You have the right to challenge that denial in an administrative hearing before an administrative law judge, and that decision can be further appealed to court. If you haven’t yet contacted an attorney to help you through the claims process, you will certainly want legal advice and representation to challenge or appeal a denial.
Pensacola Workers’ Compensation Lawyers
Protecting Your Right to Fair Compensation
When you are injured on the job or suffer an employment-related medical condition, you typically have the right to receive monetary benefits for medical expenses, lost wages, and other losses under Florida’s workers’ compensation system. Workers’ compensation is a no-fault system, meaning you do not have to prove that anyone, including your employer, was negligent or otherwise at fault for your injury. In exchange for receiving workers’ compensation benefits, however, you usually cannot sue your employer for damages.
If you have suffered a work-related injury, illness, or medical condition and need help with your workers’ compensation claim, contact the Law Office of J.J. Talbott. Our Pensacola workers’ compensation lawyers can assist you at all stages of the process, from filing an initial claim to appealing a claim denial. We serve clients throughout the Florida Panhandle and across southern Alabama.
Contact us onlineor by phone at (850) 695-8331to schedule a confidential case evaluation with a member of our legal team.
Who Can Make a Workers’ Compensation Claim?
In Florida, all employers with four or more employees must carry workers’ compensation insurance. Additionally, all employers in the construction industry must carry workers’ compensation insurance, regardless of how many employees they have. There are very few exceptions, which means that you most likely qualify for workers’ compensation benefits if you were injured on the job or suffered a work-related illness or medical condition.
Injuries & Accidents Covered by Workers’ Compensation
Workers’ compensation covers all work-related injuries, illnesses, and medical conditions. As long as you can prove that your injury, illness, or medical condition is somehow related to your work, you can seek workers’ compensation benefits.
This means you could have a claim if you suffered a work-related:
- Fall, including a slip and fall
- Repetitive motion injury
- Head or traumatic brain injury
- Spinal cord injury
- Motor vehicle accident
- Transportation accident
- Overexertion injury
- Electrocution injury
- Burn injury
- Broken bone/fracture
- Respiratory illness
- Cancer
This is by no means an exhaustive list; if you were injured or became ill at work or because of your work-related duties, you are likely covered by workers’ compensation. You could be entitled to financial benefits to help offset the costs associated with your occupational injury or illness.
Types of Workers’ Compensation Benefits in Florida
In Florida, workers’ compensation offers several different types of benefits to qualifying individuals depending on the type and severity of their injuries.
Workers’ compensation benefits in Florida include:
- Temporary Total Disability (TTD): If you are temporarily unable to work due to your occupational injury or illness, you may qualify for TTD benefits. TTD benefits are paid at a rate of 2/3 your average weekly wage, subject to weekly limits that are adjusted annually.
- Temporary Partial Disability (TPD): TPD benefits are available to qualifying individuals who are able to return to work in a partial or modified capacity while recovering from a work-related injury or illness. You can only earn up to 80% of your pre-accident wages while receiving TPD.
- Impairment Benefits: If you are able to work but lost some degree of bodily function as a result of your occupational injury or illness, you will receive an “impairment rating” based on your disability. You can then receive benefits based on your impairment rating.
- Permanent Total Disability (PTD): PTD benefits are awarded when a person is unable to work or obtain any form of gainful employment due to a work-related injury or illness. PTD benefits are paid at the same rate as TTD benefits and can last until the worker is 75 or the rest of their life.
- Vocational Rehabilitation: If you are able to work but cannot return to your old job after a work-related injury or illness, you could qualify for vocational rehabilitation benefits. These benefits aid with the cost of training and education for new employment.
- Death Benefits: When a worker dies due to a workplace accident or occupational illness, Florida’s workers’ compensation system pays a death benefit of up to $150,000 to the family/dependents, as well as funeral expenses up to $7,500.
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What if I’m Not Happy With My Doctor?
Under the Florida Workers’ Compensation Law, the employer chooses all authorized treating physicians. However, if the employee is unhappy with their choice of treating physician, then they have a right to a one-time change in treating physician.
