Workers often assume that they have workers’ comp coverage, and this is usually – but not always – the case.
Most Florida employees are covered by workers’ compensation insurance, with a few exceptions. Under Florida state law, if an employer in any industry (other than construction) has four or more employees, either full or part-time, they are required to carry workmen compensation insurance. Employers in the construction industry who have one or more employees must have insurance to cover each employee in need of workers compensation.
Construction industry employers in Florida must ensure that any subcontractor has workers’ compensation coverage for all their employees, and farmers with six or more regular employees and 12 or more seasonable employers who are employed over 30 days must provide workers’ compensation coverage for all employees. An out-of-state employer with employees working in Florida must have a Florida workers’ compensation insurance policy in force, or add an endorsement listing Florida to an out-of-state policy.
I’m Covered – Now What Should I Do?
The first thing you need to do is to report the injury to your employer, and ask them what doctor you can see. Florida workers’ compensation requires that injured workers see a doctor that is authorized by their employer or the insurance company. If it is an emergency and your employer is not immediately available, you should go to the nearest emergency room for treatment and advise your employer of the injury as soon as possible.
Your employer is required by Florida law to report the injury to the insurance company within seven days of when it was reported to them. After the injury is reported, many companies will have an insurance claims adjuster contact the injured employee within 24 hours to advise them of their rights and responsibilities.
Within three to five business days, you should receive an informational packet from the insurance company, which should contain:
- An informational brochure explaining the employee’s rights and obligations.
- A Notification Letter explaining the services provided.
- A copy of the accident report or “First Report of Injury or Illness” that you should review for accuracy.
- A fraud statement that you should read, sign, and return as soon as possible.
- A release of medical records to sign and return.
- Medical mileage reimbursement forms to fill out after seeking medical treatment.
Injured employees in Florida may be entitled to some or all of the following benefits under the state’s workers’ compensation system: indemnity benefits if they are unable to work for more than seven days; temporary total disability benefits if the doctor says they cannot work at all; temporary partial disability benefits if you can return to work but cannot earn the same wages that you did at the time you were injured; and impairment benefits once you reach Maximum Medical Improvement.
Your employer will be responsible for providing medical treatment to you, but do not go to your own private doctor for treatment. If you are unable to return to work because of permanent work restrictions, you may also be eligible for Reemployment Services assistance.
More Florida Workers’ Comp Facts
Here are some more basic facts about workers’ compensation in Florida:
- Florida employers are responsible for paying the entire premium for workers’ compensation coverage, and are not allowed to shift any of the cost to their employees.
- The law covers accidental injuries and occupational diseases arising in the course and scope of employment, including deaths within specific periods of time.
- Florida workers’ compensation does not cover mental or nervous injury due to stress, fright, or excitement, nor does it pay benefits for pain and suffering.
- If a minor child is injured while employed in violation of child labor laws in Florida, the employer might have to pay double compensation.
- If an employee fails to use safety equipment or observe safety rules, compensation may still be paid, but partial wage replacement could be decreased by 25 percent if the employee knew of the safety rules prior to the accident and failed to observe them, or refused to use safety equipment after the employer told him to do so.
Workers’ compensation insurance will compensate employees for occupation-related injuries regardless of fault, and makes employers immune from being sued by injured employees in civil court, unless the accident was caused by the employer’s or a co-worker’s intentional harmful conduct.
Florida workers’ compensation law provides workers who are injured on the job with the ability to obtain full compensation for medical bills, partial compensation for wage loss, and can also compensate workers for temporary or permanent disability and loss of earning capacity.
But workers’ compensation benefits aren’t automatic, and to get your work accident-related medical care paid for by your company’s workers’ compensation insurance carrier, you’ll need to play by their rules, or you might risk losing your benefits entirely.
Florida Workers’ Compensation Law
The first thing you’ll need to do following a work injury is report the incident to your employer or supervisor as quickly as possible.
Your employer could authorize a doctor for you at the time of your injury, but their insurance company must authorize any follow-up treatment that you receive.
If your injury is serious enough to necessitate a trip to the emergency room, make sure to alert the staff that you injured yourself while on the job, and provide them with contact information for your employer or workers’ compensation insurance carrier.
Under Florida workers’ compensation law, your employer is required to send an injured worker to an authorized primary doctor and specialist (if necessary) for all care that has been determined to be medically necessary.
Types of authorized care often include:
- Doctor’s appointments
- Hospital stays
- Home nursing services, when necessary
- Physical therapy
- Dental care
- Diagnostic tests
- Prescription medications
- Medical equipment, including prostheses, braces, and crutches
- Mileage reimbursement for traveling to and from medical appointments
An employer’s insurance carrier is required to approve the physician who will provide treatment for a work injury.
If your employer or insurance company does not respond to your request for medical treatment or you are billed for work accident related medical care, you should contact the Florida Employee Assistance and Ombudsman Office for assistance.
You Might Lose Your Benefits if You Don’t Follow the Rules
In Florida, the employer or workers’ compensation insurance carrier typically has the right to direct the medical treatment of the injured worker, which includes choosing the treating physician.
