We need climate change in the State of Florida. Big time! What kind of climate change you may ask? Well, I ask you this: when you think of “workers’ compensation fraud,” what comes to mind? The “injured” worker collecting a disability check and caught on…
Understanding Florida Workers’ Compensation
In 2019, millions of people experienced nonfatal injuries and illnesses in the workplace, according to the Bureau of Labor Statistics. Roughly 157 million adults are employed in the United States, and nearly 2% will become injured workers in any given year. This only includes incidents reported to the U.S. Department of Labor. It’s safe to say that workplace injury is more common than most people realize since many instances go unreported. Trying to make sense of workers’ compensation law after an accident can be difficult, mainly because the process varies from state to state.
What Is Workers’ Compensation?
Workers’ compensation insurance provides benefits to employees after workplace injury or work-related sickness occurs. Most states require companies to carry workers’ compensation insurance, with narrow exceptions for small businesses. In Florida, companies with more than four full-time or part-time employees must offer workers’ comp insurance.
The rules are different for construction businesses, which have to provide workers’ compensation insurance if there’s more than one employee. In the agricultural industry, businesses with more than six employees or more than 12 seasonal workers have to offer workers’ comp to injured workers. Companies are usually mandated to carry workers’ compensation insurance, and anyone hurt on the job is protected by the workers’ compensation system.
If you find out your employer does not have workers’ compensation insurance, you should report the violation to the Florida Department of Financial Services. Your employer will face fines for their non-compliance. While you aren’t usually allowed to sue after filing a workers’ compensation claim, you might be able to bring a civil lawsuit if your employer didn’t carry insurance, depending on where you live. In Florida, your employer will face a stop-work order until they meet compliance standards outlined in the state workers’ compensation statutes.
Workers’ Compensation Claims
Unlike other forms of insurance, workers’ compensation insurance is considered “no-fault,” which means that you’re eligible to file a claim regardless of who is to blame for the injury or illness you experienced. Under Florida workers’ compensation law, you won’t receive damages for pain and suffering or face a judge and jury, but you will have a compensable case. If you behaved in a negligent manner before your injury, your employer’s workers’ compensation insurance might try to challenge your claim.
So what happens after you’re injured while at work? After you notify your employer, they will reach out to their insurance company to let them know. Then, you should seek medical care and make sure everything is documented. If an injury isn’t severe, you’ll be advised to go to urgent care instead of visiting a hospital. Once you arrive at a doctor’s office, you may be asked to take a drug test to prove you didn’t injure yourself because of intoxication. After you are initially seen, you will make follow-up appointments. The seriousness of the injury will determine how much further treatment you need.
While being treated, you won’t pay for medical appointments, medical bills, or prescribed medication. Once you fully recover, your doctor will say you’ve reached Maximum Medical Improvement (MMI). According to Florida Statute 440.02(10), MMI is the “date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.” After you are placed on MMI, you’ll have a $10 copay at medical appointments. You may still be covered for future treatment if you’re still experiencing complications or side effects from the injury after maximum medical improvement is reached.
If an accident is more severe and you can’t work at all because of it, you’ll be eligible to receive Temporary Total Disability (TTD). Also known as wage loss benefits, TTD kicks in if a doctor tells you that you cannot return to work after the injury or illness. Total disability benefits will apply to you until you reach maximum medical improvement. If you can return to work with clearance from a doctor, you will be expected to do so even in a limited capacity.
How Much Will You Receive From Workers’ Compensation Insurance?
Your employer’s workers’ comp insurance will pay you benefits after calculating your Average Weekly Wage, or AWW. The compensation system determines your average weekly wage by taking your pre-tax wages for 13 weeks before your accident, adding them up, and dividing the number by 13. If you are injured in 2021, you can receive up to $1,011 weekly. If you were injured in 2020, you’re eligible for up to $971 every week.
Benefits only last until you’ve reached maximum medical improvement unless you’ve been injured permanently. In that case, your doctor will give you a Permanent Impairment Rating (PIR), which Florida Statute describes 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.” The rating is on a scale of 1% to 75%, and the amount you’re entitled to will vary based on your impairment level.
The Florida Division of Workers’ Compensation helpfully provides a formula to determine how much money you’ll be eligible for after a work injury. For the sake of this example, let’s say your injury occurred in 2021, and your average weekly wage is $1,000. You haven’t returned to work yet, and your impairment rating is 15%. You would be entitled to 35 benefit weeks and eligible for $250.01 per week. Your total disability benefits would be $8,750, along with your medical bills and other expenses being covered.
If you had a much higher weekly wage, like $2,000, and an impairment rate of 20%, you’d be eligible for over a year of benefits with over $380 a week and $20,852 in total disability benefits. Lastly, let’s assume that you have an average wage of $500, an impairment rating of 5%, and you’ve returned to work. In that case, you would only receive $125 a week for ten weeks. As you can see, there are many variables in the compensation system that affect how much Florida workers receive.
Permanent Total Disability
In some cases, a workplace injury is severe enough to meet the standard for permanent total disability. Instead of an injured worker needing temporary leave for work, coverage for a modest number of medical bills, and payment of lost wages for a short time, a permanent disability means they will likely never work again, even in a sedentary environment. Rare injuries like amputation, total blindness, and spinal cord damage can lead to a permanent total disability determination.
