Florida law requires that most employers provide workers’ compensation benefits for workers who suffer accidental injury as the result of their occupational duties.
To receive benefits, the employee must establish — with a reasonable level of medical certainty — that the injury and any related disability resulted primarily from the individual’s job. An experienced workers’ compensation attorney can help you compile and present the information you need to establish your case.
If your claim is approved, how does workers’ comp pay you?
If you’re injured or develop an illness on the job, your employer is responsible for covering your medical care. However, your employer or your employer’s insurance company have the right to choose the doctor who will provide your care. This is one of the many problems with the workers compensation system. The insurance adjuster will chose a doctor that has been favorable to the insurance company in the past. Once you receive authorization for care, be sure to make an appointment as soon as possible.
If your employer or the insurance company do not provide you with the information, contact the insurance adjuster handling your case to ask for the referral.
The health care provider who treats you must adhere to a number of regulations, including providing only the care that the insurance company authorizes and that is necessary to treat the injury or illness for which you’re covered.
The doctor also has responsibility for providing all necessary documentation to the insurance company and assessing your limitations and your ability to return to work.
Depending on the details of your injury or illness and your level of resulting disability, you may be entitled to one of several types of compensation for your lost time from work.
Indemnity benefits compensate you if you cannot work for more than seven days. This weekly benefit cannot exceed the state’s maximum rate of compensation for the year in which you were injured.
You may receive temporary partial disability if you’re able to return to work but are unable to earn at the same rate you did before the injury. Temporary partial disability and temporary total disability can be paid for as long as 104 weeks.
If your doctor determines that you are completely unable to work, you may receive temporary total disability of approximately 66.66 percent of your usual wages at the time you suffered the injury. The benefit is paid starting on the eighth day you miss work because of your injury, and you only receive compensation for the first seven days if you miss more than 21 days in total from work.
Permanent total disability becomes effective if the medical provider determines that you are unable to participate in any type of employment, including a sedentary job. Payments are 66.66 percent of the average weekly wage for the duration of the total disability, which includes serious conditions such as paralysis, amputation or severe brain damage. Permanent total disability payments end when the injured person reaches age 75 unless Social Security benefits are not available due to a limited work history because of the injury.
If the medical provider determines that you have reached your maximum degree of improvement, you may be entitled to permanent impairment benefits. You’ll receive an impairment rating, and benefits are paid at 75 percent of your weekly average payments for temporary total disability on a biweekly basis. Impairment benefits start the day after you reach your medical improvement maximum level or at the expiration of your temporary benefits. Payments are provided for three weeks for each percentage point in the impairment rating or until the employee’s death.
If you have permanent restrictions on the type of work you can do and you cannot return to your previous job, you may receive reemployment assistance through Florida’s Bureau of Employee Assistance and Ombudsman Office/Reemployment Services Section.
The Insurer’s Duties to You
Your employer’s workers’ compensation insurance company has multiple responsibilities to you under Florida law, including adjusting your claims without intimidating or harassing you. The insurer also must investigate information in a way that ensures that you promptly receive benefits to which you are entitled.
The insurance company also is responsible for filing all reports with your employer and the state, along with providing copies to you. If you submit a written request for medical treatment, the insurer must respond in three business days or less. Your attorney can assist you in ensuring that the workers’ compensation insurer fulfills all its duties to you.
What if a Workers’ Compensation Insurer Refuses to Pay?
If you do not receive the workers’ compensation benefits to which you’re entitled, you can discuss the problem with the insurance adjuster assigned to your case. If the problem remains unresolved, your workers’ compensation attorney can assist you in filing a Petition for Benefits. For a consultation, please contact Kaire & Heffernan, LLC.