Have you been injured on the job? If so, you might file a workers’ compensation claim. In Florida, employers must provide workers’ compensation benefits if they have four or more full-time or part-time employees. Within the construction industry, benefits are mandatory with one or more employees. While some industries have different regulations that affect their individual requirement, almost all employers must comply with the state’s workers’ comp laws.
A workers’ compensation claim can help you pay for ongoing medical expenses and may provide wage replacement benefits. It can also help provide for your future in the event of a serious injury. An injured worker must comply with their employer’s policies and state laws to receive the maximum benefits. Once you file a claim, you’ll need to check the status of your claim on a regular basis. If you need help with your workers’ compensation claim or have questions, contact an experienced workers’ compensation attorney.
How to File a Workers’ Compensation Claim
After an injury, the only way to preserve your rights to employer-paid medical care and lost wages is to file a workers’ compensation claim. While some people may hesitate to file a claim because of concerns for their job, an employer cannot intimidate, fire, or otherwise punish someone for making a workers’ compensation claim. If you believe your employer is treating you unfairly after an injury, contact an experienced workers’ compensation attorney right away.
To establish your workers’ comp claim:
- Report the incident: Employees have 30 days to report any injury to their employer. You can accomplish this by making a report to your direct supervisor or through your human resources department. While you have 30 days to report any incident, waiting too late may adversely affect your claim. After 30 days, your employer has the right to deny your claim.
- Go to the doctor: Unless there’s an emergency, you can’t just go to any doctor you want. Florida law allows employers to choose authorized providers for workers’ compensation claims. Before you seek medical care, be sure to check with your employer for a list of eligible care providers. Your employer must provide you with a list of authorized providers upon request. If you do not go to an authorized provider, your employer does not have to pay for these costs.
- File a claim: You are your best advocate after a workplace injury. Though an employer cannot arbitrarily deny your claim or punish you for making a claim, they may not be too anxious to guide you through the process. However, they will likely provide you with a brochure explaining your rights. It will be up to you to make sure your claim moves forward. After you report your injury, your employer has seven days to report it to their insurance provider. If you do not hear from your employer or an insurance adjuster, contact your employer.
- Contact an attorney: While you probably won’t need an attorney for a minor cut or bruise, if it’s anything more than that, it’s always a good idea to talk to an attorney. Workers’ compensation is just like any other insurance claim or legal process. You will need to negotiate with the insurance company to get a fair settlement and the benefits you deserve. An experienced attorney can help you understand your rights and guide you through the process. Once you hire an attorney, the insurance company will direct any correspondences or phone calls to your attorney.
IMPORTANT: While your employer and their insurance company may lead you to believe that they are on your side, it is to their benefit to reduce the amount of your claim. As such, be very careful about what you say to your employer, insurance agent, and health care providers. Do not exaggerate or makeup any symptoms. At the same time, don’t tough it out or try to return to work before you are ready. These actions can have a serious impact on your case.
You also need to watch your social media activity. If you cannot return to work because of a shoulder injury, do not post a picture of a kayaking trip (even if it’s an old picture). In fact, now’s a good time to tighten up your privacy settings on all your social media accounts.
Don’t assume that your employer won’t look at these accounts, because there’s a good chance they will. Remember, a third party may see your information through a mutual friend. It only takes one person on your friend list accepting a request from a “stranger” for the insurance company to have access to your photos and posts. It cannot be said enough, DO NOT POST ABOUT YOUR INJURY ON SOCIAL MEDIA.
How Do I Check the Status of My Claim?
After an injury, you’ll probably want to get back to work as soon as possible. But workers’ compensation is a process. There are certain steps that you, your employer, and the insurance company must go through before you return to work. Plus, it’s never a good idea to push it and go back to work too soon.
While you wait, it’s normal to want to check on the status of your claim and see how things are progressing. So how do you do that? First off, don’t go to your employer. They aren’t the one processing your claim. The insurance company can provide information about the status of your claim.
But remember, the insurance company works for your employer. It is in their best interest and the employers’ best interest to do everything they can to minimize your payment. Because of this, it’s a good idea to have all communication go through an attorney. Your attorney can check the status of your claim and take action to speed up the process if the insurance company is dragging their feet.
What Happens if the Insurance Company Denies My Claim?
