.