Published: November 27, 2020 | Brian L. Elstein, Esq.

Every year, millions of people are injured on the job. These workplace injuries are common enough and can happen at any time, so it is important to know what workers’ compensation insurance does and doesn’t cover. 

Like in most states, Florida requires nearly all businesses with one or more employees to carry workers’ compensation insurance to cover any on-the-job injuries that occur. In the event of an injury while working, you can file a claim in hopes of receiving compensation for any damages.

There are numerous situations in which an employee can file a claim with their employer’s workers’ insurance company. The costs that this insurance is intended to cover include:

  • Medical Bills
  • Lost Income
  • Ongoing Medical Care
  • Lost Income
  • Job Replacement Benefits

These are just a few of the many things an insurance claim can cover. There is no guarantee that an employee will receive a payment from the insurance company for these costs, either.

Who is Eligible to File a Claim?

In order to file a claim with the insurance company, there is criteria that needs to be met. The main point of getting a workers’ compensation payment is that the injury has to have happened while at work or performing a job-related duty. Beyond that, there are several circumstances in which you would not be eligible to receive any sort of benefits.

You may not be eligible for compensation if any of the following statements are true:

  • Your injury was a direct result of drug or alcohol use on the job,
  • You did not follow your employer’s safety procedures as defined by the business you work for,
  • You intentionally injured yourself or were careless with the intention of obtaining workers’ compensation benefits.

If the injuries you sustained were truly accidental and none of the points above apply to you, you may have a valid claim. After an injury at work, the clock is ticking, so it is important that you seek medical attention and file your claim as quickly as you can. If you wait beyond 30 days, there is a higher chance of your claim being denied.

How Does Workers’ Compensation Work in Florida?

As mentioned above, most businesses in Florida that employ at least one person must have workers’ compensation coverage. They can do this by contacting a private insurance company for a policy or apply for certification to self-insure.

The Florida Division of Workers’ Compensation oversees each of the workers’ compensation claims in the whole state. Florida has a no-fault workers’ comp system, like the rest of the country. This is beneficial to the employee because they do not have to jump through hoops to prove their employee’s carelessness led to their injuries. In most situations, as long as your injury happened either on the job or during your work activities, you should have no problem showing eligibility for the benefits.

Some of the benefits an employee is typically eligible for are:

  • Temporary Disability: Wage loss can be detrimental, so temporary disability benefits help keep employees afloat when out of work (due to injury).
  • Impairment Benefits: This is for those that end up with permanent limitations, including amputation and other physical issues. The benefits are determined based on the Florida Uniform Permanent Impairment Rating Schedule.
  • Reasonable and Necessary Medical Care: This includes both past and future medical care needs for this injury.
  • Vocational Rehabilitation: If your injuries impact your ability to continue doing your job, you may be eligible to receive education or training for a new line of work.

To receive benefits, contacting a personal injury attorney is a smart plan, as they are experienced negotiators and will work with the insurance company to come up with a plan that works for everyone involved.

Compensation for Injuries That Don’t Impact Your Ability to Work

When most people are injured, they are still able to perform their usual duties at work. If this is true for you, you should still be able to receive benefits to cover any medication or medical expenses, but you will most likely not receive any payment for income replacement or lost wages.

There may be other situations in which you qualify for income replacement. In most cases, the claims fall into one of the following categories:

  • No Disability
  • Partial Disability
  • Permanent Disability

The more severe the disability, the larger the payment. If the injury you sustained on the job brought about no disability, then you can expect to receive a smaller claim than employees that have a partial or permanent disability.

What Isn’t Covered by Workers’ Compensation?

You may be surprised to hear that there are things that are not included in workers’ compensation. While in a normal personal injury claim you can typically request payment for pain and suffering, you are unable to claim that with workers’ compensation. This type of coverage only gives compensation for non-economic damages.

If you were put through notable pain and suffering, you may still have an option. For those who were injured at work but can prove that another party is also liable, you may be able to file a personal injury claim outside of your workers’ compensation claim.

It is important to keep in mind that Florida’s workers’ compensation insurance would not cover the injuries if they occurred while traveling to or from work. You are only eligible for compensation if the injury happened while working.

How To Report an Injury

In order to start a workers’ comp claim, there are some steps that you will need to take. Keep in mind that while most people are capable of filing their own workers’ compensation claim themselves, the process can be frustrating and occasionally overwhelming without legal help.

Immediately following an injury in the workplace, the first thing to do is inform your employer of the accident. Florida law says that most injuries need to be reported within 30 days of discovering that it was caused while working. It is important to inform your employer as soon as possible so that you do not lose any of your benefits.

When discussing the injuries with your employer, you should give them as much detail as you can remember. The most important details are: when the accident happened, how you injured yourself, and the symptoms you are having.

Once your injury has been reported to your employer, the next step is being examined by an occupational doctor. Unless you need emergency treatment, your employer gets to choose which doctor provides you with care. Make sure you give the doctor accurate information regarding how the injury occurred and how severe your symptoms are.

What Happens After Reporting an Injury

After your employer has been informed of the injuries you sustained at work, it is their job to report your claim to their insurance company. If they refuse to do so, you should contact the insurance company directly yourself. Once the insurance company has been notified, they will be able to determine if you are eligible for benefits. They will be looking at your medical records and they may request additional testing to assess your condition.

Florida law states that the workers’ compensation insurance company must either approve or deny your claim promptly. If approved, your benefits will begin. If denied, you may be able to appeal the decision.

Can I Appeal a Denied Workers’ Compensation Claim?

If your claim is denied by the insurance company, you will need to file some paperwork to appeal the decision. To appeal you will generally need to file what’s called a “Petition for Benefits” inside of two years from the date you were injured, or within one year of your last instance of wage loss or medical payment, whichever occurs later.

Usually, unless your claim is exceedingly simple and straightforward, you should strongly consider hiring a workers’ compensation attorney to take care of the bulk of the appeal work. The insurance company will always have a lawyer, often several, and you will be at a marked and severe disadvantage if you try to go at it alone. It may sound harsh, but insurance companies are extremely adept at taking advantage of victims who are underrepresented or lack legal counsel entirely.

When your claim is denied, the best thing you can do is work with an experienced lawyer who knows how to build a strong case for appeal and knows how to best present that case at each stage of the appeal process. They have extensive experience with navigating the workers’ compensation process and the appeals process in cases where the initial claim is denied.

Why You Should Contact Elstein Legal

If you are employed in the state of Florida and were injured while on the job, you may be eligible to file a workers’ compensation claim. In order to receive a fair payment that covers your damages, contacting a personal injury lawyer is a smart move. Elstein Legal is a Florida-based law firm specializing in personal injury cases. We will help you every step of the way, from consultation to receiving your settlement payment. Contact us as soon as possible to begin your case evaluation.

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