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
Workers’ compensation cases are often adversarial, because they pit the interests of an injured worker against a company that wants to contain its financial losses. Dealing with the employer during this time is often extremely stressful. However, you can always control your own attitude. Make it a point early on to act professionally, even if your boss or other people in management do not act the same way towards you.
Attend Medical Appointments as Requested
You must produce strong medical proof that the injuries you sustained at work continue to affect your everyday life. That is why it is so important to go to all medical appointments and to follow your doctor’s advice during a Workers’ compensation case. Since this information goes back to your employer, you want it to reflect you in the best possible light. If you do not like your doctor do not ask for or accept a new one without consulting an attorney. You only have the right to a new doctor one time in any case. The carrier can always choose that new doctor, unless they do not respond to your request in a timely manner. If the response is late you can chose your doctor. It is best to have a lawyer help you with the process of requesting your one time change of doctors.
Show up on Time for All Hearings and Depositions
When you receive a notice of an upcoming hearing or deposition, try to clear your schedule immediately so that you can attend it. If that’s not possible, let your attorney know so he or she can reschedule. It won’t look good to your employer if a company representative makes it to each legal meeting and you do not.
What to Do If You Feel You’re Being Treated Unfairly
Unfortunately, your employer may choose to act in unfair or illegal ways towards you after you file a workers’ compensation claim. Your employer may demote you, wrongfully terminate you, or encourage others to treat you in an openly hostile manner. Documentation is extremely important if any of these things happen. You should write down the date, time, and the employer’s actions for anything you feel is unjust. Your next step is to contact a workers’ compensation attorney for guidance and possible representation.
DDB Law attorneys understand your vocational rehabilitation rights, and are your best advocates in Lakeland. According to Florida Workers’ Compensation statutes, Title 31, Labor, Chapter 440, if an employee who’s suffered an on-the-job injury that falls under Workers’ Compensation is still off the job 60 days after the date of injury and is receiving compensation for “temporary total, or temporary partial disability or wage loss,” the insurance provider has the duty to figure out if this employee “is likely to return to work.”
Florida Law for Serious Injuries at Work
The insurance carrier must make sure the injured Florida employee gets a reemployment assessment if the employee is at risk of remaining unemployed, and the employee has been very seriously injured. After the insurance company sends the employee to a state-certified provider for assessment, this testing is completed (within 30 days) with recommendations for reemployment services and the employee accepts the recommendation (within 15 days), the employee must begin receiving said services within the following 15 days.
If this reemployment provider ultimately decides that training and education are needed in order for this employee is to be “suitably gainfully employed,” and the employee hasn’t gone back to work in 180 days–or re-employment services reach $2500 in cost–(whichever comes first), the insurance provider must direct the employee to the state’s Department of Rehabilitation Services.
The Department may conduct its own training and education screening, and/or vocational evaluation, approve training and education, or agree to provide some other type of vocational services for this injured employee.
Workers’ Compensation Administration Trust Fund
This state Department of Rehabilitation may aid the employee is securing a high school equivalency diploma, or tap into the Workers’ Compensation Administration Trust Fund to pay for this employee’s further training/education at a Florida public college or career center.
If the most appropriate and efficient training/education for this particular injured employee can only be received from a public college or career center more than 50 miles from the employee’s residence, can only be obtained from a provider other than a public college or career center–or the nearby public college and career center can’t offer the appropriate courses in the near future–the Department must make every effort to accommodate the employee’s needs.
And, if the employee comes to attain “maximum medical improvement” and is still unable to earn at least 80% of their (previous) compensation rate, their employer–or the employer’s insurance company–must provide additional training and education temporary total compensation benefits during the time the employee takes advantage of this extra training/education, not to exceed 52 weeks. These 52 weeks may not be added to any education/training described in the previous paragraph.
These vocational rehabilitation rights–as summarized from Florida’s Workers’ Compensation statutes–are not as straightforward as they appear. Contact our workers’ compensation attorneys for expert guidance.