The vast majority of accidental injuries, illnesses, diseases, and even deaths that occur at the workplace are covered under the Florida workers’ compensation statute. In Florida, this system is a no-fault one, meaning workers don’t need to prove negligence to recover benefits. All an employee must do is report their workplace injury to their employer within 30 days of the incident. The employee then has two years to file a workers’ compensation claim after filing the initial injury report.
If you have been injured while working on or at a job in Florida, you should contact an Orlando workers’ compensation lawyer who knows how to operate within Florida’s workers’ compensation system. The purpose of the system is to circumvent the normal process of civil litigation, which can take years, and which forces the injured party to prove negligence.
Workers’ compensation system allows an injured employee to instead receive some portion of their lost wages and medical expenses very quickly, without having to prove negligence. Injured employees do lose out on some of the damages available in other personal injury cases, and they do not have the right to sue their employer in civil court. No pain and suffering damages are allowed under Florida’s workers’ compensation system. Call (954) 448-7355, (954) 833-0273 today to schedule a free consultation with a personal injury attorney and learn how we can help your claim.
Table of Contents
What Should An Orlando Employee Do If Injured At Work?
If you have an accident or are otherwise injured while you are on the job, you must inform your employer about your injury as soon as possible. Under Florida law, you only have 30 days to report your accident or knowledge of your injury to your employer before your claim is waived.
When you report your claim, it is your responsibility to ask your employer what doctor you are allowed to see; only doctors authorized by your employer or the insurance company are eligible for payment under Florida’s workers’ compensation system. Some employers will respond by instructing you to call the insurance company that handles their workers’ compensation claims. If that occurs, there should be a workers’ compensation poster hanging in your workplace, which contains the name and phone number of the claims handler. These posters hang in employee areas, like locker rooms or break rooms.
Your employer has only seven days under Florida law to report your injury to the insurance company. If your employer does not do this and does not provide you with a phone number to call at the insurance company, you can call the Florida Division of Workers’ Compensation hotline for help, at 1-800-342-1741.
What If It Is An Emergency Situation?
If you have an emergency situation and your employer is not available at the time to tell you where to go for treatment, or you are unable to contact your employer, you should go to the nearest emergency room. As soon as you are able, you should let your employer know what has happened.
What Happens Once The Insurance Company Is Notified?
Many insurance companies will have an insurance claims adjuster call you within 24 hours after your claim is reported to explain your rights and responsibilities to you. If you miss the call, you should return it as soon as possible, so you can find out what you need to do to ensure you get covered medical treatment. You will receive a brochure in the mail 3-5 business days after your accident is reported to the insurance company, which reduces your rights and obligations to writing.
Very shortly thereafter, you will receive a packet of information, which will at a minimum contain a Notification Letter that explains the services which are provided by the Employee Assistance Office Division of the Division of Workers’ Compensation. Also in that packet will likely be a copy of your accident report. You should review this First Report of Injury or Illness and make sure it is accurate. There may also be a Fraud Statement, which you must read and return as soon as possible. Benefits may be withheld until this document is returned.
There will also be a Release in the packet for your medical records, which you must also sign and return. You will receive a medical mileage reimbursement form to fill out and send to the claims adjuster for reimbursement. If you do not receive a call from the insurance company or a packet of information with some or all of these documents, you should call the Florida Division of Workers’ Compensation hotline, at 1-800-342-1741, for help.
Who Chooses The Doctor You See For A Workers’ Compensation Claim?
When you seek medical attention for the accident or illness, make sure you provide the doctor with a full description of the accident or other circumstances under which you were injured. You must also truthfully answer all the questions the doctor asks about your medical history and your current medical condition. Make sure to establish with the doctor if your injury is in fact related to your job, and if so, the doctor must determine if you can go back to work or not.
In some cases, you may be released back to work, but on “light duty” or something similar, meaning you cannot perform your regular job. If that is the case, the doctor should give you instructions on what types of work you can perform and what you cannot, and make sure it is put in writing for you and your employer. It is imperative that you keep all of the appointments with the medical professional treating your injuries. Failure to do so can result in a suspension of benefits.
After the First Doctor Visit
After leaving the initial doctor visit, speak with your employer as soon as possible. Be honest and clear with your employer regarding what the doctor said was the cause of your injury or illness, and what work you can or cannot perform if you can work at all. It is best, as mentioned, to have the doctor put all of this in writing, as well, which you can then share with your employer.
Some injuries are more serious, and an injured person may be admitted to the hospital. If you are admitted to the hospital, you or a loved one should call your employer if possible to explain what happened. As soon as you are able to, provide your employer with a doctor’s note.
If the doctor releases you to work on modified or restricted duty of some kind, ask your employer if there is work for you to return to that does not require you to engage in restricted activity. If yes, ask when you should report back to work. If no, make sure your employer knows how to get in contact with you if suitable work does become available.
