Miami Workers Compensation Claim Process

On Behalf of | Feb 1, 2017 | Workers' Compensation

If you’re injured or develop an illness because of your work, you may be covered by the Florida workers’ compensation system. Workers’ compensation replaces some wages, pays for medical care and may provide additional financial assistance for workers who qualify for coverage.

To receive benefits, you must report your illness or injury to your employer in a timely manner and meet other requirements. Understanding Florida’s workers’ compensation procedure is vital for ensuring that you get the benefits to which you’re entitled.

Who Is Covered Under Workers’ Compensation?

Florida businesses that have four or more employees usually are required to provide workers’ compensation insurance. In the construction business, employees with just one worker must carry workers’ comp.

To find out if your employer carries workers’ compensation insurance, you can search online or contact Florida’s Bureau of Employee Assistance and Ombudsman.

In Florida, the workers’ compensation system is defined as “no-fault,” meaning you are not required to demonstrate that your employer acted in a reckless manner in order to qualify for benefits. If your injury happened at your workplace or resulted from your work, you likely will have eligibility to receive benefits.

Notifying Your Employer

The workers’ compensation process begins with notifying your employer. In Florida, most injuries or illnesses must be reported within 30 days. However, if your illness or injury has developed over time, you should make your employer aware of the situation within 30 days of determining the link to your work.

If your injury or illness requires emergency treatment, you should let your employer know as soon as possible after seeking medical care.

Failing to notify your employer within the 30-day workers’ compensation timely filing limit may result in loss of some portion or all of your benefits. When you provide notice to your employer, you should give as much detail as you can, including:

  • The date, time and location of your injury.
  • How the accident or injury occurred.
  • The symptoms you’re experiencing.
  • Details of medical treatment, if you sought emergency care.

You also can report your injury directly to the carrier of your employer’s workers’ compensation insurance. After you report your illness or injury, your employer or the insurance company should give you the needed forms for filing your claim. You also can get the required forms from the state’s Division of Workers’ Compensation.

Claim Review by the Insurer

Your employer should report your injury to the insurance company no more than seven days after receiving notice. The insurance company then is required to send you information outlining your rights within three days.

If your employer fails to inform the insurance carrier, you can do so yourself. After the report, the insurer analyzes your claim, which may include:

  • Reviewing your education, wages and work experience.
  • Collecting and reviewing your medical records.
  • Asking you to undergo a medical exam.
  • Asking you to undergo an assessment of your capacity to perform your duties at work.

Florida law requires that the insurer approve or deny your workers’ compensation claim promptly.

Receiving Benefits

If the insurance company approves your claim, you will begin to receive benefits, which may include:

  • Payments for your loss of wages.
  • Impairment benefits if you have suffered an amputation or a permanent impairment.
  • Coverage of medical care.
  • Rehabilitative education of training for new work, if necessary.

The amount you’re paid for disability will vary according to how state law defines your specific situation. You should receive your initial check within a 21-day period following your report of the illness or injury to your employer.

Medical Treatment Under Workers’ Compensation

Florida law requires that your employer pay for medical care to treat an illness or injury you’ve suffered due to your work. Covered medical care may include visits to doctors or hospitals, prescription drugs, physical therapy, and tests to assess your condition. You also may receive mileage reimbursement for your travel to and from medical appointments.

You should not have to pay medical bills related to the workplace injury or illness; each medical provider should submit their bills directly to the workers’ compensation insurance company for reimbursement. Under Florida law, you have the right to choose the pharmacy you use. However, your employer can choose the doctor that treats you unless you require emergency treatment.

Filing A Petition For Workers Comp Benefits

If your employer’s insurer denies your claim or any benefits, you’ll need to file an petition. In general, your petition must be filed within two years of your injury or illness, or within one year of your latest medical payment or indemnity payment.

Filing a workers’ compensation petition for benefits can be a complex process, and your employer’s insurer will have legal representation. A qualified workers’ compensation attorney can assist you with meeting all requirements, filing the necessary paperwork and taking legal action if necessary to recover the compensation to which you are entitled.

Why You Should Be Aware of How to File a Workers’ Compensation Claim in Florida

If you think you have a worker’s compensation claim, you must act quickly and correctly from the start to avoid difficulties. Workers’ compensation provides medical treatment, wage replacement, and other benefits for a variety of physical and mental ailments and injuries. Hence, if you are not sure whether you have a claim, it is best to seek professional legal help.

Workers’ compensation is a great way to get the medical treatment you need if your employer doesn’t offer it and can lead not only to financial recovery from an injury but also peace of mind. It is, however, worth noting that the worker’s compensation system in Florida is not perfect.

In some cases, legitimate claims are denied, and injured workers are left to fend for themselves. If your claim is denied, there are options available to you, but you will need to act quickly and consult with an experienced lawyer who can help you navigate the system and get the benefits you deserve.

What Do I Do if My Workers’ Comp Claim is Rejected?

Your claim will be investigated by your employer and their insurance carrier as part of the procedure, and they may either approve or deny your claim. They might also require you to undergo an impartial medical evaluation to establish a basis for rejecting or terminating your claim. Workers’ compensation claims are often denied for several reasons, they may include:

  • You didn’t report your injury promptly
  • Your employer disputes that your injury occurred at work
  • You did not file your claim appropriately
  • They are not convinced you’re hurt, as you claim.

If your claim is denied, you have the option of requesting an administrative hearing before a workers’ compensation judge. You may also appeal if the decision by the workers’ compensation board is unfavorable.

At Kaire and Heffernan, LLC, we aim to safeguard your rights at every turn. Our objective is to address your claim as quickly as possible so that you may start receiving compensation. We can assist you with any type of injury claim, no matter how complicated it appears to be.

Why Should You Hire Our Florida Workers’ Comp Lawyer

It’s important to note that an experienced lawyer can make a significant difference in the benefits you will receive. Although we go through the procedures for submitting a workers’ comp claim in Florida, the workers’ compensation claim process may be complicated, and making errors might be costly. In most cases, an employer and their workers’ compensation carrier often try to get an injured employee out of their rights. At Kaire and Heffernan, LLC, our attorneys will:

  • Review your claim for free to determine if you have a workers’ compensation case
  • Check that everything has been submitted on time and follows requirements.
  • Make sure you receive the medical treatment you need, and that everything is recorded.
  • Prove that your injuries are job-related.
  • Ultimately help the injured worker get the workers’ comp benefits they are entitled to
  • Fight aggressively for your rights if your employer or the insurance company tries to deny or reduce your benefits.

Call Now For Immediate Assistance With Workers’ Compensation Benefits in Miami

Call Kaire and Heffernan, LLC at 305-376-7860 for a no-cost consultation with an experienced and dedicated worker’s compensation lawyer to discuss your case.

Mark Kaire has been practicing law in Miami for nearly 30 years. He is dedicated to helping the injured people of Miami receive compensation. Mr. Kaire has been blogging on Miami’s legal issues for many years.