Workers’ Compensation Claims
The Florida workers’ compensation system is designed to compensate employees who were injured on the job or suffer job-related illnesses. Although the system is supposed to work smoothly, it is actually very confusing, and it can make it hard for the injured worker to receive the benefits that they are entitled to. The aggressive workers’ compensation attorneys at the Law Office of J.J. Talbott are here to help guide you through the system and fight to get you all the benefits you deserve. If you have questions concerning your rights, contact us for your free consultation.
Reporting a Workers’ Compensation Claim
It is important that you act quickly to report all work-related injuries. If you fail to timely report these injuries, it can negatively impact your claim and your ability to receive medical benefits and disability benefits/money. Generally, you have thirty days to report a work-related injury.
Getting Workers’ Compensation Benefits
Under Florida law, to establish a compensable workers’ compensation claim, the employee must prove that they had a (1) accident at work; (2) that they suffered an injury; (3) that the injury arose from their employment; and (4) that the injury was the major contributing cause of the need for care. While the mechanism of the accident may make it easy to prove their claim (e.g broken leg), in other situations it is much harder (e.g. back injury). An experienced workers’ compensation attorney is helpful in proving your case.
An injured employee is generally entitled to two types of workers’ compensation benefits, medical benefits, and money benefits.
First, with regard to medical benefits, the employer is required to provide all medically necessary treatment, including surgeries, physical therapy, prescribed medications, mileage to medical appointments, and any medical devices ordered by the workers’ comp doctor. Florida Statutes, 440.13. Unfortunately, the employer selects the treating doctors, but the employee is entitled to a one-time change of physician.
Second, the employee could also be entitled to monetary benefits, including Temporary Total Disability benefits, Temporary Partial Disability benefits, Impairment benefits, Vocational Retraining benefits, and Permanent Total Disability benefits.
What Are The Different Types Of Money Benefits?
When a workers’ compensation doctor determines that an injured employee cannot perform his or her duties at work (temporarily), the employee may be entitled to Temporary Total Disability benefits (TTD). The TTD benefits are typically paid every two weeks for an amount equal to two-thirds of the worker’s pre-injury Average Weekly Wage (AWW). If an injured employee’s doctor determines that he or she can return to work, but with restrictions, then the worker may qualify for Temporary Partial Disability benefits (TPD) as long as he or she is earning less than 80% of his or her pre-injury average weekly wages. Like temporary total disability benefits, the workers’ compensation payments for temporary partial disability cannot exceed 66.66% of the injured workers’ average weekly wage.
Unfortunately, payments for workers’ compensation benefits do not include compensation for the employees’ pain and suffering, loss of enjoyment of life, or similar personal damages as these are not permitted under the Act.
When an employee’s work-related injuries are deemed permanent, the worker is entitled to receive either Impairment benefits (IBs) or Permanent Total Disability benefits. IB’s are based on the permanent impairment rating assigned by the workers’ doctor. IB’s are paid at the rate of 75% of the employee’s average weekly TTD benefits for the following periods: two weeks for each percentage point of impairment up to 10%; three weeks for each percentage point of impairment from 11% up to 15%; four weeks for each percentage point of impairment from 16% up to 20%; and six weeks for each percentage point of impairment from 21% and higher. However, if the employee has returned to his pre-injury earning capability, then they only receive IB benefits at the rate of 50% of the employee’s average weekly TTD benefits.
On the other hand, if the employee is not able to return to ANY gainful employment on a permanent basis, then the employee may be entitled to Permanent Total Disability (PTD) benefits. PTD benefits are paid at the rate of 66 2/3% of your AWW, plus you receive supplemental benefits which are an additional 3% per week (times the number of years since the accident).
If you have questions as to what money benefits you are owed, call the Pensacola workers’ compensation attorneys at the Law Office of J.J. Talbott and JJ can help.
Workers’ Compensation Settlements
Workers’ compensation lump-sum settlements are not mandatory but represent a voluntary agreement between the injured employee and the work-comp insurance carrier. However, if an injured worker obtains a lump-sum settlement, the worker then assumes responsibility for all future medical expenses related to his or her job-related accident or illness.
There are no provisions under the work-comp laws that require your employer to hold your job until you are able to return to work. Existing workers’ compensation laws do, however, prevent your employer from firing you because you have filed or may be attempting to file a workers’ compensation claim for work-related injuries or illness.
If you have any questions concerning your entitlement to workers’ compensation benefits, please feel free to contact the experienced workers’ compensation attorneys at the Law Office of J.J. Talbott for a free consultation.
Fighting The Insurance Company’s Denial of Your Claim or Benefits
If the employer denies your workers’ compensation claim, refuses to authorize treatment, or refuses to provide you with your benefits, you should immediately contact an experienced workers’ compensation attorney. They may be able to provide technical assistance to get the insurance company to rescind their denial of benefits. Also, since the workers’ compensation statute can require the insurance company to pay your attorney fees, sometimes getting an attorney involved early can keep the insurance “in check”, as the threat of attorney fees is a strong deterrent.
If the insurance company still denies your benefits, your attorney can file a Petition for Benefits with the Judges of Compensation Claims (OJCC). The petition must provide very specific detail of your accident, your injuries, and the benefits that you claim. The insurance carrier must either pay your claim or respond to the OJCC within 14 days. If they fail to respond, it will be deemed a denial of the claim for benefits. The OJCC then assigns a case number and the case is assigned to a judge,
After the case is assigned to a judge, the clerk will schedule the Petition for Benefits for mediation and a final hearing. These dates are flexible, so the parties can change the dates to accommodate scheduling issues. However, the final hearing must be held within 210 days of the date that the petition was filed. During this time, your attorney will have an opportunity to gather information from the insurance company, your employer, your doctors, etc. which is necessary to prove your case. This includes taking depositions, sending a request for production of documents, obtaining medical records, and even obtaining your own independent medical examiner.
Before you go to the final hearing, the parties are required to mediate your petition for benefits with a mediator. The State of Florida provides a mediator at no cost, but the parties have the option to pay for a private mediator. At the mediation, the parties attempt to resolve the outstanding issues, or they can settle the entire case. Please note that there is no requirement for the insurance company to settle with you and there is no requirement for you to settle with the insurance company. Any settlement of your case must be agreed upon by both sides.
If the issues are not resolved at mediation, then the parties will proceed to the final hearing. The final hearing is usually in the office of the Judge of Compensation Claims, whether here in Pensacola or in Panama City. At the hearing, your attorney will present witnesses and evidence on your behalf, as will the insurance company. In about thirty (30) days, the judge will issue a written opinion. If you don’t agree with the judge’s decision, you have 30 days to appeal to the First District Court of Appeals. This step of the appeal process will be even more complicated and could take more than a year. The Court of Appeals may confirm the OJCC’s decision, overturn the decision, or send the case back to the OJCC for more findings.
If you’ve been hurt on the job in Florida, call the Pensacola and Ft. Walton Beach workers‘ compensation attorneys at the Law Office of J.J. Talbott for your free consultation. You can also contact us online or call our Pensacola office directly at (850) 437-9600 to schedule your free consultation. We proudly serve Florida residents including all of Pensacola, Fort Walton Beach, Crestview, Panama City, and Tallahassee