In Florida, workers’ compensation benefits provide financial and medical support to employees who suffer work-related injuries. These benefits aim to support workers financially while they recover and assist them in getting back to work when possible.
A thorough understanding of Florida’s workers’ compensation system is essential for safeguarding both your financial stability and physical health.
This guide will cover:
- An overview of workers’ compensation
- The types of benefits available
- Steps for filing a claim
- How to appeal a denied claim
To determine your eligibility and navigate the complexities of the claim process, consulting with an experienced attorney, such as the dedicated workers’ compensation lawyers at Berlin Law Firm, is the most effective way to secure the best possible outcome.
Understanding Workers’ Compensation
Workers’ Compensation is a type of insurance most businesses with four or more employees are required to have. If an employee is injured on the job because of a job-related activity, they are entitled to financial compensation for a portion of lost wages and medical care benefits. In serious injuries, additional benefits may apply. Workers’ compensation also applies to any illnesses that have been caused by coming into contact with hazardous material or pollutants.
Workers’ comp covers a broad range of eligible employees, including full-time, part-time, and seasonal workers—although independent contractors are typically not covered under the law.
In Florida, workers’ compensation operates under a no-fault principle, meaning that employees are eligible for benefits regardless of who was at fault for the injury, eliminating the need to prove negligence. The no-fault principle is intended to streamline the process and allows injured workers to receive benefits quickly.
However, determining what qualifies as a work-related injury can sometimes be complicated. It is important to know that injuries sustained off the job or those resulting from personal misconduct, such as intoxication, horse-play, or self-inflicted harm, are not covered (Fla. Stat. § 440.09).
What Workers’ Compensation Benefits Are Available?
Some of the benefits you may be entitled to after a workplace injury may include:
- Medical Benefits: Covers all necessary medical treatments related to the injury, including doctor visits, hospital stays, surgeries, medications, physical therapy, and medical equipment.
- Temporary Total Disability (TTD): Provides two-thirds of your average weekly wage if you cannot work temporarily.
- Temporary Partial Disability (TPD): Helps make up the difference if you return to work at a lower pay due to your injury.
- Permanent Impairment Benefits (PIB): Offers compensation for lasting injuries based on impairment ratings.
- Permanent Total Disability (PTD): Provides long-term support if you cannot return to any work.
- Death Benefits: Financial assistance for dependents if a work injury leads to death.
- Vocational Rehabilitation: Offers job training and support if you cannot go back to your old job.
The type of workers’ compensation coverage you qualify for—such as total disability, partial disability, temporary, or permanent benefits—depends on the severity and nature of your injury, as well as its impact on your ability to perform your job.
After reporting your injury, you’ll be evaluated by an authorized medical professional who will assess your condition and determine your level of impairment. Based on this medical evaluation, the doctor will classify your disability according to whether it is temporary or permanent and total or partial.
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Filing a Workers’ Compensation Claim
When filing a workers’ compensation claim, there are a few steps you need to follow to ensure you receive benefits:
- Notify Your Employer Right Away
You need to let your employer know as soon as possible, ideally on the same day it happens. Under Florida law (Fla. Stat. § 440.185), you have 30 days from the date of your injury—or from when you realized your condition was work-related—to make this report. Missing that window could mean losing your right to claim benefits.
- Get Medical Treatment from an Approved Provider
Your employer or their workers’ comp insurer will direct you to an approved doctor. Only seek treatment from these authorized providers; otherwise, you might be stuck footing the bill. Follow the prescribed treatment plan closely, as your medical records will play a huge role in supporting your claim. If you are unhappy with your doctor’s diagnosis, you have the right to request a new doctor. You can only change doctors one time under Florida law.
- Ensure Your Employer Files the Claim
Once you have reported your injury, it is up to your employer to officially file the workers’ compensation claim with their insurance carrier. They are required to do this within seven days of your notification. Double-check that this step has been completed, as any delays could affect the timeline of your benefits.
- Stay on Top of the Insurance Carrier’s Response
The insurance company has 14 days to evaluate your claim and determine whether you qualify for benefits. During this time, they might ask for more information or clarification. Keep communication lines open, respond quickly to their requests, and do not hesitate to follow up if you don’t hear back promptly.
- Document Everything
Keep a detailed log of your injury, medical treatments, conversations with your employer and insurance adjuster, and any other related expenses. This kind of documentation can be invaluable if your claim faces delays or if you need to challenge a denial.
How to Handle a Denied Claim
If your workers’ comp claim is denied, it could be due to several reasons, such as insufficient evidence, missed deadlines, or the insurance company’s dispute regarding the circumstances or severity of your injury. But do not panic—it is not the end of the road. You have the right to challenge the decision by filing a petition for benefits with the Florida Division of Administrative Hearings (DOAH).
At Berlin Law Firm, we encourage you to consult with one of our experienced workers’ compensation attorneys who can guide you through the appeals process and strengthen your case.
Having our legal team on your side can make a significant difference. We will help you gather evidence, represent you in hearings, and negotiate with insurance companies on your behalf. We know their tactics well and have proven methods to overcome them.
Get the Best Outcome Possible. Consult With a Florida Workers’ Compensation Attorney.
Injuries at work can disrupt your life significantly, but workers’ compensation is designed to help during this difficult time.
However, claim denials and complications often arise during this process. The only way to safeguard your claim and position yourself to get the best outcome possible is by teaming up with an experienced workers’ compensation lawyer here at Berlin Law Firm.
We will fiercely protect your job, your benefits and make sure your claim is handled efficiently.
Contact Berlin Law Firm to schedule a free consultation where we can discuss your options and outline the immediate steps to secure the benefits you are rightfully owed.
Discuss Your Work Injury Claim for Free
Learn the types of compensation you may be eligible for and have your questions answered. Call today.
