WHAT IF I AM INJURED AT WORK?(WORKERS' COMPENSATION)
Workers' Compensation benefits are designed to cover most injuries or diseases cause or aggravated by your work or working conditions.
If you are injured in the course and scope of your employment, you must first report your injury to your employer and request medical care. It is then the employer's responsibility to provide necessary medical treatment, to report your injury to the insurance company, and the State of Florida.
If you fail to report an injury promptly, or you do not accept medical attention offered, you may lose your rights to benefits.
For information on your particular case, contact your employer who will refer you to the claims person of your employer's insurance company or the insurance adjuster who is handling your file. In some cases, your employer and its carrier may use a managed car company to handle all of your medical needs. If you have a problem you cannot resolve with the employer or insurance company regarding Workers' Compensation benefits, you may either contact the Employee Assistance Office of the State Division of Workers' Compensation in Tallahassee (Toll Free Number: 1-800-342-1741), or you may also consult an attorney of your own choice.
The principal types of benefits which you may be entitled to are: payments to your doctors and other health care providers, compensation if you are unable to work, compensation if you are unable to earn your pre-injury wages, and death benefits for the families of those who die as a result of their work injuries.
Medical benefits include all necessary medical, surgical and hospital services, supplies, nursing care, and such items as crutches and artificial limbs. If you are unhappy with the treatment or the doctor provided, you may request a one-time change of physicians through the insurance company. Your request should be in writing. You must obtain authority from your employer or the insurance company before seeing any physician the first time, or you may be responsible for the cost of unauthorized treatment. Please be sure your doctor understands that your bills are being paid under workers' compensation.
If you are able to return to work and earn the same wages being earned at the time of injury, you may still be due compensation, which is called Impairment Benefits, if your doctor says you have a permanent impairment.
No compensation is payable for the first seven (7) days of disability, unless you are disabled for at least 21 days. If so, you will receive checks from the beginning of your disability. Such benefits, called Temporary Total Disability benefits, are payable every two weeks and continue until you are able to return to work on at least a light duty basis.
Once your doctor releases you to return to work, you may continue to receive weekly checks, called Temporary Partial Disability benefits, if your doctor states you have at least one work-related restriction but you have not reached maximum medical improvement (MMI), AND you are unable to earn your pre-injury wages. If you are unable to return to the same employer, then you should perform a job search looking for work within your restrictions.
When your doctor states that you have reached maximum medical improvement, you may receive weekly Impairment Benefits if your doctor states that you have a permanent impairment from the work injury. Permanent Impairment benefits are paid at one half (½) of the compensation rate (1/3 of AWW or less) for 3 weeks per percent of impairment. If the impairment is greater than 20% and you cannot return to your former employment, supplemental benefits may also be payable.
Permanent Total Disability benefits may be payable in certain circumstances usually involving the most severely injured workers who cannot return to work as a result of their injuries. Permanent Total Disability benefits, like Temporary Total Disability benefits, are computed at 1/3 of your average weekly wage, and are paid biweekly for so long as you remain in this category.
Death Benefits may be payable to the dependents, if the industrial injury results in the death of an employee.
Workers' Compensation benefits are not subject to income tax.
If you fail to receive benefits, or have been denied benefits, and you believe you have a legitimate claim, you should contact the carrier, the Employee Assistance Office or an attorney. The Employee Assistance Office is listed in the telephone book and has a toll-free phone number, 1-800-342-1741.
Sometimes the parties to a disputed claim may want to agree upon a total sum in return for which the claim will be settled. Any such settlement must be approved by a Workers' Compensation judge before the settlement is paid. Once the employer is released from liability by approval of the settlement, the employee's claim is ended for all time. Future medical benefits can be settled, left open, or limited in a settlement, but this can vary from case to case.
At any time, you are free to engage the services of a lawyer to advise you on the handling of your claim. It is your responsibility to pay your attorney, and usually fees are based upon a percentage of those benefits obtained for you by the attorney, but the Judge of Compensation Claims under certain circumstances can require the insurance company or the employer to pay your attorney. Any attorney's fee, even one payable by you, must be approved by the Judge of Compensation Claims before the lawyer receives any money. It is important for you to know your rights under Workers' Compensation law. You can get further information from your local Division of Workers' Compensation or an attorney. If you believe you need legal advice, call your attorney.
Auto Accident Claims: If you have been injured while on the job in an automobile accident, you will most likely have the option of having your medical bills and lost wages paid through your automobile PIP coverage. PIP pays eighty percent of your medical bills and you are free to consult with the physician of your choice, rather than having your worker's compensation carrier direct you to a physician of their choice. Pre-authorization of necessary medical testing and procedures is often mandatory under workers compensation and as a result, can take months to obtain, if at all. Such delays are unlikely if you request your pip carrier to pay your medical bills. In addition, PIP pays sixty percent of your lost wages, which is often a higher rate of pay that afforded under worker's compensation. The draw back, however, is that PIP is usually limited to ten thousand dollars, while workers compensation does not have this limitation on the amount paid out, at least for medical bills. Also, you cannot collect lost wages under both pip and worker's compensation if to do so results in a payment of more than your actual lost wages.
As a general rule, it is advisable to immediately submit notice of both a worker's compensation injury claim and an auto accident resulting in injuries to your auto carrier, so that you retain the option to recover benefits from either.
The worker's compensation law, as a general rule, does not allow you to sue your employer for benefits other than those owed by workers compensation. Primarily this means that you are not entitled to have your compensate you for your pain, physical suffering and inconvenience resulting from your injuries. The exceptions to this rule are extremely limited and apply to very few situations. However, if a third party is responsible for your injuries, you may bring a claim or suit against that individual and still collect worker's compensation benefits. However, if you recover money on your third party claim or suit, your worker's compensation carrier is entitled to take a portion of that recovery as partial compensation for the benefits which they paid to you pursuant to your worker's compensation claim.
If a potential third party claim does and you fail to file suit to recover money from the at-fault party, after the passage of a certain period of time, the law allows your worker's compensation carrier to bring that suit in your place.
IMPORTANT: The 2003 legislature is considering a variety of bills which will substantially change your rights and benefits under the law. Most of these proposed changes limit your rights to benefits and make it more difficult for you to challenge insurance carrier decisions, even though current law often does not provide fair compensation to those who are injured on the job and frequently leads to those in need of medical care waiting many months for approval from the carrier or a determination from the court of compensation claims. If you believe further limiting the rights of injured workers is unfair, and instead, more stringent regulations and investigation of insurance company profits and actions be initiated, call your state legislators today!
As a result of these pending claims, it is anticipated that a portion of the information provided herein will be superceded by new laws, later in 2003 and that further changes will be made in later years. Consult your attorney if you have specific questions concerning a workers compensation claim.
Source: The Florida Bar
and Allen R. Seaman & Associates, PA
The information contained herein is published for the purpose of providing general legal information to the public for educational purposes. This information is not intended as a substitute for the hiring of a lawyer in order to assist in answering specific legal questions or providing specific legal advise. In addition, while all efforts have been made to insure that the information contained herein, it is not warranted as such. All those visiting this site should remember there is no substitute for obtaining qualified legal representation by an attorney licensed by the Florida Bar.