The employee must request this one-time change, usually in writing, and the employer has five days to select a new physician. If the employer selects the physician within five days, then the employer chooses the new physician. However, if the employer/carrier does not select a physician within five days, then the employee is entitled to select the treating physician.
Please note that you are only entitled to a change in treating physician for one time during the entire course of treatment. As such, at the Law Office of J.J. Talbott, we recommend that our clients do not select a change in treating physician early on in the case as it may be necessary to change doctors at a later date.
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What if I Can’t Return to Work After I Reach Maximum Medical Improvement?
Under the Florida workers’ compensation law, once you reach maximum medical improvement, you are entitled to two types of benefits: impairment benefit or permanent total disability benefit.
Impairment benefits are a nominal amount of benefits, usually a few thousand dollars, which compensate you for your impairment based on the permanent impairment rating that the physician has provided you.
For example, if the physician gives you a 3% impairment to the body as a whole, you’re entitled to six weeks of impairment benefits. If you have returned to work and are making the same amount of money as you were at the time of the accident, then the impairment benefits are simply 50% of your average workers’ compensation check. If you have not returned to work or are not making the same as you were at the time of the accident, then the impairment benefits are 75% of the average compensation check.
Impairment benefits cease when you’ve been paid the specific number of weeks of impairment benefits. However, if an employee is unable to return to any type of gainful employment, then the employee could be entitled to permanent total disability benefits. It is very hard to prove entitlement to permanent total disability benefits so you need to talk to your attorney about whether you would qualify.
If an employee is permanently totally disabled, then they are entitled to two-thirds of their average weekly wage until approximately age 75 (with exceptions). The employee may also be entitled to a cost of living increase at the rate of 3% per year.
Unfortunately, if the employee is not permanently totally disabled, then they would only be entitled to impairment benefits. This leaves a significant gap for an injured worker who has a significant wage loss as the result of the injuries.
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What does the law mean about “medically necessary treatment?”
A medically necessary treatment is any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to your diagnosis and status of recovery, and is consistent with the location of service, the level of care provided, and applicable practice parameters. Such treatment should be widely accepted among healthcare providers and not be experimental in nature.
As you can see, terms like “medically necessary treatment” have both medical and legal components to them. See an approved doctor for your diagnosis and treatment, but see an experienced workers’ compensation attorney when filing your claim or appealing a denial of benefits.
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Should I Quit My Employment?
Many employees indicate that they are treated differently once they file a workers’ compensation case or indicate that the employer makes them work with restrictions. As such, they indicate that they want to quit their job.
At the Law Office of J.J. Talbott, we do not recommend any employee quit their job. If you quit your employment, then the employer will have a defense that you voluntarily limited your income and this could prevent you from receiving any type of temporary partial disability benefits or permanent total disability benefits. Quitting your job could also reduce the value of your case. Instead, we recommend that the employee make sure that the employer provides work within the restrictions and not work outside of the restrictions.
If you think your employer is making you work outside of your restrictions, you need to speak to an attorney immediately, but do not quit your employment.
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Do I Get Compensated for My Lost Wages While I’m Recovering From My Accident?
Under the Florida’s Workers’ Compensation Law, an injured employee does not receive “lost wages” while they’re recuperating from their injury, but instead they may be entitled to temporary total or temporary partial disability benefits.
Specifically, if you are taken totally off work by your treating physician, then you’re entitled to temporary total disability benefits. If you are returned to work with restrictions, then you may be entitled to temporary partial disability benefits.
These benefits are not intended to totally compensate the employee for their lost wages, but intended to provide the employee some money while they’re recuperating.
Moreover, an injured worker is only entitled to receive temporary total disability benefits or temporary partial disability benefits up to the point that they reach maximum medical improvement. Once they’ve reached maximum medical improvement, the employee would then become eligible for either impairment benefits or permanent total disability benefits.
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What Is Maximum Medical Improvement?
Maximum medical improvement (MMI) is simply a date, selected by your treating physician, where he indicates that you are “as good as you’re going to get”.
MMI does not mean that you are not having problems, that you are not having pain, or that you’re better. It just means that lasting improvement is not expected to occur within the next year.
