Workers’ Compensation FAQ
Florida Workers’ Compensation Overview
Workers’ compensation is an insurance program that is mandated by the state. It provides certain benefits to employees who have suffered job-related injuries or illnesses. Individual states implement their own laws and general programs regarding workers’ compensation. Employees who work for the federal government may also benefit from a separate, specific workers’ comp program designed for federal employees.
Read on to learn more about workers’ compensation in Florida or contact our Daytona Beach workers’ compensation lawyer with your questions at (386) 223-1651.
How Long After an Accident Do I Have to Report It to My Employer?
You should report it as soon as possible—but no later than 30 days or your claim may be denied.
What Kind of Medical Treatment Can I Get?
A medical provider authorized by your employer or their insurance company will provide the necessary medical care, treatment, and prescriptions related to your injury.
Do I Have to Pay Any of My Medical Bills?
No, all authorized medical bills should be submitted by the medical provider to your employer’s insurance company for payment.
Will I Be Paid If I Lose Time from Work?
Under Florida law, you are not paid for the first seven days of disability. However, if you lose time because your disability extends to over 21 days, you may be paid for the first seven days by the insurance company.
If I’m Only Temporarily Disabled, How Long Can I Get These Checks?
You can receive temporary total, temporary partial disability payments, or a combination of the two benefits during the continuance of your disability for no more than a maximum of 104 weeks.
Can I Receive Social Security Benefits & Workers’ Compensation Benefits at the Same Time?
Yes. However, an offset, or reduction in your workers’ compensation check may be applied because the law states that the two combined may not exceed 80% of your average weekly wage earned prior to your injury. For further information on Social Security, you may contact the Social Security Administration at 800-772-1213 or visit their website at www.ssa.gov.
Can My Employer Fire Me If I Am Unable to Work Because of an Injury & Am Receiving Workers’ Compensation Benefits?
No, it is against the law to fire someone because they have filed or attempted to file a workers’ compensation claim.
If I Am Unable to Return to the Type of Work I Did Before I Was Injured, What Can I Do?
The law provides, at no cost to you, reemployment services to help you return to work. Services include vocational counseling, transferable skills analysis, job-seeking skills, job placement, on-the-job training, and formal retraining. To find out more about this program, you may contact the Department of Education, Division of Vocational Rehabilitation, Bureau of Rehabilitation and Reemployment Services at 850-245-3470 or visit their website at www.rehabworks.org.
Can I Get a Settlement from My Claim?
Settlements may be made under certain circumstances and are voluntary, not automatic or mandatory.
If I Settle My Claim for Medical Benefits with the Insurance Company and My Condition Gets Worse Later, Who Pays for My Future Medical Care, Surgeries, or Other Procedures?
You are responsible for your future medical needs after your claim for medical benefits is settled.
What Can I Do When It Is Difficult to Get a Prescription Filled or I Am Having Problems with the Pharmacy Where I Get My Workers’ Compensation Medications?
In Florida, an injured worker has the right to select a pharmacy or pharmacist. Florida law prohibits interference with your right to choose a pharmacy or pharmacist. However, a pharmacy is not required to participate in the workers’ compensation program. If at any time, you become dissatisfied with your pharmacy or pharmacist’s services, you can seek another pharmacy to fill your prescriptions.
Am I Even Covered by Workers’ Compensation? How to Know?
The discovery process to learn if you are actually covered by workers’ compensation can be involved and sometimes difficult.
However, two main factors will generally determine one’s status and they are as follows:
- Whether you are determined to be an employee, and
- Whether your injury occurred directly as a result of your current employment.
But demonstrable proof of either does not necessarily guarantee coverage. Every state has its own unique set of rules that govern these decisions and the awarding of compensation, and some employees may not be covered at all depending on certain situations or types of employment. It is best to get a full understanding of your state’s individual laws before an accident happens, so you will be better prepared if you do suffer an injury.
It is important to note, intentional injuries and situations in which a worker is intoxicated on the job, may not be covered by workers’ compensation at all. If you have questions or are unsure, contact an experienced workers’ compensation attorney, and they can certainly advise you on your rights in these matters.
Are There Any Types of Injuries That Are Not Covered by Workers’ Compensation?
Worker’s compensation does pay for any type of injury that’s on the job, whether it’s a broken arm, back injury, neck injury, or eye injury. However, you are not entitled to receive compensation for pain and suffering.
What If My Work-related Illness or Injury Is Not the Result of an Accident? Am I Still Covered?
Workers’ compensation covers all work-related injuries, including non-accident, repetitive motion type injuries. Many people suffer from work-related carpal tunnel syndrome, and this would be an example of a covered repetitive motion injury.
It is certainly possible for workers to develop many types of illnesses related to their jobs, such as stress-related digestive disorders, carbon monoxide poisoning, breathing problems, and much more. Many jobs are potentially hazardous, and while some may suffer as a result, many others experience no problems at all.
The Accident Was My Fault. Am I Still Eligible for Workers’ Compensation Benefits?
