Workers compensation exists to pay vital benefits to employees when they suffer occupationally incurred injuries or get sick because of their job, regardless of fault. Workers compensation benefits include medical care and ongoing treatment, payments to cover lost income, and even death benefits.
In Florida, most businesses are required to have workers compensation insurance for their employees. Specific worker coverage requirements are based on the number of employees, the type of industry, and the organization of the business. However, for workers to successfully claim workers compensation benefits, they must take specific steps, follow certain rules, and meet strict deadlines.
The Lake City workers compensation attorneys at Florida Lawyers 360 assist injured employees in recovering the Florida workers compensation benefits. We aim to ensure injured workers have the resources, tools, knowledge, and representation they need to ensure claims are adequately reimbursed. Call us today at (786) 249-7999 for a free consultation.
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How to File the Workers Comp Claim in Florida?
After suffering an injury on the job, you must move quickly and do things correctly from the start to protect your right to compensation. Below, you will find a thorough breakdown of the steps involved when filing a workers comp claim in Florida – from the moment you sustain an injury to the last stage of an appeal following a denied claim:
Step 1: Report the Injury
Step 2: Get Medical Treatment
Step 3: Your Employer Reports the Injury
Step 4: Employer’s Workers Comp Carrier Sends Information Packet To Injured Employee
Step 5: Employer’s Workers Comp Carrier Accepts Claim
If your workers comp claim is successful, you can expect to receive the first benefit check within 21 days after reporting your injury. The benefits you receive will depend on whether you qualify for temporary total disability or temporary partial disability and whether your injury is “crucial.”
You should continue to receive checks every two weeks from the workers comp carrier until you return to work or after 104 weeks pass. You will receive a permanent impairment rating if you reach MMI (maximum medical improvement).
Step 6: Employer’s Workers Comp Carrier Denies Claim
What happens when your workers compensation claim is disputed? An employer and their workers comp carrier can dispute your workers comp claim when they don’t believe your injuries or illness occurred within the scope or course of employment. When this happens, you still have options, and you claim can proceed following the steps below:
Step 7: Make a “Good-faith Effort” To Resolve Benefit Disputes
Step 8: Petition for Workers Comp Benefits
Step 9: Employers’ Workers Comp Carrier Responds to Petition
Step 10: Dispute Goes to Mediation
Step 11: Case Is Settled
Not all workers comp disputes can be resolved through mediation. When your claim is denied, and no agreement is reached, other options remain for you to recover the compensation you deserve. Below are the steps involved in a workers comp claim process when a claim is denied, and mediation fails:
Step 12: Case Goes To Pre-trial Hearing
Step 13: Final Hearing
Step 14: JCC (Judge of Compensation Claims) Issues Decision
Step 15: Parties Agree With the Decision
If all parties, i.e., the injured worker and the employer/insurance carrier, are satisfied with the JCC’s ruling, it becomes final. If the Judge of Compensation Claims rules in your favor and allows your claim, you should receive the compensation ordered by the court, including a lump sum, attorney fees, interest and penalties, and periodic payments.
Step 16: One or More Parties Disagree With the Decision
Do you disagree with the JCC’s decision following a hearing? You have 30 days from the decision date to file a notice of appeal. You can appeal with the First District Court of Appeal and pursue workers comp benefits there. Below are the steps involved in a workers comp claim when you disagree with the JCC’s decision.
Step 17: JCC Sends Record on Appeal to First District Court Appeal
Step 18: First District Court of Appeal Issues a Final Decision
Florida’s workers comp claim process can be complex, and mistakes can be costly. It’s common for employers/insurance carriers to use the system’s complexities to manipulate injured workers out of their entitled benefits. If you have questions regarding the workers compensation claim process in Lake City, FL, and want to protect your interests, seek counsel from Florida Lawyers 360. We can provide a 100% free, confidential consultation about your case.
How Can I Know if A Workers Comp Claim Will Cover My Injury?
Workers compensation can be incredibly valuable when you are hurt on the job, and getting full compensation can be a tough endeavor.
With few exceptions, workers compensation covers injuries and illnesses that employees suffer within the course or scope of their employment. In other words, if you were engaged in an activity that benefits your employer in Florida, your injury will be covered.
For example, a construction worker struck by or stuck between equipment while working at a construction site would be covered. Injuries and illnesses caused by repetitive work duties are also within the scope and course of employment. For example, if constant lifting, pushing, and pulling in a warehouse causes disk herniation, your injury will be covered by workers comp.
What if I’m Injured at Work While on a Break or After I Clock Out?
Were you taking a break in your company’s cafeteria or break room when your injury occurred? In that case, your injury is still covered by workers comp. However, if you leave the job site, you typically won’t be eligible for workers comp unless your activities were furthering your employer’s interests. For example, you suffered an injury during an off-site business lunch meeting.
Workers comp covers injuries that occur at a job site or are job-related, even if you clocked out for the day. This typically includes injuries that happen in a parking space controlled or owned by your employer. If you clock out and leave the company’s premises, any injuries that occur are not covered.
What if My Injury Occurred Off-site?
Workers who get hurt while away from the workplace will be covered only if their activities were job-related or benefited their employer. For example, you could be eligible for benefits if your injury occurs:
- While traveling between two work sites;
- While working from home;
- During job-related training;
- While taking a work call in the car, and
- While off-duty during business travel.
Whether you were taking a break or you had clocked out, if your injury falls within the scope or course of your employment when they happen, you might qualify for workers comp. While workers comp in Florida covers countless types of injuries, the most common tend to be:
- Slip and falls
- Vehicle accidents
- Machine entanglements
- Falling object injuries
- Repetitive motion injuries
What Injuries Does Workers Comp Not Cover?
Not all injuries will be covered by workers comp. There are exclusions that could result in a denied claim, including:
- Intoxication or substance abuse: Workers comp may not cover your injuries if you were intoxicated and that contributed to your injury.
- Commuting: Workers comp generally does not cover travel to or from work. You may be covered only if the injury occurred while in a company vehicle.
- Workplace fight: Injuries caused by workplace fights are considered self-inflicted and are excluded from workers comp coverage.
Also, workers comp does not usually cover stress or other psychiatric disorders, injuries incurred while fooling around, violating company policies, or committing a crime.
If any of the above situations applies to your case, talk to a Lake City workers comp lawyer to learn more about your eligibility for compensation.
How Long Do You Have to File a Workers Comp Claim in Florida?
Under Florida Statute chapter 440, injured workers who sustain an injury in the course or scope of employment must report the injury to their employer as soon as possible but no later than 30 days after the injury or initial manifestation of the injury. Failure to report your work injury could result in a denied claim.
Was your employer’s definition of “necessary care” different from yours? You have two years from the date of the injury to lodge a petition for benefits with the Division of Administrative Hearings. Here, a judge will step in to identify what remedies can solve the differences. You could qualify for additional compensation.
The time limits get a little grayer for cumulative job-related injuries or illnesses. For example, say you’re a web designer and develop carpel tunnel syndrome over time because of repetitive activities. Generally, the clock for reporting your injury or illness starts ticking when:
- You take time off work because of the injury.
- You know your work caused the injury.
Enlist the Help of Experienced Florida Workers Comp Lawyers
The best way to ensure you take the correct steps when filing a workers compensation claim is to work with an experienced and knowledgeable attorney.
At Florida Lawyers 360, our Lake City workers comp lawyers work every day to understand what’s right for every injured worker out there. After a work injury, you have a lot to keep track of – including your recovery – and navigating the workers compensation claim process is one of those things you need to consult a skilled lawyer. Call us today at (786) 249-7999 to get started with your workers comp claim process.