How to File a Workers’ Compensation Claim

How to File a Workers’ Compensation Claim In one recent year, private industry employees reported nearly 2.8 million nonfatal workplace injuries and illnesses to the Department of Labor. While that statistic offers some peace of mind—thanks to nearly 50,000 fewer reported injuries the year before—it sheds light on just how common it is to find oneself the victim of a workplace injury.   Most people have heard of workers' compensation, but many fail to understand how the process of filing a claim works. Employers often offer no more than the bare minimum of information concerning employees' options for benefits and compensation after a workplace injury; this, however, does not change the fact that those who have suffered illness or injury in the workplace are often entitled to these benefits.   Victims of work-related illnesses and injuries may be able to receive compensation for lost wages and medical expenses via the Florida State Workers' Compensation Program. Many individuals opt to work in tandem with a trusted workers compensation attorney during this process; many more realize that they should seek legal counsel after their initial claims are denied.  

The Benefits of Working With a Lawyer to File Your Claim

If you partner with a legal professional to file your workers' compensation claim, you may find the process goes more smoothly and is easier to understand than if you tried to handle the claim yourself. Most individuals feel confused and have questions about their rights when confronting the workers' compensation system for the first time. While the procedure to file a claim is not difficult, it can prove challenging without an experienced hand to help guide the process.   Partnering with an attorney to file a workers' compensation claim provides these benefits:

• Worker's compensation law is governed on a state-by-state basis; experienced attorneys understand their state's regulations and are familiar with the state system for filing claims and pursuing compensation
• An attorney can assist you when it comes time to gather medical records, take depositions, conduct legal research, and draft important court documents
• Your lawyer will work with your best interests in mind; many claimants find it beneficial to feel that they have a support team as they fight to receive benefits
• Attorneys lend a considerable degree of knowledge and skill to your case
• Legal professionals understand how to negotiate settlements and often manage to attain larger settlements than claimants who attempt the legal process unassisted

 

How to File a Workers' Compensation Claim in Florida

Report Your Injury

If you plan to pursue workers' compensation you must report any injuries that you sustain in the workplace. This process begins with informing your employer of your injury. Florida law dictates that, should victims wish to file a workers' compensation claim, they must report injuries within thirty days of the date of the incident. A few exceptions to this rule do exist:

• Your employer knew about the injury AND
• You informed your employer more than thirty days after the incident; the cause of the injury could not be identified without a legal professional AND
• Your employer failed to inform you of the time restrictions surrounding workers' compensation claims by posting notice OR
• Other exceptional circumstances outside the scope of the first two requirements

  Some illnesses and injuries emerge over an extended period of time. If this is the case for your injury, you must notify your employer of the issue within thirty days of discovering that your medical condition resulted from your work. Failure to promptly notify your employer of illness or injury can (and often will) lead to the loss of benefits.   Promptly reporting your injury (as defined by Florida state law) often proves one of the most critical aspects of filing a workers' compensation claim. Even if your injury or illness is severe, the eyes of the law will not hesitate to look in another direction if you fail to abide by legal deadlines.  

What to Tell Your Employer

You should give your employer as much detail as possible about your injury, including how and when it happened, who witnessed it, and the nature and extent of your injuries. Victims must also be able to explain what symptoms they are experiencing as a result of their injuries.   After you inform your employer of your injury, it is your employer's responsibility to refer you to an occupational doctor. Florida law mandates that employers select victims' treating doctors provided that emergency treatment is not necessary.  

Monitor Your Employer's Progress

Employers in Florida must report your claim to their organization's insurance company within seven days of your initial report. If at all possible, victims should work to hold their employers accountable for doing their part to file a claim. It's critical to ensure that an employer fills out an incident report after they receive details of a workplace injury.  

What to Do When an Employer Refuses to File

Some employers refuse to help workplace injury victims pursue the compensation and benefits that they deserve. If your employer fails to file your claim with its insurance company within seven days of your report, you have the right to contact the insurance company directly.   Victims should not give up on their claim as a result of their employers' negligence. After contacting your employer's insurance company, you'll be able to speak to an adjuster and describe the details of your accident. By law, the insurance company must contact your employer after this report and discuss the information that you communicated.  

The Insurance Company's Response

Your employer's insurance company will work to confirm the legitimacy of your claim. They often ask for medical documentation and may even require you to meet with another doctor for a special evaluation. Each insurance company and each claim is unique; because of this, there's no way to predict exactly what you may experience as the insurance company conducts its investigation.   Some of the most common parts of the process tend to include:

• Analyzing medical records
• Ordering medical or functional capacity evaluations
  • A medical examination may help further assess your condition
  • Functional capacity evaluations serve as a way to determine your ability to perform expected work duties
• Assessing your work experience and wages

  You shouldn't have to wait long before your employer's insurance company comes to a decision. Insurance companies within Florida must deliver notification of their decision promptly after a claim is filed.  

