If you are injured in the State of Florida, the most important thing that needs to occur as soon as possible is reporting of your claim to the employer’s worker’s compensation insurance Company. Per Florida statute, once you report your claim to your employer, they have a legal requirement to report the claim to their insurance Company within 7 days. It is extremely important not to wait after a work injury to report the claim as there is also a provision in the Worker’s Compensation Law which states that an injured worker must report his/her claim to the employer within 30 days after the accident. Therefore, if the claim is not reported timely to the employer, that could serve the basis for a total denial of the existence of that injury.
Steps to Take After Reporting the Injury
Once the injury is reported to the employer, it is also extremely important for the injured worker to seek medical attention as soon as possible. The employer has the right to specifically direct the initial care and, if done so, the injured worker should attend the physician suggested by the employer. If, however, the employer either does not direct care or refuses to report the claim to its worker’s compensation insurance Company, it is imperative that the injured worker seek medical treatment on his/her own. This can be done either through a walk-in clinic or an emergency room. Presuming the injury occurred while the injured worker was employed and in the course and scope of their employment, all medical treatment received by the injured worker prior to the employer providing medical treatment is the responsibility of the employer.
Therefore, it is always better for the injured worker to seek medical treatment as soon as possible after a work injury. Additionally, on many occasions, even if directed by an employer to a specific medical facility, so as to potentially avoid liability for Worker’s Compensation benefits, the employer will request that the injured worker tell the medical provider that the injury occurred outside of work. Under no circumstances should any injured worker lie or misrepresent to any party, whether that be an adjuster, employer, or medical provider, the circumstances under which the injury occurred.
Initial Contact with the Insurance Company
Once a claim is reported to the Worker’s Compensation carrier, the insurance company will reach out to the injured worker usually within 3 business days to perform part of what is called a three-point contact. Specifically, the adjuster assigned to your claim will investigate the existence of the injury by speaking with the employer, any physicians involved, and the injured worker. Many times, the adjuster will attempt to get the injured worker to submit to a recording of their conversation. This is not advisable as any information provided to the adjuster at that time or any information which is not disclosed, could be used later as a basis to deny the claim based on possible omission or misrepresentation.
Receiving Your Information Packet
Presuming the injury is appropriately and timely reported to the insurance company to the injured worker within 7-10 business days. That packet of information will include information regarding the two-year statute of limitations in worker’s compensation and other relevant factors regarding the effects of the injured worker in the State of Florida. However, it is also important to note that in almost all instances, informational packet will be several releases that the insurance company will request that the injured worker sign. Under no circumstances should an injured worker sign any documents or releases other than the document entitled “FRAUD STATEMENT.”
Florida law requires an injured worker to acknowledge that they understand that they will be honest and truthful and the fraud statement signifies understanding of that premise. However, most carriers will also include client signature which allow them to send out and obtain any and all medical records of the injured worker without restriction. This should never be signed and something we always revoke when we initially taken on representation of a client.
Lost Wage Benefits
To the point where the injured worker misses time from work, the next phase will be the administration of lost wage benefits by the insurance company. The adjuster is required to contact the employer and obtain the actual wages earned by the injured worker over the 13 full weeks immediately preceding the week of the injury. That is called the average weekly wage and is the amount that is used by the insurance company to calculate the benefits to which the injured worker is entitled to on a weekly basis during the period of the disability.
The first 7 days of time for which an injured worker misses from work is not paid until the entirety of the time out of work eclipses 21 days. As such, with regard to the administration of checks, in most instances the will receive a check following the 2nd full week of time missed from work. Then, presuming the disability continues, the next check, which continue on a biweekly basis, will follow approximately 2 weeks later and will include weeks 1 and 3.
Dealing with Insurance Representatives
It is important to note that insurance adjusters and assigned nurse case manager’s are representatives of the insurance company. As such, while they may attempt to represent to the injured worker that they are they are to protect the rights of the injured worker, that is not the case. As such, if the insurance company sends a nurse case manager to any of the injured workers medical appointments, it is advisable that the injured worker decline the nurse case manager attending the actual appointment of the injured worker.
Florida law does allow the insurance company free access to medical information and the ability to speak with your medical providers. However, they need to do so at their own schedule and on their own time. Many times, adjusters will sent out nurse case manager’s to actually attend the client appointments so that the nurse case manager can attempt to manipulate the physicians into reducing work restrictions, decreasing medical treatment, and prematurely releasing injured workers back to work, without necessary medical treatment.
TO DO’S
- report your claim to your supervisor as soon as possible, hopefully, within 30 days of the accident or within 30 days of the injured worker reasonably believing that the injury sustained are the result of a work-related incident.
- Seek medical treatment as soon as possible following the injury. If the employer does not direct medical treatment, go to an emergency room or walk-in clinic
- maintain records, including any incident reports completed regarding the accident or description of injury
- maintain copies of any and all communication with the employer regarding the actual reporting of the accident/injury
NOT TO DO
- do not consent to a recorded interview requested by the insurance company
- do not sign any medical release forms requested by the insurance company
- do not discuss the nature of your medical treatment with the employer
- do not mischaracterize the nature or description of an accident to any medical providers
- do not allow a nurse case manager to attend any of your medical appointments
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