Permanent disability is only declared when a debilitating condition has significantly impacted the employee’s quality of life. In many cases, injured workers with permanent total disability also have hefty medical bills. If an injured worker is still undergoing treatment, it will take time for a permanent disability declaration to be reached. Usually, it must be determined that further medical care would not improve your condition, and you will probably never be fit to return to work. If you meet this standard, you will typically be eligible for benefits until you turn 75, and you’ll receive two-thirds of your average weekly wage.
Workers’ Compensation Settlement
After maximum medical improvement is reached, you’ll likely hear from your employer’s insurance carrier about settling the case. They’ll offer reimbursement based on a few things, like unpaid medical bills and costs, but one of the top considerations is how much money you’ll need in the future. If your injury caused permanent damage, you would likely be entitled to additional benefits. You’re not required to settle, and if an injured party and an insurance company can’t reach a compromise, the case will be resolved by the courts. It’s essential to navigate the settlement process carefully. Once your case is closed, you will likely not be able to return to your employer and seek extra compensation.
If you decide to settle, you may be asked to voluntarily resign by your employer and their insurance carrier. Often, this is a condition of the settlement. Voluntary resignation may seem like a harsh conclusion — why would you need to leave your job after a settlement? There are a few reasons this is so common. In many circumstances, the insurance company is worried that you will get injured again while working, and they will have to pay another settlement. Other times, your employer may just decide that it’s better to part ways.
Which Industries Are Most At Risk?
Anyone can be injured or get sick while at work, but some industries are more likely to see workers’ compensation claims than others. If you are in a higher-risk occupation, it’s important to know workers’ compensation insurance regulations and how it works. A recent report from the U.S. Department of Labor analyzed a few industries that see days away from work due to occupational injuries. The most common professions are listed below.
- Nursing assistants
- Truck drivers
- Freight, stock and material movers
- Construction workers
- Maintenance and repair workers
- Stockers and order fillers
- Janitors and cleaners
- Registered nurses
- Retail salespersons
Another report from the Department of Labor looked at the industries that most commonly reported workplace illness and injury in 2020. The raw numbers below show the scope of workplace injury claims and how some fields see significantly more than others.
- Health care and social assistance: 544,800 injuries
- Manufacturing: 395,300 injuries
- Retail trade: 401,100 injuries
- Accommodation and food services: 271,000 injuries
- Transportation and warehousing: 213,100 injuries
- Construction: 195,600 injuries
- Wholesale trade: 157,100 injuries
- Administrative and waste services: 112,800 injuries
- Other services (except public administration): 70,800 injuries
- Professional and technical services: 66,100 injuries
How Are People Getting Hurt?
It’s important to remember that many injuries aren’t reported to employers or insurance companies and therefore don’t lead to workers’ comp claims or get reported in national statistics. Research from the National Safety Council estimates that anywhere from 20 to 70% of workplace injuries go undercounted. Of those reported to the Bureau of Labor, there are clear trends in how injuries occur.
Overextension and bodily reaction are the leading cause of workplace injury. Overextension usually happens when an employee is pushing, carrying, or lifting something heavy. The second most common cause of workplace injury is falls, slips, or trips. This includes slipping and trying to catch yourself, and it can also have serious instances like falling off a ladder or through scaffolding. Lastly, injuries are frequently caused by contact with objects or equipment. This can happen when an employee is struck by a moving object or caught in a piece of machinery.
Can You Represent Yourself In A Workers’ Compensation Claim?
If your workers’ comp claim is relatively straightforward, you may be able to handle it yourself. Let’s say you have a minor injury that isn’t permanent, and your employer accepts that your injury happened at work. If it’s an agreeable situation, it might make sense to handle it on your own. It’s never a bad idea to consult with a workers’ compensation attorney to make sure you’ve covered all of your bases and that everything will be handled properly.
Too often, cases aren’t as simple as you think they will be. Here are a few scenarios where you should consider hiring a workers’ comp attorney.
- You have a preexisting condition that could have exacerbated the injury. If you have chronic back pain and then injure your back while working, insurance may try to challenge your claim and say the workplace accident didn’t significantly affect your health. An attorney can help you if you’re facing issues with a claim due to a preexisting condition.
- Your boss retaliates after you file a claim. Your employer might decide they do not want to face the cost of a workers’ compensation claim, even though they’re required to do so. You may even be disciplined or fired for pursuing a workers’ compensation claim. This isn’t allowed under Florida law, and you may need to involve an attorney to remedy this.
- You meet the standard for permanent total disability. If a serious injury prevents you from working again, you’ll be seeking more than lost wages and reimbursed medical bills. You will be receiving workers’ compensation benefits until you reach retirement age. You shouldn’t navigate the workers’ comp settlement process alone, given the complexity of your situation.
- An insurance company denies your claim. If you have a preexisting injury, you fail a drug test, or you don’t report your injury immediately after it happened, your workers’ comp claim may be denied by insurance. Even though these factors can complicate your case, they don’t always disqualify you. You can appeal, and a lawyer will help you do so.
- Your settlement is not adequate. You’re entitled to receive payment to offset the cost of lost wages and medical bills. If you receive a settlement offer that doesn’t fully cover your injury-related expenses, you’ll need to challenge the insurance carrier. An attorney can help you throughout that process.
Florida’s workers’ compensation policy can be confusing, especially if you have no prior knowledge of the system. While you can handle things yourself, consulting a qualified workers’ comp attorney can make the process easier and alleviate any stress in reaching successful results.