What to Do When the Insurance Company Denies Your Claim

All too often, Florida workers' compensation insurance companies fail to give victims the support and compensation that they deserve following a workplace illness or injury. Many insurers deny workers' compensation claims for injuries that went unwitnessed by third parties. Victims who wait to file their claims also often end up battling with insurance companies for benefits; insurers tend to be wary when employees take a long time informing somebody about an injury.   A handful of other factors have also been known to play into workers' compensation claim denials. If your employer's insurer has denied your claim, consider whether any of the following may be true:

• Your accident report and initial medical records contained discrepancies concerning the details of your injury or the extent of the harm you suffered
• Medical reports indicate the presence of alcohol or illegal substances in your system
• You filed a claim after being laid off or fired
• You failed to sign medical authorizations

  If the insurance company denies your workers' compensation claim, you may still be able to receive benefits. Employees have the right to file a Petition for Benefits with the DWC. This petition grants an additional chance to request compensation for medical care and lost wages. A skilled attorney can assist you during this process and may even help you file a lawsuit against the insurer.  

Filing a Petition for Benefits

The first section of Florida's Petition for Benefits often proves simple for victims to complete on their own. You'll need to include information concerning your accident, injuries, and recovery. The next two pages of the document, however, are best completed with the assistance of a knowledgeable attorney.   The Petition for Benefits requires that legal details like impairment ratings and compensation rates be included. Because the process of determining these details often proves confusing for victims at best and impossible at worst, it's wise to seek legal counsel. Your lawyer is likely to partner with your doctor to complete these sections of the petition.  

The Potential of Going to Court

Filing a Petition for Benefits does not necessarily mean that you'll need to face the insurance company in court. Florida's robust workers' compensation system mandates that both victims and insurers attempt to find a compromise before resorting to court. Ideally, this process can be completed via standard negotiations—other times, mediation becomes necessary.   The mediation process allows a third party to step into your case and attempt to facilitate a resolution to your problems without the need to go before a judge. Many cases settle during the mediation phase; it's an informal discussion meant to allow for you and your employer's insurer to come to a mutual agreement.   If the parties cannot settle through mediation, a pre-trial hearing will be scheduled. The process from this point onward depends heavily on a victim's individual case and their employer's insurance company. All parties involved in the legal proceedings should receive a date for a final hearing to occur within ninety days of their mediation conference.   If you must attend a final hearing to pursue workers' compensation benefits, you should plan on spending anywhere between two and four hours in court proceedings. The judge may or may not rule on your case that very same day.  

Receiving Your Benefits

Workplace illness and injury victims may receive four different types of benefits:

• Medical care coverage
• Temporary total disability (TTD)
  • Up to 66 2/3 percent of victim's regular wages
• Temporary partial disability (TPD)
  • Reserved for scenarios where victims can return to work but cannot earn the wages they earned before the incident
  • 80 percent of the difference between 80 percent of pre-injury wages and current earning potential
• Impairment benefits
  • Cover permanent disabilities resulting from your injury

  Those receiving TTD or TPD benefits cannot receive more than 104 weeks' worth of compensation. In some cases, victims may be awarded benefits totaling 80 percent of their regular wages—this only occurs in the event of a critical injury and shortens the benefit timeframe to a total of six months.   Victims suffering from disabilities lasting fewer than 22 days do not receive benefits until the eighth day of their disability. Those with disabilities that last longer than 21 days, however, have the potential to receive compensation that dates back to the first day of disability.   Understand that the amount of compensation you receive may prove disappointing. Florida recently approved a 13.8 percent workers' comp rate decrease, citing that worker's compensation insurance costs often prove too heavy a burden for business owners to carry. Despite creating a reported $454 million in savings for employers, this shift has proven devastating for many injured employees.  

The Importance of Quality Workers' Compensation Representation

It's all too common for victims' workers' compensation claims to be denied once they reach the insurance company—it's the driving force behind most victims' motivation to seek legal assistance in their pursuit of benefits. Those who experienced injuries with ample witnesses or who manage to attain compensation after their initial filing often fail to understand how stressful the legal process can be.   That's why, in many cases, it's victims need legal advice from a compassionate and trustworthy lawyer. The right attorney can help you prepare documentation, communicate with your employer's insurance company, and fight for your rights in the courtroom.   If you or a loved one need help filing your worker's compensation claim,  contacting an experienced workers' compensation lawyer can answer your questions and help you through the application process. Clearwater Office 800 N Belcher Rd. Clearwater, FL 33765 Phone: (727) 451-6900