Workers’ compensation is designed to provide benefits to an injured worker without the need to find who is at fault for the accident. But a worker might not receive benefits in every injury case. As mentioned above, intentional injuries and situations in which a worker is intoxicated on the job may not be covered by workers’ compensation at all.
What Types of Benefits Are Offered Through Workers’ Compensation?
The benefits offered can vary as all states make their own determinations, and injury type and the extent or severity of the injury may be factored into decisions as well.
Temporary disability benefits, which are often approximately two-thirds of your regular wage earnings, may be extended to you if your injury lasts more than a set minimum number of days.
Medical costs for treatment are typically paid for, as long as they are necessary.
Additional benefits such as vocational rehabilitation may be offered as well to enable a worker to rejoin their work team or to train for a new job altogether.
What Factors Determine the Viability of a Workers’ Compensation Claim?
To have a viable workers’ compensation claim, you first must be an employee. Second, you must be working for your employer at the time of your accident. So long as you are an employee, your employer has worker’s compensation coverage in place, and you are working at the time of your accident, then you are covered under your employer’s workers’ compensation insurance.
Fault is not a factor in determining whether you are entitled to workers’ compensation benefits. Even if the accident is your fault, assuming that you do not intentionally hurt yourself, you are still entitled to receive workers’ compensation benefits. As long as you are working as an employee and you get hurt, we can help you obtain much-needed benefits.
What Are Some Reasons That Workers’ Compensation Claims Are Initially Denied?
There are many reasons that your Florida workers’ compensation claim may be denied, including:
- Delay in filing your workers’ compensation claim: In Florida, if you fail to notify your employer of your injury within 30 days, the employer may deny your claim.
- Filling out your claim incorrectly: If your paperwork has an error, your claim may be denied.
- Offsite injury: Claims are commonly denied if your accident did not happen at work. To qualify for workers’ compensation benefits, you must be injured in the “course of employment.” Typically, this means that you are injured at the workplace while performing work duties. So, if you are injured outside of work and are not conducting any business for your employer, your claim may be denied.
- Pre-existing injury: The insurance carrier may deny your claim if you had a pre-existing injury to the same body part that you injured on the job. For example, if you were previously treated for a back injury and then you re-injure your back while picking up a heavy box at work, the insurance carrier may try to deny your claim. The insurance carrier may argue that any medical treatment that you need is related to the pre-existing back injury as opposed to the new worker’s compensation injury.
Any denied claim can be appealed. If you have received a denial notice and would like to appeal your claim, we recommend reaching out to a workers’ compensation attorney for assistance.
Does Someone Have to Be Injured in Their Physical Place of Employment In Order to Pursue a Workers’ Compensation Claim?
No, you do not have to be injured in your physical place of employment in order to pursue a worker’s compensation claim. For example, if you are a traveling employee, such as a truck driver or a salesperson, and are involved in a car accident, you will be covered by worker’s compensation insurance. As long as you are actually working for the employer providing the employer a benefit, the injury does not have to occur on the actual property of the employer.
What Steps Does Someone Need to Take After Suffering an On-The-Job Injury?
First, you should immediately report the accident. Preferably you should report the accident to a supervisor or a manager. We recommend that you report the accident on the day that it happens. However, you need to make sure that you at least report the accident within 30 days. If you fail to report a work-related accident within 30 days the employer or insurance carrier may deny your claim.
Second, when you report an accident it is important that you state what body part(s) you injured. For example, if you have a back injury, make sure you specifically tell your employer you injured your back. After a work accident is reported the employer should report the accident to the employer’s workers’ compensation insurance company. The insurance company representative will then rely on your description of the accident and injuries when authorizing medical treatment. Therefore, it is important to be specific and complete as possible.
Following a work accident, the insurance carrier or the employer will authorize you to see a doctor. Usually, the first doctor to be authorized is a primary care provider or a walk-in clinic. When you go to the first doctor’s appointment and any new doctor thereafter, make sure you provide a complete and accurate history of how you were injured and what injuries you sustained. It is important that the history you give the doctor is accurate and consistent with the history that you provided to your employer. Once you begin treatment with a workers’ compensation doctor make sure that you follow the doctor’s advice and follow up with all recommended medical treatment.
When you are injured on the job, in addition to medical care, you may be entitled to wage loss benefits. If the doctor has you on a no-work status you are entitled to workers’ compensation checks until such time as the doctor releases you to go back to work. If the doctor places you on light duty with work restrictions and the employer does not have a job available for you, then you are entitled to workers’ compensation checks until the doctor releases you to go back to work full duty. If at any time the employer or the insurance carrier is not providing you with medical care for your work-related injuries or you are not receiving wages you are entitled to you should contact an experienced workers’ compensation attorney immediately.
Should I Consult with an Attorney Regarding My Workers’ Compensation Claim?
The duration or severity of your injury or illness may influence your decision as to whether you need or want assistance from an attorney regarding your workers’ compensation claim. It is important to keep in mind that the severity of a work injury and what you have on the line are often connected—meaning if your injury is severe you may have a lot at risk and may need to be certain your claim is handled perfectly. Severe, long-term, and permanent injuries quite possibly warrant an attorney’s experience in order to be certain that you receive the maximum benefits that you deserve.
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