After contacting your employer, contact the insurance company and inform them of what the doctor said regarding your injuries and work status. Through the entirety of your treatment and recovery, you should stay in regular contact with your employer and the insurance company.
What Workers’ Compensation Benefits Are Available In Orlando?
There are some amounts of cash you may be entitled to if you are injured on the job. You might qualify for indemnity benefits if you are unable to work for more than seven days. In those cases, you should be compensated at least in part for lost earnings. Your weekly benefit can never legally exceed the maximum compensation rate for the year in which your illness or work-related accident occurred.
Total Disability Coverage
If your doctor says you cannot work at all, you should receive two-thirds of your regular wages at the time you were injured, beginning on day eight of missing work. The first seven days of missed work is paid (at a reduced rate) only if you are out of work for longer than 21 days). If you suffer a critical injury, you may receive 80% of your regular wages for a total of six months after your accident. You are entitled to receive a total of 104 weeks (two years) of temporary total or partial disability payments.
Partial Disability Coverage
If you are able to return to work, but you cannot earn the same wages that you were earning at the time you were injured then you can receive payments in an amount that equals 80% of the difference between 80% of what you earned before your injury and what you are earning after your injury. So, for example:
- If your average weekly wage is $500: $500 (Earnings before injury) X .80 = $400
- Your weekly earning after injury are $250 less than they were before the injury, and you are making only $150 per week
- $250 X .80 = $200.00
- Your weekly temporary partial disability benefit is $200
Again, you can receive up to 104 weeks (two years) of temporary disability, made up of any combination of partial and total disability payments.
You may also qualify to collect impairment benefits. Once your doctor says you have reached maximum medical improvement, you are as healed as you are expected to become. At that point, your doctor will evaluate you for possible permanent work restrictions, and a permanent impairment rating. If you receive a permanent impairment rating, you will receive monetary benefits based on your rating.
As long as you follow the proper procedures, your employer is responsible for providing medical treatment. It is important that you do not delay when seeking medical attention, and important that you go to a doctor authorized by the insurance company, not your own doctor. If your insurance company does not provide you with a list of approved medical professionals, you should contact the adjuster and ask.
You might also qualify for reemployment benefits if you are unable to return to your previous position due to permanent work restrictions, in place as a result of your on-the-job injury. If you are in this situation, the Bureau of Employee Assistance and Ombudsman Office/Reemployment Services Section can help you with this. Reemployment services can include:
- vocational counseling
- job analysis
- transferable skills analysis
- job-seeking skills training
- selective job placement
- training and education
- other services considered necessary and appropriate to help an injured Orlando citizen return to work.
What If You Have A Dispute With The Insurance Company?
Sometimes the insurance company does not step up and pay for the benefits you are entitled to. If this happens, the first thing you should do is attempt to resolve the issue with your insurance adjuster, and if that is not successful then seek out the supervisor of the adjuster. If the insurer will still not agree to pay benefits you think you are entitled to, then you should file a Petition for Benefits (PFB) with the Office of the Judges of Compensation Claims (OJCC). If you do this, you should consider retaining an attorney to represent you.
The jurisdiction of the OJCC begins with the filing of the PFB with the Central Clerking Office in Tallahassee. Once a case number is assigned, you can monitor the status of your case on the OJCC website. Once filed, your PFB will be scheduled for mediation, except in rare events, when a PFB is scheduled for an expedited final hearing.
Even in cases scheduled for mediation, a trial, or final hearing, may be scheduled simultaneously, further out than the mediation. It will depend on what judge is assigned to our PFB. Some Judges schedule the final hearings right when a petition is filed, while others schedule final hearings after an unsuccessful mediation has occurred. There is a pretrial hearing before any final hearing.
Prior to each final hearing, a preliminary hearing called a “pretrial hearing” will occur. If you retain an attorney, then instead of a hearing, the pretrial process may occur by a written exchange. This process provides each side the opportunity to exchange information supporting their claims and defenses (much like in the discovery process in a civil lawsuit). The Florida rules of evidence govern what evidence is admissible in final hearings. Following the final hearing, a final order must be issued within thirty (30) days.
Which Employers Are Required To Carry Workers’ Compensation Coverage In Florida?
Any non-construction industry employer with four or more full or part-time employees is required to carry workers’ compensation coverage. Employers in the construction industry with one or more employees are required to carry workers’ compensation insurance as well. When determining whether someone is an employee, exempted corporate officers do not count. All state and local government employers are required to carry workers’ compensation coverage. Farmer with more than five regular employees or twelve or more workers used for seasonal employment lasting at least 30 days also must carry workers’ compensation insurance.
To find out whether or not your employer has workers’ compensation coverage, you can call the Employee Assistance and Ombudsman Office. You can also search on your own, using the Division of Workers’ Compensation’s Proof of Coverage Database to see if your employer has coverage.