It is not uncommon for insurance companies to deny a workers’ compensation claim. However, legally, they can only do so under certain circumstances. This includes:
- The employer believes (and can prove) your injuries were intentional.
- You were under the influence of drugs or alcohol.
- Your injuries were not the result of a workplace accident.
- You did not report your injury within 30 days.
- Your claim is not eligible for workers’ compensation insurance. Florida law excludes mental health injuries that are the result of stress, fright, or excitement on the job.
- Fraud. Insurance fraud is a crime. Do not lie about a workplace accident or injury or exaggerate any injuries to increase your claim.
If the insurance company denies your workers’ compensation claim, the law allows you to appeal this decision. If you do not already have an attorney, this is a good time to get one. An employer cannot just claim that you were intoxicated, caused your own injury, or say that you were injured before the accident—they must prove it. You only have a limited amount of time to appeal, so be sure to talk to an attorney right away.
After a Claim: What Does Workers’ Compensation Cover?
Many employees only use workers’ compensation claims to cover necessary medical costs. However, there is so much more to a workers’ compensation claim. An on-the-job injury can leave you out of work for weeks, or even months. Workers’ compensation benefits can help you make sure you are okay during this time. Every workers’ compensation claim is different, and the degree of your injury will determine what benefits you are eligible for and what you will receive. This may include:
The law requires employers to cover all medical care directly related to your injury, as long as you go to an authorized provider. The employer must cover 100 percent of these costs and allow you time to attend necessary appointments. Additionally, you may receive mileage reimbursement for any appointments you attend that exceed the roundtrip mileage to your place of employment. Medical costs may include:
- Doctor appointments
- Physical therapy
- Alternative care (if pre-approved by the insurance company)
Coverage will continue for the entirety of your treatment. If you suffer a permanent injury for which you require long term care, these costs may be payable as a one-time payment as part of your final settlement.
Temporary Total Disability and Temporary Partial Disability (TTD and TPD)
If your injuries cause you to miss time from work, you may be eligible for TTD or TPD. Disability payments are available when you cannot return to work, or can only do so in a limited capacity. TTD begins on the eighth day you miss from work. You will not receive benefits for the first seven days unless you miss more than 21 days total. These payments are calculated based on your average wage before your accident and are 66 ⅔ percent of your full-time wage.
TPD covers you if you can return to work but cannot make the wages you did before your injuries. In this case, your employer will use a separate formula to determine your TPD benefits.
Serious injuries may affect your ability to move, work, or participate in certain tasks to the same extent you could before your injury. In this case, you may be eligible for impairment benefits. You can only receive impairment benefits once your doctor decides you are medically stationary, in other words, you are not expected to get better or worse. At this point, they will issue an impairment rating that the insurance company will use to decide your final payout. Impairment benefits are a lump sum payment payable near the end of your case.
In some cases, a workplace injury may make it so you can’t return to the line of work you were in before your injury. In this case, you may qualify for worker retraining benefits. Retraining benefits can help you learn skills that will prepare you for a job in a different industry. The type of benefits you receive will depend on your pre-injury wage, as well as employment opportunities in your area.
Available programs may include:
- Career certification programs
- College classes or degree programs
- Trade school
- Apprenticeship and/or internship programs
A worker retraining program does not guarantee that you will make the same wage you did before your injury, but the goal is to get you as close to your prior wage as possible. Most workers are not aware of this benefit, so be sure to talk to your attorney about your options.
Take Control of Your Future: Know Your rights
Far too many workers don’t get the care and treatment they deserve because they don’t know their rights after a workplace injury, or they are afraid to fight for them. Your rights matter. A workplace injury can change your life: It should not ruin it. A workers’ compensation claim can help you secure appropriate medical care and help secure your financial future.
The law allows you up to two years to file a workers’ compensation claim. Even if you did not initially file a claim, you may still be eligible for some benefits, as long as you reported your injury. A workers’ compensation attorney can review your case and sit down with you to discuss your rights.
Don’t take your health for granted. Get the help you need. Regardless of what step of the process you are in, it’s never too late to talk to an attorney. To learn more about your rights or for help with your workers’ compensation claim, contact an experienced workers’ compensation attorney.
Dolman Law Group
800 N Belcher Rd
Clearwater, FL 33765