How to file a workers’ comp claim in Florida

You are not the only one who has been hurt on the job. Every year, thousands of Florida workers file workers’ compensation claims for injuries or job-related conditions. However, more than half of these workers’ comp claims are denied by their employer or insurance carrier. It is crucial to adhere to specific rules and follow deadlines in order for workers’ compensation cases to be successful.

You will find detailed instructions below to ensure you have the best chance of obtaining your benefits. It is essential you contact an attorney that specializes in Florida workers’ comp claims as soon as possible. This will ensure you have the best chance of the disability benefits you deserve.

Steps to take if you Think you May Have a Worker’s Compensation Claim

STEP 1: WRITE OR RECORD ALL THE DETAILS OF YOUR INJURY

Note down the details in writing.

STEP 2 – TAKE PHOTOS

To gather as much information as possible about an accident that you are involved in, such as a work-related accident, take photos.

STEP 3 – GET NAMES OF WITNESSES

Make sure you ask for the contact information and names of all witnesses to the accident that caused your injury, especially if it was on the job but not in your normal work environment.

STEP 4: GET MEDICAL TREATMENT

If you are experiencing an emergency, seek medical attention immediately. You should not wait to report the injury or illness to your employer. You will then need to visit an insurance-authorized doctor.

STEP 5: DESCRIBE EACH OF YOUR SYMPTOMS IN DETAIL

If you visit a doctor, make sure you are thorough about your symptoms and what you think is the root cause. Your visit and injury should be documented by your doctor.

STEP 6: REPORT ANY INJURY/SYMPTOMS

Even if you are not taking time off work, report your injury to your employer. Your employer must be notified within 30 days of the injury or when your doctor has diagnosed you with a work-related condition.

STEP 7: REPORT YOURSELF

You can also report an injury to your employer using this form.

STEP 8: FOLLOW UP

To ensure that your claim has been reported, you should follow up with the insurance company. You will be provided with a form called “First Report of Injury/Illness” by your employer to complete and sign. It should be submitted by your employer to the insurance company within seven days.

WHAT IS INCLUDED IN THE FIRST REPORT ON INJURY / ILLNESS?

This form collects information about the employee who has been injured, the employer, and the accident. It also details the injuries sustained at work.

The Florida Division of Workers’ Comp form has three sections.

The top section contains information about the employee who was injured, as well as a description of the accident. The middle section collects information about the employer and the wage of the injured employee.

The form must be completed in these two sections. Once it is complete, the insurer should send it. If the injury is severe or lasts more than eight days, the insurer must fill out the bottom section and send it to the Division of Workers’ Comp.

ARE YOU ELIGIBLE FOR FLORIDA WORKER’S COMP BENEFITS?

Workers’ compensation covers a variety of mental and physical injuries. It can also replace lost wages and provide other benefits. Workers’ compensation benefits are available to you if your injuries were sustained on the job or while performing work-related activities off-site.

If you have a new or worsening health condition that is related to your job, you may be eligible for workers’ comp in Florida.

If any of the following conditions exist, your employer should participate in the state insurance program.

• Your employer is an agency of the state or local government.
• Four (4) employees or more are employed by the business, whether they work full-time or part-time.
• If the employer is in the construction industry, he or she must have one (1) or more employees (which includes the owner if he/she works in the business).
• A farming employer has five or more regular workers, and 12 or more seasonal workers working 30+ hours.

Medical Benefits

You are entitled to all medically required treatment and care related to your injury, such as:

• Doctor’s visit
• Hospitalization
• Physical therapy
• Medical tests
• Prescription drugs
• Prostheses
• Assistant care
• Travel reimbursement up to and including your pharmacy and doctor’s office

Helpful tips:

• Your employer should be notified of your injury as soon as possible. Although your employer may have authorized a doctor to treat you at the scene of an accident, the insurance company must approve any follow-up treatment.
• If you are injured on the job and require emergency treatment, tell your employer and your insurance company.
• You should not visit your private doctor on your own. You must have your insurance company authorize you to see the doctor.
• Don’t miss appointments. You could lose your benefits.

