Whether your workers’ compensation case goes to trial depends on whether the work comp carrier has denied your claim for claim or refused to provide benefits you’re entitled to. A Petition for Benefits (PFB) is the first step in initiating a claim for workers’ compensation benefits. A PFB is much like a complaint filed in a civil litigation matter. The PFB lists all the specific benefits for which you are claiming entitlement to. Lost wages, medical benefits, reimbursement for amounts paid for prescriptions, reimbursement for mileage incurred going to and from authorized health care providers, physical therapy appointments, and authorization for medical treatment recommended by an authorized physician. Such are all examples of benefits claimed within a Petition. Within 14 days after receipt of a PFB, the carrier must either pay the requested benefits, or file a response to the Petition. A response to a PFB states the benefits claimed and the carriers’ position with respect to such claimed benefits.
The PFB is a critical component of any work comp claim because once filed, the carrier is forced to acknowledge your claims. A decision on their end as to how to proceed and respond must be made. Are they going to provide the claimed benefits in a timely manner? Are they going to maintain their denial of the claim, or refusal to authorize requested treatment?
If the carrier does not provide you with benefits in a timely manner, your attorney is entitled to payment of attorney fees and costs from the workers compensation insurance carrier. With the filing of a PFB comes the risk that a work comp carrier would have to pay attorney fees and costs. Such a financial factor helps motivate the carrier to address your concerns timely. In addition to the risk of having to pay your attorney fees and costs as a result of the late provision of benefits, or acceptance of a denied claim, the carrier can also be obligated to pay you penalties. These penalties apply when they do not pay your lost wages in a timely manner. The penalty is equal to 20% of the amount of wages you have been entitled to. See Fla. Stat. §440.20(7). If any compensation, payable under the terms of an award, is not paid within 7 days after it becomes due, there shall be added to such unpaid compensation an amount equal to 20 percent thereof, which shall be paid at the same time as, and in addition to, such compensation, unless review of the compensation order making such award is had as provided in s. 440.25. Pursuant to Fla. Stat. §440.20(8)(a), in addition to any other penalties provided by this chapter for late payment, if any installment of compensation is not paid when it becomes due, the employer, carrier, or servicing agent shall pay interest thereon at the rate of 12 percent per year from the date the installment becomes due until it is paid, whether such installment is payable without an order or under the terms of an order. The interest payment shall be the greater of the amount of interest due or $5. So, once a PFB is filed, the carrier is compelled to view your claim differently. Your case is now in litigation. As a result of us filing the PFB on your behalf, the carrier could become liable for our attorney fees, costs, penalties on late payments to you, and interest thereon. The penalties and interest are amounts you receive. Furthermore, they must hire a defense attorney to represent them if the matter proceeds to a mediation and trial.
Unless the Petition is withdrawn, the matter will proceed to mediation. The most common reason for a Petition to be withdrawn is that the benefits claimed in the Petition have been provided. Therefore, there are no issues to mediate. The mediation must occur within 120 days of the filing of a Petition for Benefits. Mediations can occur sooner. Often times they do. We go through a full explanation of the mediation process, what it involves, what to expect, and what we hope to accomplish. If we undertake representation of you, you can take comfort in the fact that you will never be walking into any situation without knowing what to expect.
If the issues are not resolved at the mediation, or resolved after the mediation, and before the date upon which a trial must occur, your claim for benefits proceeds to a trial before a Judge of Compensation Claims. A trial on the benefits at issue must occur within 210 days of the filing of a Petition.
So, the question of whether your work comp case will proceed to trial depends on how the carrier handles your claim. More specifically, the manner in which they provide benefits you’re entitled to is the determining factor in whether a case proceeds to trial. Before taking the case to trial, we discuss all relevant factors that apply to your circumstances. We will advise you of the laws governing your particular issues. We will discuss the pros and cons of proceeding to trial. If a settlement is an option, we will discuss the pros and cons of settlement. With Sibley Dolman Gipe Accident Injury Lawyers, PA, what you will receive is a timely response to questions you have during the course of your work comp claim. We will also make you aware of issues relevant to your case, and important in determining the outcome. You will have the benefit of a dedicated and competent attorney with your best interests at the forefront. You will have the benefit of our firms’ extensive resources and experience. Sibley Dolman Gipe Accident Injury Lawyers, PA creates lasting relationships with our clients through establishing a positive impression. That positive impression comes about from our clients knowing that we are doing everything possible in the handling of their case. As most people know, predicting exactly what will happen in the future of any case is not possible. To counter that uncertainty, we do exactly everything we can to put you in the best position possible. We find doing so results in future matters related to your claim going better than they might otherwise have ended up.
