Worker's Compensation

Workers Compensation

Basic Information About Worker's Compensation

Workers Compensation coverage is paid by your employer at no cost to you
It is your responsibility to report a work related accident as soon as it happens
This coverage will pay for the most reasonable and necessary medical care if you get hurt or get sick because of an injury on your job
Workers compensation coverage will also replace part of your lost wages if your doctor says you must be out of work for a certain length of time because of a work-related injury or illness

A total settlement or cash payout or washout is always possible in your workman's compensation case, as well as a settlement against a third party that may have been responsible for your injury
There are many reasons to have an attorney represent you in dealing with your worker's compensation carrier or adjusters. There are situations where your actions, without an attorney looking out for your interests, can cause your case serious problems. You must cooperate with the carrier, but you must know exactly how to do this, without being taken advantage of by the employer/carrier. And with any possible total washout or settlement, it is hard to see how an employee can deal on an equal level with trained experienced adjusters who are a phone call, or even a desk away, from well paid insurance company lawyers. Even the doctors may be on the insurance company's side on any issue, right from the outset. Within the information below are also points where an attorney may be helpful or even necessary for your case, at a relatively smaller cost than one would expect for hiring an attorney. When an issue is litigated before the Judge of Compensation claims, your attorney would seek a fee for such time and effort litigating, but he would seek this amount from the insurance carrier if possible. Generally for any total work comp settlement, the percentage fee in worker's compensation is much less than a standard personal injury or tort case. The percentage fees for any settlement are more carefully described in the questions and answers below. Attorneys fee percentages are presribed by statute, and the ultimate amount is required to be reviewed by your Judge, and cannot be paid to your lawyer unless the Judge first is satisfied and approves of the fee. Under the law the Judge must protect the employee. With these safeguards, the attorney's fee must always be reasonable and within the law.

How To Get Medical Care And Benefits

Follow these simple rules:

Report your job-related injury or illness to your supervisor as soon as possible
Go to the doctor chosen by your employer or your employer's workers compensation insurance carrier

For you to begin getting benefits, your employer must report the injury to its workers compensation insurance carrier either by telephone or by completing a First Report of Injury or Illness. Your employer or the workers compensation insurance carrier must provide you a copy of your First Report of Injury or Illness. To keep receiving benefits during the time you are unable to work (or working at a reduced salary), you must complete forms when asked. If you have any questions about those forms, contact an attorney.

Cooperate with your workers' compensation insurance carrier. If you do not, your benefits may stop or be delayed. However you must be very careful in what you do in this cooperation, so as not to jeopardize any case you may ultimately have. If you have any question at all about your responsibilities or what you must do in cooperation with the workers' compensation carrier (and you probably will) you really should contact an attorney immediately. But very generally, you must:

Keep all appointments
Report any earnings (including social security and unemployment compensation benefits) you get after your injury to the workers compensation insurance carrier
Get approval from the insurance carrier before receiving treatment. If you are not satisfied with the doctor first assigned, ask your claims handler or workers compensation insurance carrier to approve another doctor. You really however, should contact an attorney who can represent you and assist in obtaining another doctor or specialist. This is strongly recommended
At least try to return to work as soon as the doctor says you can
Keep all records in a safe place for future reference. Be aware generally that your right to receive benefits and medical care may end if there has been no payment made or necessary medical care provided for a one year period. You may need your records in the future to prove or disprove these time limit issues. But for any workers' compensation case, one really should contact an attorney immediately to find out exactly how any time limits, statutes of limitation or statutes of repose will affect their case. You should find out from an attorney exactly what time limit situation of any kind will affect your own individual case, and what should be done about it immediately

What Types of Medical Benefits Can You Get?

Medical Benefits

Workers Compensation insurance pays for all reasonable and necessary medical care related to your on-the-job injury or illness including:

Visits to an approved health care provider (chiropractic visits may be limited)
Surgery
Hospital care
Dental care
Prescription drugs
Braces and crutches
Other medical supplies when ordered by your approved physician.