Maximum medical improvement is important as it establishes the date for which temporary total disability benefits or/and temporary partial disability benefits cease. After the date of maximum medical improvement, the employee would be entitled to impairment benefits or permanent total disability benefits.
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What Is a Managed Care Arrangement (MCA)?
Under the Florida Workers’ Compensation system, an insurance carrier can select to provide benefits under a managed care arrangement. If the carrier has elected to provide benefits under a managed care arrangement (MCA), then this provides the claimant additional rights, but greater duties in order to seek medical care.
Perhaps the most significant duty or obligation of the employee is that they have to exhaust the managed care agreement procedure prior to seeking assistance from the judge compelling medical care. Specifically, under most managed care arrangements, if the insurance carrier does not authorize care, then the employee has to request the medical care from the insurance adjuster, the medical care must be denied, then the employee must file a grievance, and the grievance procedure must be exhausted before the employee can seek help form the Court.
Unfortunately, this causes some delay in getting medical care authorized. On the other side, the MCA does provide additional benefits to an employee, which we feel are very helpful. For example, under most managed care arrangements, the employee is entitled to a change in treating physician, they are entitled to a second opinion, they’re entitled to an employer paid independent medical examiner (the employee actually gets to choose a doctor and have that physician issue an opinion concerning their need for medical care or treatment), and very importantly, the claimant is entitled to their choice of primary care physician.
A primary care physician is usually a general practitioner doctor, or family practitioner, and acts as a gatekeeper for the claimant during the entire course of care. Many insurance carriers imply that this would be the urgent care physician or the first physician that the claimant sees, but this is not necessarily so. Likewise, the claimant gets to choose their primary care physician. This provides the claimant some significant benefit in controlling their medical care.
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What if My Benefits Are Denied?
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When Should I Report the Injury to My Employer?
Any time that you are injured in an accident, we suggest that you immediately report the injury to your employer. Under Florida workers’ compensation law, an employer has a defense to a workers’ compensation case if the employee does not report the injury within 30 days (90 days if it is an occupational exposure case).
While an employee may injure themselves and think that they will simply get better, not reporting the accident and not seeking medical care may act to invalidate the employee’s workers’ compensation claim and/or establish a defense or the carrier of late notice. Therefore, notify your employer of the accident immediately. If the employer refuses to provide medical care, then put it in writing, whether by email, fax or have someone witness you reporting the accident to your employer.
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What Happens After I File a Claim?
You should receive information about the claims process from your employer’s insurance carrier that will tell you what to do. Your employer is required to inform the carrier about your claim within seven days after you report it. If you don’t hear from the insurance carrier or suspect that your employer did not notify them, you can contact them directly. Contact information for the company’s workers’ compensation insurance carrier should be posted in the break room or elsewhere in the workplace. If not, contact the Employee Assistance and Ombudsman Office or contact a workers’ compensation attorney for advice and assistance.
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Why Are Florida Worker’s Compensation Claims Denied by the Insurance Company?
The number of denied Florida workers’ compensation claims has increased over the last 10 years and now exceeds 10%. If the insurance company is going to deny your claim, they are required to file a Notice of Denial with the Florida Division of Workers Compensation. You should receive a copy of the Notice of Denial. However, sometimes the insurance company may wait to deny your workers’ compensation claims: Florida Law allows them 120 days to pay and investigate your claim if they are uncertain of their responsibilities.
Some reasons that the insurance company may deny your claim include:
- The application for Compensation was late or incomplete
- Discrepancies between the accident report and the claimed injuries.
- The employee did not seek medical care from the employer’s doctor.
- The injury did not happen at work.
- The employer claims a pre-existing condition
- There were no witnesses to the accident
- The injury was caused by the employee or the use of drugs
- No Medical evidence that an injury occurred
The attorneys at Talbott & Lampert, PA are experienced workers’ compensation attorneys and will provide you a free consultation to discuss your case. Contact us today.
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What Is the Average Weekly Wage in a Workers’ Comp Case?