FURTHER DISCUSSION ON WORK COMP CARRIERS, PETITIONS FOR BENEFITS, AND DISPUTE RESOLUTION
If the benefits claimed in a PFB are provided, the Petition can be withdrawn through what is called a voluntary dismissal without prejudice. The voluntary dismissal simply means that issues raised in that PFB have been resolved. We can still file additional PFB’s on your behalf. In fact, it is not uncommon for us to file multiple PFBs in any case. Any time a benefit is at issue, a PFB can be filed. Our approach does not include playing phone tag with the adjuster. Unless the circumstances dictate otherwise, the general policy is that we are not interested in attempting to speak with an adjuster about providing you with a benefit that is due and owing. We move directly to the filing of a Petition. We can always withdraw the PFB as explained above. Worker’s Comp cases do not always move as quickly as our clients would like. Therefore, we explore every opportunity to make the process for efficient. Filing the Petition in response to a denied or delayed benefit saves time. Here’s how – if you’re entitled to a benefit that is past due, trying to speak with an adjuster about it could take time in reaching one another. In addition, once any conversation does take place, there’s no guarantee that such a discussion will achieve a favorable result for you. We consider waiting find out if a phone call, letter on your behalf, or other lesser measure works, to be a waste of time. It is a waste of time that could have been better spent through already having a PFB filed.
More often than not, less aggressive means of handling work comp claims is indicative of less dedicated attorneys. Unfortunately, we understand there are attorneys that do not take their clients work comp case as seriously as Sibley Dolman Gipe Accident Injury Lawyers, PA. Law firms exist that do not file Petitions with the same expediency or efficiency. Perhaps they do not want the obligation of tracking the progress of their client’s case in determining whether a resolution of the issues raised through the PFB have been resolved. Such knowledge comes about through regular communication with our clients. If all benefits have been resolved, we have the option of filing a Notice of Voluntary Dismissal. The process of maintaining consistent client communications and drafting necessary pleadings can be an overwhelming burden for some law firms. Not every firm has the same level of resources as Sibley Dolman Gipe Accident Injury Lawyers, PA. Other attorneys may not file a PFB due to preferring to avoid having to attend mediation. Regardless of the reason, we know what works and what doesn’t. Our clients are generally already upset that they aren’t receiving what they’re entitled to. Our response – DO NOT WASTE TIME. Obtain any and all benefits on our clients’ behalf as quickly as possible.
Workers’ Compensation carriers are not known delays and denials with respect to the provision of benefits to injured workers. Carrier’s have this reputation despite the intent of the legislature in creating the Workers’ Compensation Act.
One common practice seen on behalf of work comp carriers is to deny a claim entirely. In the event of a complete denial (a controverted claim) we can file the PFB on your behalf, and a consideration will be made as to whether the adjuster’s deposition is taken.
Whether it’s through a denial of benefits, or a delay in receiving benefits, the carrier has an ultimate and particular goal in mind. Their goal is to influence the injured worker in such a way that he or she believes they are simply not entitled to certain benefits; or that the pursuit of benefits is not worth the effort.
Work comp adjusters have been known to provide false information for the purpose of intentionally misleading employees about the work comp benefits they’re truly entitled to. In doing so, the carrier’s hope is that the employee will simply abandon their claim to benefits. You can lose your right to work comp benefits as a result of not filing a PFB within a specific period of time. With certain exceptions, employees have 2 years from the date of accident to file a Petition for Benefits. Another way an employee can lose entitlement to benefits is if they undergo treatment initially and for the proscribed period of time. However, they do not continue, and allow an entire year to pass without filing a PFB or attending an appointment with an authorized physician. This loss of eligibility for benefits occurs as a result of the passage of time and an application of the statute of limitations. The law governing worker’s compensation claims states in relevant part, except to the extent provided elsewhere in this section, all employee petitions for benefits filed under this chapter shall be barred unless the employee, or the employee’s estate if the employee is deceased, has advised the employer of the injury or death pursuant to s. 440.185(1) and the petition is filed within 2 years after the date on which the employee knew or should have known that the injury or death arose out of work performed in the course and scope of employment. We can discuss the facts of your case and whether the statute of limitations is an issue.
Once an injured employee has retained an attorney, the carrier is aware of the fact that their opportunity to manipulate and otherwise take advantage of the employee is over. There is no reason why you should know the laws related to workers’ compensation cases. Luckily, we are aware of the laws related to your issue and can alleviate some of the stress that comes with dealing with a work comp carrier. You no longer have to worry about whether you’re doing everything you can, or receiving the full extent of the benefits you’re entitled to. That’s our job and we’re honored to do it.
If everything is going great between you and your work comp carrier, great. We welcome you to contact us and ask any question related to your matter anyway. Doing so ensures that you are in fact receiving everything you’re entitled to. If the circumstances of your case are such that you do not need an attorney at that time, we will inform you of that fact. We are not interested in opening a case just to open a case. We are aware of firms employing scare tactics with people through insisting that absolutely everyone must have an attorney to handle their work comp case. While having counsel may indeed be in your best interest, we will inform you of whether there are any issues we would file a PFB for or not. If not, then whether you retain us to represent you is your decision. Regardless of whether we end up representing you or not, the consultation concerning you claim is free.
Sibley Dolman Gipe Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33765