Before being treated, be sure you or your attorney have the approval of your employer's workers compensation insurance carrier. You are not responsible for the doctor bills as long as the carrier approves the doctor you are seeing. If you see a doctor without the workers compensation insurance carrier's approval, you will probably be responsible for the bill. When you receive approved treatment, the doctor will bill the workers compensation insurance carrier directly. If you are billed, send the bill to your employer or the carrier, or if you are represented, to your attorney. There is one exception. If you were injured on or after January 1, 1994, your doctor is responsible for collecting a $10 co-payment per visit directly from you after you reach maximum medical improvement (MMI).

If you need copies of any medical reports, you can get them from your doctor or workers' compensation insurance carrier, but there may be a charge for these copies. If your attorney has copies, he would be glad to provide copies for you.

Payment For Lost Wages

If your earnings are lower because of a work related injury or illness, you may be able to receive some cash benefits (indemnity benefits). You may be eligible for these benefits if you have been out of work for more than seven (7) calendar days on the advice of your approved doctor and one of the following is true:

You are unable to return to work as a result of the accident
You are able to work but because of your injury you earned wages less than 80% of what you earned before your injury
Your doctor says you will have a permanent loss of a bodily function as a result of your injury. (This is called permanent impairment)

These payments can help you through the period of time you are disabled from your workplace injury or illness. Your coverage begins on the eighth day of partial or total disability. You will be paid for the first seven (7) days only if you are disabled for more than twenty-one (21) days. These days do not have to be continuous calendar days.

To help the workers compensation insurance carrier calculate the benefits that are due, your employer or employers are required to send the workers compensation insurance carrier and you a report of your wages and certain fringe benefits for the 13 weeks immediately before you were injured. The carrier will use this information to calculate your average weekly wage and your workers compensation benefits. If you have a second job, your average weekly wage may include both incomes.

Reemployment Services

If, as a result of your work injury or illness, you cannot earn wages similar to those you earned before your injury, you may qualify to receive reemployment services. The goal of these services is to help you return to work as soon as you can. The types of services you may receive will vary depending upon the date you were injured or became ill. They may include:

Help in writing resumes
Vocational testing and counseling to help identify employment options
Help in finding a job
Training and education if needed for you to be able to return to work

Preferred Worker Program

If you have a permanent disability and are unable to return to your regular job because of a workplace injury or illness, you may be eligible to receive a Preferred Worker Card. The card will tell a future employer about financial benefits that come from hiring you. This may make it easier for you to get a job.

Questions And Answers

Return to Work Questions

Q- Can my employer fire me if I am out and receiving workers compensation benefits?

A- You should not be fired in retaliation for filing or attempting to file a workers compensation claim. While the workers compensation law does not require your employer to hold your position for you until you can return to work, you should consult with an attorney about whether an action taken on the part of the employer is in fact really a firing.

Q- Must I be released to full duty before I can return to work?

A- No. Your doctor may release you for modified or light duty work before you have reached maximum medical improvement (MMI).

Insurance Questions

Q- Is my employer required to have workers compensation insurance?

A- Employers with four or more employees, part-time or full-time, are required to have workers compensation coverage. An employer in the construction industry with one or more employees is required to have insurance.

Q- Do I have to pay for coverage under this insurance?

A- No. Your employer pays the premium. Your employer cannot require you to pay any part of the premium.

Benefit Payment Questions

Q- Where does my workers compensation benefit check come from?

A- It comes from your employers workers compensation insurance carrier or from your employer if it is individually self-insured.

Q- Are workers compensation benefits taxable?

A- No.

Q- Can my benefits be lowered for failure to use safety appliances or follow safety rules?

A- Yes, your cash benefits may be lowered by 25% if your injury occurred while you were not following safety rules or using safety appliances provided by your employer.

Q- When will I get my first check?

A- The earliest date you can expect your first check is within three weeks of your injury. This can only happen if you report your injury immediately to your employer and the First Report of Accident or Illness is completed and sent to the workers compensation insurance carrier shortly after that. The carrier is required to send out a check within fourteen days after learning you will be disabled for more than seven days (the carrier will gather information from you, your employer and/or your doctor).

Q- How long can I collect workers compensation benefits?