Talk to the Authorized Treatment Physician

Your appointed disability physician is the most important factor in your claim being granted. Be sure to:

• Keep all appointments.
• Clarify your work status before you leave the doctor’s office.
• Follow treatment prescribed by your doctor.
• Get a copy of the Medical Treatment/Status Reporting Form (DWC25) from your doctor.
• Inform your doctor if you have changed your address or phone number. If you have an urgent need to see the doctor, call the office of the designated treating physician. You may be able to place your name on a cancellations list. If one becomes available, you can be scheduled for an earlier appointment. You can contact your adjuster, or the EAO, if you have an urgent need for a doctor.

Types of Disability

Temporary Total Disability (TT)

Your doctor may decide that you cannot work due to an injury or illness at work. You will be reimbursed up to 66 2/3% of the regular wage you earned when you were injured.

Temporary disability benefits will not be granted for the first 7 days of your disability unless the doctor has determined that you have been disabled for more than 21 days because of a work-related injury.

You may be eligible for up to 80% of your regular earnings for as long as 6 months following an accident.

A maximum of 104 weeks of temporary disability can be received.

Temporary Partial Disability (TP)

If your doctor says you can return to work without restrictions, you might be eligible for Temporary Partial Disabilities Benefits. This is if you are unable to earn 80% of what you earned at the time you had the accident.

A maximum of 104 weeks of temporary disability can be received.

Impairment Benefits (IB)

If your doctor declares that you are at Maximum Medical Improvement (MMI), that means your condition will not improve. The doctor will then evaluate you for permanent work restrictions or an impairment rating.

You will be paid money if you have a permanent impairment rating higher than 0%.

Permanent Total Disability

Maximum Medical Improvement is a treatment that allows you to receive benefits for permanent total disability if your injuries become so severe as required by law.

How to Appeal a Denied Claim

Within a few days of receiving your report, the workers’ compensation carrier should contact you by mail. The company will review the claim and make a decision within 30 working days. Many claims are denied at first. Even if your claim is denied at the beginning, it is not the end.

APPEAL A DENIED CLAIM

Injured workers may appeal a denied claim by contacting the Office of Judges of Compensation Claims. You must a Petition for Benefits within two years after the date of the accident. This will be sent to the insurance company. The insurance company could then either agree to pay benefits or file a response explaining why they are denying the claim. (A company’s agreement to initially pay benefits does not mean that it will not deny the claim later).

MEDIATION

The mediator is then scheduled to settle any dispute. Finally, a judge will make a decision. In an administrative hearing, you can challenge the outcome of an unfavorable case. This hearing is similar in format to a trial. You (or your lawyer) can present evidence or testimony to support your claim. Within 30 days of the end of the final hearing, the judge will issue a decision. Even the “final” decision is subject to appeal to the First District Court of Appeals.

Why Florida Workers’ Comp Claims are Denied

Over 10% of workers’ comp claims are denied. There are many reasons for the denial.

• The application contained insufficient information.
• There was an inconsistency between the accident report and the documented injuries.
• The filing deadline was missed by the applicant.
• It was unnecessary to seek medical treatment.
• The certified list did not include the medical provider.
• The injury is not serious enough to be eligible for benefits.
• The claim was denied by the employer.

You should get a letter explaining the reason behind the denial. It also provides information about how to appeal. You generally have two years to appeal the decision.

If you are appealing a denial of a specific benefit, your appeal deadline is one year after the date of your last payment or treatment. It is better to file your appeal sooner than later.

FAQs

HOW LONG DO I HAVE TO REPORT AN ACCIDENT TO MY EMPLOYER AFTER IT HAS OCCURRED?

It is important to report the claim as soon as possible, but no later than thirty (30 days), or you could be denied.

