Workers’ Compensation Case Guide – Are You Eligible?

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By Marcus Fernandez

If you suffer an injury or illness related to your job, you may be eligible for benefits through workers’ compensation. A workers’ compensation system has been created in every state, including Florida.

The purpose of a workers’ compensation system is to provide benefits to pay the medical expenses and wages lost because of work-related injuries and illnesses. Without a workers’ comp system, injured or sick workers would rely on their employers to voluntarily pay for medical treatment.

The following guide gives an overview of the system administered by the Division of Workers’ Compensation. This division is a part of the Florida Department of Financial Services. The guide includes information about eligibility, benefits, and the process for filing a claim. It also explains how a Tampa workers compensation attorney may be able to help when a work-related injury is the result of the negligence of someone other than your employer or a co-worker.

What is workers’ compensation?

Legislation created a system providing medical and wage replacement benefits to employees injured at work in Florida in 1935. Today, most employers in the Sunshine State must have workers’ compensation insurance covering the workers they employ.

A person who is injured or ill because of a job-related accident can file a claim against their employer’s workers’ compensation insurance. This includes payment of all medical expenses, such as doctor visits and medical treatments they need to recover and return to work. The law also allows them to recover wage replacement benefits. This is for time lost from their jobs because of illness or injury. 

In exchange for the right to obtain benefits without having to resort to lawsuits to force employers to pay for a worker’s medical treatment, state workers’ comp laws generally prohibit lawsuits by workers against their employers for injuries or illnesses resulting from their jobs. Instead of filing lawsuits, employees need to notify their employer directly. This must happen within 30 days of the accident or condition causing them to be injured.

Medical benefits payable through Florida workers’ compensation

Once a claim has been made to your employer or the workers’ compensation insurance company, the claim will be reviewed. They will then determine whether you are eligible for benefits. As a general rule, the injury or illness must be related to the work that you do for your employer. For example, an accident that occurs while you are commuting to work would not be work-related. An accident occurring while traveling from one job location to another would be part of your job. 

If you are eligible for benefits, the cost of the reasonable and necessary treatment for the injuries will be paid. This includes all expenses related to the following: 

  • Hospital stays and treatment in emergency departments.
  • Physicians’ services, including office visits.
  • Prescription medications.
  • Physical and occupational therapy.
  • Prostheses.
  • Nursing and in-home attendant care.
  • Mileage for travel to and from appointments for treatment.

You may not be able to obtain care from the doctor that you normally go to for medical care. The insurance company will give you the name of a doctor authorized to provide medical services for your claim.

Wage replacement benefits

If you miss time from your job because of a work-related injury or illness, you may recover benefits as wage replacement as follows:

  • Temporary total disability: You may receive 66 2/3% of your average weekly wages, up to a weekly maximum that is set by law each year. You cannot receive wage replacement benefits for the first seven days that your doctor declares you are unable to work. The maximum temporary total disability benefit period is 104 weeks.
  • Temporary partial disability: If your doctor allows you to work with restrictions, you may be eligible for wage replacement benefits for up to 104 weeks provided the work restrictions limit you to earning less than 80% of what you earned before the accident or illness. 
  • Impairment income benefits: The doctor treating you may at some point determine that you have reached maximum medical improvement. This means that no significant improvement is anticipated in your current medical condition. An evaluation of your condition will result in a permanent impairment rating and payment of a benefit paid based on it.

Workers with serious injuries and a permanent impairment rating of at least 50% may be eligible for permanent total disability benefits equal to 66 2/3% of their average weekly wages up to a maximum amount established each year by state law. Permanent total disability benefits are payable until a person reaches age 75. The benefits may continue for life for those workers who do not qualify for Social Security benefits.

Death benefits through workers’ compensation

When a work-related injury or illness claims the life of a worker within one year of the accident or incident, workers’ compensation pays up to $7,500 toward funeral expenses. It also pays a percentage of the deceased worker’s average weekly wages to the spouse and children, according to Florida law.  

Appealing a denial of a workers’ comp claim

You must notify your employer within 30 days of being injured or becoming ill from a work-related accident or condition. The workers’ comp insurer has to either accept the claim as valid or deny it. They have 120 days from when you first give notice. 

If your claim is denied by the insurer, you have the right to challenge the determination by filing a petition with the state. The appeal is heard by an administrative law judge with the authority to determine whether the action taken by an insurance company regarding your claim for benefits was correct.

If you suffer an injury in a work-related accident, Florida’s workers’ compensation law prevents you from filing a lawsuit against your employer. You may have a claim for compensation against a third party, though. For example, the manufacturer of a defective machine or other equipment that caused your injuries may be held responsible.

A common situation is when a worker is involved in a motor vehicle accident while engaged in work-related activities. The owner and driver of the vehicle may be held liable for causing the accident. They may also be forced to pay compensation to the injured worker. 

The right to sue third parties for their negligence is separate from any rights that you have through workers’ compensation. Learn more about your rights through workers’ compensation and third-party claims in Florida by contacting a KFB personal injury attorney to schedule a free consultation.