The average weekly wage (AWW) is the claimant’s average weekly earnings during the 13 weeks prior to the on-the-job accident.
The AWW is important as this is the monetary amount for which the insurance company will calculate temporary total, temporary partial, permanent impairment, and permanent total disability benefits. Specifically, if the employee has worked for the employer for the entire 13 weeks prior to the accident, then the AWW will be equal to all the wages the employee earned during those 13 weeks and divided by 13. However, if the employee does not work the entire 13 weeks, then the carrier has to use other methods to obtain the average weekly wage.
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What if the Medical Bills Are Not Paid by the Workers’ Compensation Insurance Company?
Often, the workers’ compensation carrier delays paying medical bills for various reasons. In our practice, we have had employees communicate concerns that the carrier’s failing to pay the medical bills will affect their credit.
Under Florida Law, if the insurance carrier authorizes treatment, then the insurance carrier, and not the employee, is responsible for the payment of medical bill. If the carrier does not pay the medical bill, then the employee may be required to seek assistance from the Division of Administrative Hearing to get the medical bill paid.
At the Law Office of J.J. Talbott, we help our clients to get their medical bills paid by using other laws and statutes against the insurance company.
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Insurance Company Denied My Workers’ Compensation Claim-What Do I Do Now?
Even if you are injured on the job, the insurance company can still deny your workers’ compensation claim. Sometimes they deny your claim for strategic reasons, like wanting to push you to settle, and sometimes they deny the claim as they may believe that they are not liable for the accident or injuries. It is important to know that the insurance company is not the final word.
Under Florida law, you have a right to have an Administrative Law Judge who is knowledgeable of the workers’ compensation system hear your case and determine if you are entitled to workers’ compensation benefits.
However, you should contact an experienced worker’s compensation attorney to handle your case and to guide you through the complicated law. The attorneys at Talbott & Lampert, PA are experienced workers’ compensation attorneys and will provide you a free consultation to discuss your case.
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Do I Need an Attorney on My Workers’ Compensation Case?
The workers’ compensation laws in Florida and Alabama are very complex. While the law was initially drafted in order to provide the claimant medical care in a quick fashion, the insurance company usually takes every opportunity to prevent the employee from getting medical care or limit the amount that they have to provide the employee for medical and/or indemnity benefits.
That is why we recommend that you at least get a free consultation with a worker’s compensation attorney, like the attorneys at the Law Office of J.J. Talbott, as they can help the employee understand the workers’ compensation law, can provide quality advice and can assist you in obtaining all the benefits that you are entitled.
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Do I Have to Let the Workers’ Compensation Nurse Case Manager Into the Room With Me When I See My Doctor?
Under the workers’ compensation law, the treating doctor must communicate with the insurance company about your medical care and need for treatment.
However, the nurse case manager does not have the right to go into the room with you when you are seeing the doctor. The employee has a right to control who attends the doctor appointments and has the right to keep the nurse case manager out of the room during the appointment. We suggest that our clients do not have the nurse case manager come into the room when the employee is seeing the doctor as this often interferes with the doctor/patient relationship and because the nurse case manager may try to persuade the doctor to limit the medical care that you are entitled to.
If you do not want the nurse case manager in the room with you, then simply advise them that you want to see the doctor without them in the room.
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Can I Sue for Damages Instead of Filing a Workers’ Compensation Claim?
In most cases, filing a workers’ compensation claim is your exclusive recourse for an on-the-job injury. Although you cannot sue for damages such as pain and suffering, there is a benefit in not having to go to court and prove negligence or fault in order to recover, provided you have the help of an experienced workers’ compensation attorney to guide you through the process.
There are limited instances where you can sue, however. For instance, if your employer engaged in willful or intentional misconduct which could be said to lead with a virtual certainty to an employee injury or death, you may be able to sue for the injuries caused. You might also be able to sue if your employer does not have workers’ compensation insurance. Additionally, you may have a cause of action against a negligent third party if you were injured by a defective product, in a car accident, or on another’s dangerous property, even if you were working at the time.