Requirements For Orlando Employers Under The Workers’ Compensation System
If your employer is required to provide workers’ compensation benefits, then the company is responsible for providing medical treatment through an insurance carrier. The medical treatment includes (but is not limited to) an authorized primary physician and any specialists that are medically necessary, all medically necessary care and treatment authorized by a medical professional, including visits to the doctor, hospitalization, medical tests such as x-rays and MRI’s, physical therapy, prescription drugs, and any prosthetic devices or medical supplies such as crutches or wheelchairs. Employers must also cover mileage reimbursement for visits to the authorized medical professionals.
Temporary Disability Benefits
There are two types of temporary disability benefits that injured workers may be entitled to during their recovery, to make up for some of the wages being lost: temporary total disability, and temporary partial disability. The amount of benefits an employee is entitled to varies, and depends on whether the doctor deems them partially or totally disabled.
If you are injured in a workplace accident and the authorized medical professional says you cannot work at all, you will be on temporary total disability, and during that time you will receive 2/3 of your regular wages, subject to Florida’s maximum reimbursement amounts. These benefits are not provided for the first seven days of disability unless you will miss more than 21 days in total. Some more severe injuries entitle injured employees to 80% of their regular wages, for up to six months after the accident, before being reimbursable at the lower 66 and 2/3%.
If the doctor does release you to return to work but places you on restricted duty, and as a result, you can no longer earn at least 80% of the wages you were earning at the time of the accident, you might be eligible to receive partial disability benefits. Whether you receive partial disability benefits, total disability benefits, or some combination of the two, you can only receive up to a total of 104 weeks of benefits in total (two years of weekly benefits).
You may also receive impairment benefits if a doctor states you are at what is called Maximum Medical Improvement. This means your condition is not expected to improve significantly from that point, and you will be examined for potential permanent work restrictions. If you receive a permanent impairment rating greater than 0%, you will be compensated based on your rating. Permanent impairment is defined under Florida law as “any anatomic or functional abnormality or loss determined as a percentage of the body as a whole, existing after the date of maximum medical improvement, which results from the injury.”
In the most extreme cases, a doctor may determine that your injuries are so extensive you have been left permanently unable to work, even after reaching Maximum Medical Improvement. In such cases, you may be entitled to receive permanent total disability benefits.
If a work-related death occurs either within one year of the date of the accident or after five years of continuous disability, a combination of benefits may be payable, referred to as death benefits, up to a maximum of $150,000. Employers may have to pay $7,500 in funeral expenses, educational benefits to the surviving spouse, and compensation to the surviving dependents.
Florida Law Limits the Amount of Time you can Receive Workers’ Compensation Checks
The workers’ compensation system in Florida is calculated to get people back to work as quickly as possible. The moment the doctor releases you back to work, the insurance company no longer has an obligation to issue you benefits. Because of this, most people return to work the minute this determination is made, whether they are physically ready or not. Additionally, there is no job protection guarantee; employers do not have to hold your job open for you until you can return to work.
How Can Orlando Employees Protect Their Rights?
Even if you follow every step of your workers’ compensation claim strictly “by the book,” there is no guarantee that you will be successful in obtaining benefits. However, if you follow these steps if you are injured on the job, you will maximize your chances of recovering benefits.
- Report your injury promptly. Whether you receive an acute, traumatic injury or find out you are suffering from a chronic occupational disease, you should report the issue to your supervisor as quickly as possible, and always within 30 days.
- Have your Supervisor prepare a company accident report. If your Supervisor refuses to prepare the report, you should make a record stating the facts of your injury and provide a copy to your supervisor. If you are able to get a signature on the document, that is even more persuasive.
- Get a copy of the accident report. Once you have it in your possession, put it in a safe place, along with any letter you have prepared to your supervisor, and copies of all other documentation supporting your claim for benefits.
- If you are not a member of a union available at your job, join. If injured, make sure to tell your steward, who will defend your interests.
- Keep detailed records of all significant contacts you have with anyone relating to your claim. This includes your supervisor, the insurance company, doctors, and any other professionals you may have seen regarding your work injury.
- Get medical attention only from a doctor approved by your employer Even if you have difficulty obtaining care, you must go to a doctor approved by the insurance company for your employer. If the doctor denies you care, continue to demand proper care. However, going to your own doctor is a bad idea, as that visit will not be covered by your employer.
- Tell the doctor very clearly and in a detailed manner how your work caused your injury. You may want to provide your doctor with a written statement to this effect, and keep a copy for yourself. As time goes by, it is good to have a written statement explaining how your injury was caused and is a result of your employment.
- Follow all medical directions, and do not miss any appointments. Failure to follow medical directions can result in an employer arguing that you purposely did not seek proper care and heal quickly enough, so you could stay out of work. Missing appointments can result in a suspension of benefits.
Make sure that the doctor sends all bills to your employer for payment.