What to Do After a Workplace Accident
Just as the landscape is in Florida, the type of work that people do here is likewise extremely diverse. What happens, though, when employees get hurt on the job? Is there a way for injured workers to receive compensation? Is there a safety net available if they’re unable to work for a long time or even permanently? As a matter of fact, there is. Read on for more information about Florida’s Workers’ Compensation program.
How Common Are Workplace Injuries?
Workplace injuries are common in Florida. According to the state’s Division of Workers’ Compensation, more than 55,000 claims were made in 2018. The average worker benefits for a workers’ compensation claim that year was $21,400 for medical payments and lost work costs. As of 2017, the average length of time following a workplace injury in which the employee returned to work in all Florida industries was 40.3. For those injured in the construction industry, the average length of time to return to work was 45.6 days. 97 percent of workers in the state who suffer a workplace injury return to work within one year after the accident.
How Florida Law Protects Injured Workers
Workers compensation is insurance coverage that employers purchase on behalf of their employees that provides benefits for job-related injuries. Workers’ compensation is designed as no-fault insurance, meaning that you don’t have to prove that your employer did anything wrong that resulted in your injury, but merely that you were injured while doing a task within the scope of your employment. As explained in a brochure from the Florida Department of Financial Services, most companies who employ others in the state are required to provide workers compensation insurance for their employees, including:
- Non-construction industry employers with four or more full-time or part-time employees.
- Construction industry employers with one or more full-time or part-time employees.
- Subcontractors for construction industry employers must either have workers’ compensation insurance for their employees or provide to the general contractor proof of a valid exemption for the corporate officer or member of a Limited Liability Company. If the subcontractor is exempt from providing workers’ compensation for its employees, then the general contractor must provide it.
- Farmers with six or more regular employees or 12 or more seasonal employees who work for more than 30 days.
- Out-of-state employers who have employees in Florida.
- A Florida contractor who employs workers out-of-state must either have a Florida workers’ compensation policy or an endorsement for an out-of-state policy that lists Florida in section 3.A of the policy.
According to information from the Department of Financial Services, in order to access benefits, injured workers should report their workplace injuries to their employers within 30 days. Once notified of the injury, employers have up to seven days to report the injury to their insurance carrier. The insurance carrier must then send the injured employee an informational brochure that explains the employees’ rights and responsibilities and more about the state’s workers’ compensation law.
Medical treatment for the employee’s injuries must be provided by a medical provider who is authorized by the employer or insurance company and bills for medical treatment will be submitted to the employer’s insurance company for payment. In addition to medical treatment, injured employees may also receive indemnity payments, which are compensation for lost wages due to missed work because of your injury. Claimants are not paid for the first seven days of disability unless the disability extends for a period of longer than 21 days. More about payment for lost time at work is as follows:
- Workers’ compensation recipients will receive their benefit checks on a bi-weekly basis.
- Benefit checks are generally 66 2/3 percent of the worker’s average weekly wage as calculated by the 13 weeks immediately preceding the injury. Your employer must provide your wage information to the insurance company within seven days after learning that your injury will cause you to miss more than seven days of work.
- Workers’ compensation benefits are not taxed, though recipients who return to work on a limited basis and earn a portion of their previous income will still have to pay taxes on the hours they work.
- Recipients may receive compensation for temporary partial or temporary total disability for up to 104 weeks. Note that the state Supreme Court found this time limit to be unconstitutional in cases where the 104-week limit has been reached but the claimant has not reached maximum medical improvement.
- In the case of temporary total disability, the worker may receive 80 percent of their average weekly wage, up to a maximum of $700 per week for up to six months.
- Those receiving permanent total disability may receive 66 2/3 percent of their average weekly wage until age 75 unless they’re unable to receive Social Security benefits due to the injury preventing them to work a sufficient number of quarters to be eligible for those benefits.
- Temporary disability payments will stop when one of three things happen: 1) Your doctor determines that you’re able to return to work; 2) Your doctor determines that your medical condition will not improve, even with further medical treatment; or 3) You reach the time limit for receiving temporary disability payments.
- In some cases, a worker may either request or be offered compensation for their injury in one lump sum rather than in bi-weekly indemnity payments. However, we strongly recommend that you consult an experienced workers’ compensation attorney before agreeing to a lump sum settlement, as you will no longer be able to seek compensation for your injuries, should the cost of your medical treatment and missed time for work exceed the amount that was offered to you.
- Workers are not required by law to hold your job for you until you are able to return to work.