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Common Injuries With Construction Workers
Construction Worker Injuries in Florida
Construction sites are dangerous places. Not only is the work physical, but construction workers are often required to use heavy machinery, work around dangerous equipment, work in high places, and work on roadsides where automobile accidents occur. Unfortunately, because of the nature of this work, construction workers face a greater risk of injuries on the job.
If you are a construction worker who was injured on the job, you may be faced with serious medical problems, ongoing pain, and financial worries due to missed work and medical limitations. Florida law provides a number of protections for construction workers who are harmed at work. It is important that you understand your rights and make sure you receive the benefits that you are entitled to.
Call the Law Office of J.J. Talbott today for a free consultation and allow us to examine your case. We can also advise you whether you can file a third-party liability claim against the person who caused your injuries.
Simply call us today at (850) 695-8331">(850) 695-8331
Construction Site Injuries
There are many different hazards that construction workers face. According to the United States Occupational Safety & Health Administration (OSHA), the top causes of injuries on construction sites include:
- Falling from heights – A worker may fall from a roof, scaffolding, or fall off a piece of machinery to the ground. Workers can also fall into holes or ditches on construction sites.
- Trench collapse – When a trench collapses, a worker can be buried alive, the worker’s air supply can be cut off, and they can suffer crushing injuries.
- Collapsed scaffolding – OSHA has strict rules to ensure the safety and stability of scaffolding, but things can and often still go wrong, causing a worker to fall and sustain serious injury or death.
- Electric shock and or arc flash/blast – Working with generators, power tools, machinery, and electrical wiring all create potential hazards that put construction workers at risk of being electrocuted or suffering other electrical injuries such as burns.
- Failure to use appropriate protective gear – Hardhats, safety glasses, and other personal protective equipment (PPO) should always be worn on construction sites to prevent injury.
- Repetitive motion injuries – When the body is repeatedly asked to do the same things again and again, the muscles and soft tissues can become worn and damaged, limiting mobility and causing pain.
Additionally, workers on a construction site are hurt as a result of traffic accidents, such as being hit by another vehicle, ladder collapses, removed safety devices, malfunctioning tools or equipment, and errors made by other workers.
At the Law Office of JJ Talbott, we represent construction workers who have suffered a variety of serious injuries, including:
- Burns
- Electrocution
- Eye injury, including vision impairment or blindness
- Broken bones
- Knee injuries
- Foot and ankle injuries
- Shoulder injuries
- Neck or back injury
- Spinal cord injuries,
- Illnesses caused by toxic chemical exposure
- Head injuries and/or brain injuries.
How We Can Help You!
If you or a loved one was hurt while performing work in a construction job, a workers’ compensation lawyer from the Law Office of JJ Talbott can provide you with comprehensive legal representation concerning your case. We can help:
- File a workers’ compensation claim.
- Determine whether you have a third-party liability claim.
- Force the insurance company to pay the medical bills for work-related accidents,
- Force the insurance company to provide appropriate medical care,
- Collect unpaid indemnity or money benefits,
- Make sure the insurance company is paying you at the proper average weekly wage,
- Gather and preserve evidence to prove your eligibility for compensation
- Keep your claim moving forward
- Fight a workers’ compensation claim denial
- Negotiate a settlement if there is a dispute over benefits
- File a third-party lawsuit in court and/or negotiate a settlement with a responsible third party
These are just some of the many services that our lawyers provide to clients across the State of Florida and Alabama. For more information about how we can assist you after your construction accident, give us a call today to schedule a free consultation. You will pay no attorney fees unless we secure benefits for you.
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Can I see my own doctor for treatment?
Initially, you are required to see a doctor designated by your employer, or more specifically, by your employer’s workers’ comp insurance carrier. If unhappy with the doctor, in Florida you are allowed to make a written request for a different doctor, but you can only do this one time. If the carrier doesn’t respond to your request within five days, you can choose your own lawyer to treat you. In Alabama, if unhappy with your doctor, you can select another doctor from a panel of four doctors provided to you.
When the doctor you see is chosen by and works for the insurance company, you may feel like they are biased, and this may be so to a certain extent. You are not prohibited from getting a second opinion from a doctor you trust. This will be at your own expense, but it may help you in your case to receive benefits and the proper treatment. Ask your attorney if unsure of what to do.