Reference: Section 440.185, Florida Statutes

WHEN SHOULD MY EMPLOYER NOTIFY THEIR INSURANCE COMPANY OF THE INJURY?

Employers should notify the injured party as soon as possible. However, this must be done within seven (7) days of their knowledge. Within three (3) days of receiving notification from your employer, the insurance company must send you a brochure. The brochure will outline your rights and responsibilities and additional information regarding workers’ compensation law.

Reference: Section 440.185, Florida Statutes

MY EMPLOYER WON’T REPORT MY INJURY TO THE INSURANCE COMPANY. What can I do?

You have the right to report the injury to the insurance company. However, if you need assistance, contact the Employee Assistance Office (EAO) at (800) 342-1741 or e-mail wceao@myfloridacfo.com

Reference: Section 440.185, Florida Statutes

What kind of medical treatment can I get?

Your employer or insurance company will authorize the medical provider to provide you with the required medical care, treatment, and prescriptions in relation to your injury.

Reference: Section 440.13(2), Florida Statutes

Do I have to pay any of my medical bills?

All authorized medical bills must be submitted by your medical provider to your employer for payment.

Reference: Section 440.13(13), Florida Statutes

WHAT IF I LOSE TIME AT WORK?

Florida law does not allow you to be paid for the first seven consecutive days of disability. If your disability lasts more than 21 days, however, the insurance company may pay you for the first seven days.

Reference: Section 440.12, Florida Statutes

WHAT PERCENTAGE WILL I BE PAID?

Your benefit check will usually be paid bi-weekly and is 66 1/3 percent of your average weekly salary. This amount will be calculated based on wages earned in the 91 days immediately preceding your injury. It cannot exceed the state’s limit.

You may use the wages of an employee who worked less than 90% during the 91-day period. Your average weekly wage if you are injured after October 1, 2003, is calculated using the wages earned in the 13 weeks preceding your injury. This does not include the week you were hurt.

Additionally, if you have worked less than 75% during the 13-week period, an equivalent employee who has worked 75% or more of the period shall be used.

Reference: Section 440.02(28) & 440.14, Florida Statutes

Do I have to pay income tax on this money?

No. You can find additional information about Income Tax at the Internal Revenue Service website: www.irs.gov

WHEN WILL MY FIRST CHECK BEGIN?

Within 21 days of reporting your injury, you should receive your first check.

Reference: Section 440.20, Florida Statutes

WHAT IF I’M TEMPORARILY DISABLED?

You can get Temporary Total or Temporary Partial Disability payments during your disability. This is for a maximum of 104 weeks.

Reference: Section 440.15(2), Florida Statutes

CAN I RECEIVE SOCIAL SECURITY BENEFITS AND COMPENSATION BENEFITS FROM WORKERS AT THE SAME TIME?

Yes. However, a reduction or offset in your workers’ comp check could be applied. The law says that they cannot exceed 80 percent of the average weekly wage you earned before your injury. You can contact the Social Security Administration at 800 772-1213 for more information or visit www.ssa.gov to find out more about Social Security.

Reference: Section 440.15(9), Florida Statutes

CAN I RECEIVE REEMPLOYMENT HELP AND WORKERS COMPENSATION BENEFITS AT ONE TIME?

You can’t apply for unemployment if you’re receiving temporary total or permanent total disability benefits. However, you must be able to work and medically competent in order to qualify.

Reference: Section 440.15(10), Florida Statutes

WHAT CAN YOU DO IF YOUR BENEFIT CHECK IS NOT RECEIVED?

Ask the insurance company for the claims adjuster. If you still have questions and don’t understand why the checks have stopped, call the EAO at (800) 342-1741 or e-mail wceao@myfloridacfo.com.

Reference: Section 440.14, Florida Statutes

If I cannot return to work until my doctor releases me, does my employer have to do my job?

There is no law that says your employer must keep the job for you.