A- There are limits on how long you can receive benefits. These limits vary depending upon the date you are injured, how serious your injury is, and what benefits you are receiving. You should consult with an attorney as soon as possible if you have any question about whether the carrier has wrongfully stopped your benefits or not paid your entire benefits. If you suspect this is the case you should obtain legal representation.

Medical Benefits Questions

Q- Do I have to pay any of the medical costs?

A- Your employer or its workers compensation insurance company must pay for all approved and medically necessary care. If you are injured on or after January 1, 1994, you are required to pay a $10 co-payment per visit for the medical treatment after you reach maximum medical improvement (MMI).

Q- How are the doctors and other health care providers paid?

A- All authorized health care providers must bill your employer's workers compensation insurance carrier directly. If you receive a bill mail it to the carrier, or if you have an attorney, bring it to your attorney. Do not pay it yourself. If you know the claim number the carrier has assigned to your case, note it on all bills and correspondence.

Q- Can I choose my own doctor?

A- No. Your employer or its workers compensation insurance carrier can choose the doctor to treat you. If you are unhappy with the doctor chosen by the carrier or want to request a second opinion, you or your attorney must ask the carrier to provide you with another doctor. One of the important things that your attorney may do is assist in persuading the carrier to obtain a second opinion.

Q- How is an impairment rating assigned?

A- When you reach maximum medical improvement (MMI), your treating doctor must give you an impairment rating if you have a permanent loss of function of a part of your body. If you have received temporary benefits for 98 weeks and your doctor has not said you have reached MMI, it is very important for you or your attorney to contact your employer's workers compensation insurance carrier about this.

General Questions

Q- How long do I have to report the accident to my employer?

A- You should report the accident immediately to your supervisor.

Q- What can I do if my employer refuses to complete a First Report of Injury or Illness for my accident or illness?

A- Call your employers workers compensation insurance carrier, The Employee Assistance Office of the Division of Workers Compensation or the Employee Assistance Office near you, or contact an attorney immediately.

Q- If my employer has a Drug Free Workplace Program, can I still get workers compensation benefits?

A- Yes; however, if you tested positive for drugs or alcohol at the time of the accident, you could lose your workers compensation benefits.

Q- Where do I get help if I think my employer or workers compensation insurance carrier is not treating me fairly?

A- Call the Employee Assistance Office of the Division of Workers Compensation or the Employee Assistance Field Office near you, or contact an attorney immediately.

Q- Am I entitled to a lump-sum settlement of my case?

A- A lump sum settlement is allowed but is not mandatory. Any negotiations are strictly voluntary between your attorney and your employers workers compensation insurance carrier, and must be approved by a Judge of Compensation Claims. It is our experience that an attorney can be helpful in negotiating in a way that can maximize the benefits due or which may be due in the future. These things are what is used by the carrier to measure the total value of a potential settlement. It is our experience that it is difficult for the average worker to deal with employer/carrier representatives and adjusters who are much more experienced on the issue of the total value of a settlement and all of its components.

Q- Should I hire an attorney?

A- You may hire an attorney to help you if you choose. If you are at a point where you feel you are not receiving the proper medical or wage benefits, indemnity benefits or care generally, it is at least time to begin consulting with an attorney. Many attorneys only charge at the time of the washout, or final settlement, and do not ask for any money at all along the way from the employee. And at the time of settlement, you make the decision whether to settle, with you knowing exactly how much of the settlement you will receive clearly spelled out in writing. The settlement is then reviewed and approved by you, and then it must also be reviewed and approved by your worker's compensation judge. The Fee schedule prescribed by statute is briefly, as follows: 20% of the first $5,000.00, 15% of the next $5,000.00 of all benefits obtained and 10% of the benefits in excess of $10,000.00 during the first 10 years, and 5% of the benefits obtained after 10 years. This is a bit of a simplification of the fees which, depending on the case (and when the injury occurred) may be more or less than these percentage amounts. Sit down and read the entire fee contract and percentages. The fee contract was designed by the Florida legislature and the Florida government to be reasonably understandable and fair to all involved. There are other parts of the standard workers' compensation contract that you should take time to read. But note that these attorneys fees, and the contract for workers' compensation, are very different than a personal injury or tort case. Workers' compensation attorneys fees are usually much less than in personal injury cases.