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Can I Choose My Own Pharmacy to Get My Prescriptions Filled?
Many insurance companies like for the employee to use the insurance company’s mail-order pharmacy or local discount pharmacies, as it saves the insurance company money. However, this often causes issues with the employee getting the prescription filled or delays authorization for the prescription.
The employee does not have to use the insurance company’s pharmacy and is entitled to select the pharmacy that they want to use. At the Law Office of J.J. Talbott, we also recommend using companies such as Injured Workers Pharmacy as they provide significant help to injured employees.
Client Experiences
We Treat Our Clients Like Family
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I really appreciated all the hard work that this law firm put in for me and how nice the people were that worked on my behalf.Dewitt L.
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I was very pleased with the service and the recovery of my lost wages.Ann M.
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I love you all so much. Thanks for all of your hard work! If I ever need to come back it will be you guys. Thanks.La Rheasa M.
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Has always done it correctly and thoroughly. You can give complete trust to J.J. and the whole Talbott staff.Brian C.
What Makes Us Different?
Reasons Our Clients Love Us
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Work Directly With Your Attorney
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Welcoming and Laid-Back Atmosphere
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We Always Return Phone Calls Within 24 Hours
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We Treat Our Clients Like Family
What to Do If Your Workers’ Compensation Claim Is Denied
If your workers’ compensation claim is denied, you can file an appeal up to two years from the date of your work-related injury. It is a good idea to discuss your options with a knowledgeable attorney, like those at the Law Office of J.J. Talbott, as the appeals process can be confusing and some claims may even need to go to trial.
To appeal a denied workers’ compensation claim in Florida, you must typically do the following:
- File a “Notice of Appeal” and filing fee within 30 days of receiving notice that your initial claim has been denied. There are several options for people who cannot afford the filing fee.
- Wait for a response from the insurance company. The insurance company has 14 days to respond to your appeal; if it does not respond, it must pay your claim.
- Participate in mediation with the insurance company, your attorney, and a mediator who will attempt to resolve the dispute. If an agreement cannot be reached, the process proceeds.
- Attend a formal hearing before the Office of Judges of Compensation Claims (OJCC) if mediation is not successful. An administrative law judge (ALJ) will hear and decide on your case.
- If you do not agree with the ALJ’s decision, submit a final appeal with the First District Court of Appeals with the assistance of your attorney.
Our Pensacola workers’ compensation lawyers are well-versed in the workers’ compensation appeals process in Florida. We can help you at all stages of the process, protecting your rights and best interests every step of the way.
Whether you’re one of the 250,000+ Floridians injured in an auto accident each year, or you’ve suffered an injury at work and your employer’s insurance company is not co-operating, the Law Office of J.J. Talbott can help get you the compensation you deserve. Founder, J.J. Talbott is among the 1% of trial lawyers in the United States who have won multi-million dollar verdicts and settlements.
How Our Workers’ Compensation Attorneys Can Help
We understand how difficult it can be to heal and move forward with your life after a serious work-related injury or illness. The recovery process can be made all the more difficult when you do not receive the fair benefits you are entitled to receive.
The Law Office of J.J. Talbott is committed to helping injured workers and their families. We can handle all the necessary paperwork, meet all applicable deadlines, and work with the insurance company to negotiate a fair settlement or payment of benefits. We are prepared to assist you with appealing a denied workers’ compensation claim or early termination of benefits. No matter the situation at hand, you can rely on our team to fight tirelessly for you.
For help with your workers’ compensation claim, call (850) 695-8331 or contact the Law Office of J.J. Talbott online.
Client Testimonials
The Law Office of J.J. Talbott helped me through the process of my legal issue. They helped me get the medical and financial assistance I needed during my injury. - Lori D.
He has actually handled two cases for me. He handled my workers comp and my social security after I was hurt at work. I send people to them all the time. I would definitely use him again, for anything. He even gave me his cell number and would take my calls after hours. They’re great! - Ginger L.
