Workers’ compensation claims are fairly common. Last year, in Florida, over 48,000 workers’ compensation claims were submitted, accounting for $524,610,219. In 2018, the average workers’ claim received $17,984 on benefits. However, workers’ compensation can be a confusing and complicated claim to make.
At LJW Legal, our workers’ compensation attorneys handle several claims each year. Throughout the years, our team has gathered the most frequently asked questions regarding workers’ compensation claims, benefits, and more. Continue reading to find the answers to your FAQs about workers’ comp claims and benefits.
Workers’ Compensation Claims
Workers’ Compensation Benefits
What is workers’ compensation?
Workers’ compensation, sometimes called workers’ comp, is a state-mandated insurance program that provides benefits to employees who have suffered job-related injuries or illnesses. In Florida, this form of no-fault insurance offers benefits such as medical care coverage, wage supplementation, and more.
What should I do if I am injured at work?
If you’re involved in an accident at work, the first thing you should do is report the accident to your employer. Even if you’re not sure if you’re injured, if you’re ever involved in a workplace accident, you must report it to your employer. In many cases, injuries won’t manifest themselves until a few hours or days after the incident.
Does workers’ compensation cover all work-related injuries?
While workers’ compensation covers almost all work-related injuries, there are exceptions. For example, workers’ compensation won’t cover injuries that result from an accident when the employee is intoxicated or using illegal drugs. Coverage can also be denied if the situation involves:
- Self-inflicted injuries
- Injuries suffered while an employee was committing a serious crime
- Injuries occurred when the employee was not on the job
- Injuries suffered when an employee’s conduct violated the policy’s established by the employer
Does workers’ compensation cover all employees?
No. Workers’ compensation coverage requirements in Florida can vary from employer to employer and depend on various factors, mostly the number of employees the company has and the sector they work in:
- Construction Industry – one or more employees including the owner
- Non-construction Industry – four or more employee including the owner
- Agricultural Industry – six regular employees or twelve seasonal workers who work over thirty hours
- Out of State Employers – must notify their insurance company they’re working in Florida. If they don’t have insurance, they’re required to obtain a Florida’s Workers’ Compensation Insurance policy.
- Contractors – must be certain all sub-contractors have the required Workers’ Compensation Insurance before they start working on a project
How do I know whether workers’ compensation covers me?
First, you need to verify that you have employee status with the company. Secondly, you need to make sure your injury occurred as a result of your employment. Then, you can see if the workers’ compensation covers you. To determine if you’re covered, a claim process should start, and with the legal counsel of an attorney, you can see what qualifies for your workers’ compensation claim.
Can my employer fire me if I am unable to work because of an injury?
Absolutely not. It is against the law to fire an employee because they have filed or attempted to file a workers’ compensation claim.
If, for any reason, you’re unable to return to the type of job you did before the accident, there are options. In Florida, the law provides reemployment services that can help you get back to work at no cost to you. The services offered include retraining, on-the-job training, job placement, job-seeking skills, vocational counseling, and more.
Will I be able to go back to my job?
In the case you’re able to perform your previous job once you recover from your injuries, your employer should give you the next position that becomes available. They should be able to place you back in your role, or a similar one.
What kind of medical treatment can I get?
The medical treatment you receive will depend on the recommendations from the authorized medical provider, your employer, or their insurance company provider. Medical treatment and prescriptions related to your injury should be included in your benefits.
Workers’ Compensation Claims
How long do I have after an accident to report it to my employer?
You need to report the accident as soon as possible to your employer. There is a 30-day period to file your workers’ compensation claim, or it can be denied.
How long does my employer have to report the injury to their insurance company?
Just like you, your employer should notify their insurance company about your claim as soon as possible. However, they can’t take longer than seven days after their knowledge of the incident. You should expect some response from the insurance company roughly three days after they receive notice from your employer.
What can I do if my employer doesn’t report the injury to the insurance company?
If your employer doesn’t contact the insurance company, you have the right to report the claim directly.
Can I still receive workers’ compensation benefits if the accident was my fault?
In Florida, workers’ compensation is set to work as no-fault insurance coverage. This means you may be able to receive benefits even if you were at fault. However, there are instances when the employee won’t be able to receive benefits, such as if they were intoxicated at the time of the accident.
Can I see my own doctor for a workers’ compensation claim?
It depends. Since 1997, Florida employees are required to seek treatment with an authorized physician. They are allowed to seek a second opinion by another doctor practicing the same specialty, which includes an independent medical examination. Even if you choose to go with your personal doctor, the insurance company may still require a medical examination from one of their authorized doctors.
Do I have to be injured at my workplace to be covered by workers’ comp?
No. But your injury or illness must be work-related. For example, if your injury occurred while traveling for work, attending a business-related social function, or even doing a work-related errand.
Will workers’ compensation benefits cover me for a work-related illness that is not the result of an accident?
Yes. You don’t have to be involved in an accident to suffer a work-related injury or illness. Carpal tunnel is a great example of this case because it’s the repetitive movement performed at work that leads to the injury.
What happens if my employer and the insurance company deny my claim?
You can hire an attorney to start a dispute to further complete and file a new petition for workers’ compensation benefits.
Can I sue my employer in court over a work-related injury?
Generally speaking, no. However, in very limited circumstances, such as your employer intentionally hurting you or it failed to have workers’ compensation insurance, then you can sue them.
Do I need an attorney to help with my workers’ compensation claim?
It depends. The greater your injuries, the more you have at stake. Filing a workers’ compensation claim can also be extensive and complicated, which is why having the legal counsel of an experienced attorney can help you make sure you get the benefits you’re entitled.
Workers’ Compensation Benefits
What kind of benefits can I receive from workers’ compensation?
If you’re injured at work or are suffering from a work-related injury or illness, you may be eligible for workers’ compensation benefits. These can vary according to diverse factors including the extent of your injuries, for how long you’re out of work, and more. You may be eligible for:
- Temporary disability benefits – usually 2/3 of your regular wage
- Permanent disability benefits – based on guidelines by the American Medical Association
- Medical treatment payments – all reasonable and necessary medical treatment
- Vocational rehabilitation – available for workers that cannot return to their previous line of work due to injuries or illnesses
Does workers’ compensation cover long-term illnesses?
Long-term injuries and illnesses such as heart conditions, stress-related digestive issues, and lung disease, for example, can be covered under workers’ compensation if they can be tied into your work.
Does workers’ compensation cover just medical bills?
No. Workers’ compensation covers any expenses related to diagnosis and treatment of your injury. It also provides disability benefits, rehabilitation benefits, and in case of death, workers’ compensation insurance may also provide death benefits to relatives who were financially dependent on the deceased.
Will I be able to recover lost wages caused by my injury?
Under Florida law, workers’ compensation benefits are not paid for the first seven days of disability. However, if your disability time extends beyond 21 days, you may be reimbursed for those first seven days. In most cases, employees claiming workers’ compensation will still receive part of their weekly wages.
If I am unable to return to work until my doctor releases me, does my employer have to hold my job?
Unfortunately, no. No provision in the Florida law states your employer must hold the job open for you.
Can I get a settlement for my claim?
Settlements are entirely voluntary, and they may be made under certain circumstances.
Have More Questions?
If you still have questions about workers’ compensation claims and benefits, reach out to our attorneys by calling our office at 561-989-9190 or filing our complimentary consultation form. At LJW Legal, our attorneys are dedicated to helping you understand every aspect of your case and your claim so that you can make informed decisions about your future. If you or someone you know has been injured at work, contact an experienced attorney today and fight for the benefits you are entitled to.