CAN MY EMPLOYER FIRE ME IF I’M UNABLE TO WORK DUE TO AN INJURY?

It is illegal to fire you for having filed or attempted to file workers’ compensation claims.

Reference: Section 440.205, Florida Statutes

What can I do if I cannot return to the same type of work I did before I was injured?

Reemployment services are available to assist you in returning to work if you are eligible. These services may include job-seeking skills and job placement. To find out more about this program, you may contact the Department of Financial Services, Division of Workers’ Compensation, Bureau of Employee Assistance, and Ombudsman Office (EAO) at (800) 342-1741 or by e-mail to wcres@myfloridacfo.com.

Reference: Section 440.491, Florida Statutes

MY EMPLOYER and THE INSURANCE COMPANY DENIED MY CLAIM ABOUT WORKERS’ COMPENSATION BIENFIELDS. DO I NEED LEGAL REPRESENTATION TO GET MY BENEFITS? What should I do?

You decide whether to hire an attorney. Or, The EAO can help you resolve your dispute. The EAO can assist you with completing and filing a Petition for Benefits if the dispute is not resolved. This service is free to you. For assistance call: (800) 342-1741 or e-mail wceao@myfloridacfo.com. See District Offices for the address of the closest EAO.

Reference: Section 440.191 & 440.192, Florida Statutes

What is the time limit for submitting a petition for benefits?

A Petition can be filed within two (2) years. You may call the EAO at (800) 342-1741 or e-mail wceao@myfloridacfo.com for specific information.

Reference: Section 440.19(1), Florida Statutes

Is there a time limit after which my claim is closed?

If you were hurt on or after January 1, 1994, your claim is closed one (1) year following the date of your last treatment or payment of damages. This time period is known as the Statute of Limitations. The statute of limitations is two (2) years if you were injured prior to January 1, 1994.

Reference: Section 440.19(2), Florida Statutes

CAN I GET A SETTLEMENT FROM MY CLAIM?

Settlements can be made in certain circumstances, but they are not mandatory or automatic.

Reference: Section 440.20 (11)(a)(b)(c), Florida Statutes

If I settle my claim for MEDICAL Benefits with the INSURANCE COMPANY and my condition gets worse, who pays for my future MEDICAL CARE, SURGERIES?

After your claim for medical benefits has been settled, you are responsible for any future medical expenses.

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 MEDICATION?

Florida law gives injured workers the right to choose a pharmacist or pharmacy.

You can always seek another pharmacy to fill your prescriptions if you are not satisfied with the services of your pharmacist or pharmacy.

Reference: Section 440.13 (3)(j), Florida Statutes

EXPERIENCED ATTORNEYS CAN MAKE A BIG DIFFERENCE

Filing a workers’ comp claim in Florida can be complicated. It is not uncommon for insurance companies and employers to attempt to deprive injured workers of their entitlements.

You must file a workers’ comp claim in order to receive the benefits you are entitled to after a work-related accident. This is according to the requirements of the state. Although it may appear simple to file a claim, this is not always the case. Many injured workers find themselves surprised when their claim is denied or delayed.

The Time to Find a qualified Worker’s Comp Attorney is NOW!

You have 30 days to notify your employer if you are hurt at work or become aware of workers’ compensation illness or injury. Your claim may be canceled if you fail to notify your employer within 30 days. You generally have two years to file a workers’ compensation claim from the date you were injured or ill.

Your claim may be denied if you fail to notify your employer within 30 days of your injury or illness. This is regardless of the two-year statute of limitations. You may lose your eligibility for benefits one year after the date you received a wage replacement or approved medical treatment.

KNOW YOUR RIGHTS

It can lead to a serious setback for your family and you as well as yourself if you get hurt at work. The injury can not only affect your ability to earn a living but also your physical and psychological health.

Workers’ Compensation Florida provides benefits such as compensation for lost wages, medical treatment, and financial assistance to assist you after an injury or recovery.