In addition to medical and lost wages, the state’s workers’ compensation program will also provide free reemployment services for those whose injuries prevent them from returning to work at the same job they had before they became injured. Unlike personal injury claims, pain and suffering claims are not eligible through workers’ compensation as they are considered a non-economic damage.
For a free legal consultation, call 833-552-7274
Filing a Worker’s Compensation Claim
If you’ve been hurt on the job, these are your responsibilities in order to access benefits:
- Notify your employer about your injuries as soon as possible. This notification must occur within 30 days of your injury, of knowledge of your injury, or within 30 days of a doctor determines that you are suffering from a work-related injury.
- You must ask your employer for the name of an authorized doctor for you to see.
- Your employer should either submit your claim or provide you with the information for the insurance company who handles the company’s workers’ compensation policy in order for you to submit your claim. This information may also be located on the “broken arm” poster at your work site.
- If your injuries are emergent and you’re unable to gather information from your employer before seeking medical treatment, you should go to the nearest emergency room and let your employer know later what happened.
- Once you or your employer have submitted your claim, a claims adjuster for the insurance company should contact you within a day to explain your rights. Additionally, within 3-5 days you should receive an informational brochure as well as a copy of the accident report (which you should look over for accuracy), a fraud statement which you must sign and return, a release of medical records for you to sign and return, and medical mileage forms for you to complete in order to be reimbursed for the miles you must travel in order to obtain your medical treatment.
Employers are prohibited by law from firing or refusing to hire an employee who has collected workers’ compensation benefits. Additionally, employers may be charged criminally if they present an altered or fraudulent certificate as proof of their workers’ compensation coverage or violate a stop-work order issued by the division due to a lack of required workers’ compensation coverage.
What if My Claim Gets Denied?
Workers’ compensation may deny a claim for many reasons, including:
- The workplace incident was less than 50 percent responsible for the injuries you suffered.
- You lied about being injured or exaggerated your symptoms.
- You failed to sign and return the fraud statement provided to you by the insurance company after you filed your claim.
- Your injury was self-inflicted or caused purposely in order to obtain workers’ compensation benefits.
- The injury was caused while you were impaired by drugs or alcohol.
- You failed to heed safety instructions or use equipment in a safe manner.
If you feel that your workers’ compensation claim was wrongfully denied, you may file a Petition for Benefits with the Division of Administrative Hearings. This petition must be filed within two years following the date of your accident. The process of appealing a claim denial generally occurs as follows:
- Within 40 days after you file the Petition for Benefits, the Judge of Compensation Claims must set a date for public or private mediation and notify all parties. The mediation conference must be held within 130 days following the date of the injury.
- If stipulations for receiving benefits aren’t agreed upon by all parties or a settlement is not offered or accepted, the Judge of Compensation Claims may impose sanctions on any party impeding progress. Additionally, the Judge must schedule a live pretrial hearing. All parties must have at least 14 days notice of the pretrial hearing.
- If no progress has been made at the pretrial hearing, then the Judge will schedule a final hearing in which to determine whether benefits should be awarded. This hearing must take place within 90 days after the mediation conference and within 210 days of the filing of the Petition for Benefits.
- Within 30 days after the final hearing, the Judge issues a final order on the merits of the disputed issues. This order is entered into the Division’s website and may be viewed by the general public.
- Any party may appeal the decision by the Judge of Compensation Claims by filing an appeal with the First District Court of Appeal. A record of the hearing will be forwarded to the Court, who will either affirm, reverse, or remand the Judge’s decision.
It should be noted that the workers’ compensation process is generally the only way to recover compensation from your employer for a workplace injury. You cannot sue the employer directly for an injury that you sustained on the job unless the employer did not carry workers’ compensation insurance and was legally obligated to do so. However, if your workplace injury occurred due to the negligence of a third party, you may file a personal injury lawsuit against the third party.
If your employer refused to notify the insurance carrier of your injury, you may also have cause for further action. The following penalties may be imposed by the Division of Workers’ Compensation against employers who fail to notify their insurance carrier of a claim in a timely fashion:
- $100 for up to seven days of untimely filing.
- $200 for days eight to 14 of untimely filing.
- $300 for days 15 to 21 of untimely filing.
- $400 for days 22 to 28.
- $500 for more than 28 days of untimely filing.
- The employer may also incur penalties and interest on compensation due if they failed to submit the claim in a timely manner.
Seek an Experienced Worker’s Compensation Attorney
A job injury is often accompanied by fear and confusion over the workers’ compensation process. Whether you were just injured and have yet to file a claim, you have questions about information you received from your employer or others, or you need to file a Petition for Benefits after a claim denial, it helps to have a knowledgeable workers’ compensation attorney on your side.
Dolman Law Group Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33765