It is extremely important that you are compliant with the recommendations given by your treating physician, because if you don’t, you risk losing your medical benefits.
Skipping appointments may also cause your benefits to stop, as will going to your own private doctor instead of the one the workers’ compensation insurance company has chosen for you.
It is important to note that doctors authorized by the workers’ compensation carrier tend to be extremely employer-friendly and likely will do everything possible to get you back on the job as quickly as possible, at the lowest possible cost.
To save money, your employer’s insurer might urge your employer to put you back to work too soon.
If you feel this is happening to you, you should get a detailed description of your proposed job duties and have your doctor review it to ensure that you are capable of performing the work.
Don’t Go Back to Work Until Your Doctor Says You Should
You should never go back to work until your doctor releases you to do so.
But be aware that if your treating doctor releases you to return to work, you are mandated by law to make a good-faith effort to do so.
If you refuse to go back, you will give up your ability to collect lost wage benefits.
Because your doctor’s diagnosis is crucial to the amount of medical benefits you will receive to treat your injury, if you disagree with the orders given by your assigned doctor, rather than being noncompliant with his recommendations, you should instead ask for permission to change treating physicians by notifying the insurance company of your request in writing.
Protect Your Interests by Hiring an Experienced Florida Workers’ Compensation Attorney
After an injury on the job, the decisions made by your employer, their insurer, and your treating physicians will have a great impact on not only your workers’ compensation claim, but also your overall health.
For these reasons, it is important for injured workers to follow their treating physician’s advice and also obtain the representation of an experienced workers’ compensation attorney to ensure that they’ll receive the best medical treatment possible, and that workers’ compensation will pay for it.
If you’ve been injured at work, workers’ compensation is there to take care of you, right?
Yet, we have talked to hundreds of people from Lakeland and across Polk County who’ve learned the hard way that while technically true, reality was something else entirely when it came to navigating a workers’ comp claim.
How Workers’ Compensation Works
Workers’ compensation is a type of insurance administered by the workers’ compensation boards of individual states that is designed to protect both the employer and the employee, and to provide benefits to injured workers while eliminating the need for litigation.
Under workers’ compensation law, benefits are generally available to a worker who is hurt on the job, but benefits are by no means automatic.
While hiring an attorney may seem a bit aggressive, workers’ compensation law is relatively complex and legal expertise may be required to ensure that you will be found eligible for benefits.
Here are four things a workers compensation attorney can help you with:
1. Explain What Injuries Qualify for Workers’ Compensation
Generally, if your employer employs at least three to five workers and you are no
t part of a class of employees that may be excluded from workers’ compensation coverage in Florida, you will have access to workers’ compensation benefits. Although no proof of fault on the part of your employer is required, you will need to establish that the injury occurred on the job and is connected somehow with the work performed to be eligible for benefits.
If a worker is injured outside the course and scope of his employment, he is not usually covered under workers’ compensation. But as a workers’ compensation attorney will tell you, this does not mean that an employee is only covered for injuries occurring at his principal place of work. Employees who are required by their employers to perform work-related activities in other locations, such as construction workers and road maintenance crews, are usually covered by workers’ compensation, as long as the injury occurred while they were engaged in duties related to their employment.
2. Assemble and File a Proper Claim
Workers’ compensation will pay for medical care, rehabilitation, and some wage replacement if you have to miss work because of your injury, but to obtain these benefits, you’ll have to file your claim and follow your state’s procedures carefully.
You will need to get immediate medical care if your injury requires it, and then inform your employer about your injury as soon as possible, in writing. In Florida, it is best to submit no later than 30 days after the day the accident occurred. Overall, the sooner you’re able to submit, the better off your case will be.
Your employer will have claim forms for you to fill out and submit. Generally, you will need to provide the following documentation:
• Date, time, and location of injury.
• Parties involved in the accident.• How the accident occurred.
• Type of injury and area of body affected.
• Medical treatment received.
After you have filled those out (with or without the help of an attorney, who can ensure that they are completed properly),. There is a time limit for this too.
3. Guide You Through the Appeals Process if Necessary
If the insurance company for your employer denies your claim, your first step should be to contact them and find out why it was denied. If the denial was due to incorrectly filed paperwork or a missing document, you may be allowed to fix these types of mistakes and your claim might be reconsidered.
But if the workers’ compensation carrier believes that you have not met the eligibility requirements to receive benefits, you may have to provide additional facts and documentation or file a formal appeal, something you might consider hiring a workers’ compensation attorney to help with, since if you fail to follow the rules, you may be denied benefits that you would have otherwise been entitled to.
4. Advise You of Any Other Benefits You Might be Eligible For
If you do not qualify for workers’ compensation benefits, you might be able to apply for Social Security Disability or file a personal injury claim to obtain compensation for your injury, something an attorney can help you do.
Dealing with a complex workers’ compensation claim can be difficult and stressful for non-lawyers, particularly those feeling the effects of a serious work injury. For this reason, successfully navigating the workers’ compensation claims process often requires the assistance of an experienced legal profession