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Workers Compensation


Am I entitled to Workers’ Compensation benefits?

If you have been injured during the course and scope of your employment, you may be entitled to benefits.  However, there are certain exceptions.  For instance, the work-related accident, must be at least 51% or more the cause of your current symptoms and need for treatment.  There are also other exceptions.  If you are unsure whether or not you qualify, please feel free to call us to discuss the matter?

 

If I do qualify, what benefits will I receive?

If you do qualify for Workers’ Compensation benefits, you may be entitled to medical benefits and/or lost wages.  However, you must receive medical treatment from a medical provider that has been authorized by the workers’ compensation carrier.  You may not seek treatment from just any provider.  The carrier may not pay for any unauthorized medical care.

 

For how long will I receive medical benefits?

You could be entitled to receive medical benefits under your workers’ compensation claim for the rest of your life.  However, there are some exceptions.  For instance, if your hurt your back on the job and you later re-injure your back in some way (i.e. a motor vehicle accident, another work-related accident with a different employer, etc.), the employer/carrier may argue that the subsequent accident has become the cause of any further treatment and may cut off your workers’ compensation benefits.  In addition, if the Statute of Limitations runs out (see below), you may not be entitled to any further benefits.

 

How long is the Statue of Limitations?

The Statute of Limitations is typically two years from the date of the accident, or 12 months from the date of the last authorized medical care or last payment for non-medical benefits by the workers’ compensation carrier.  However, there are some exceptions.

If you are unsure whether or not the Statute of Limitations has run on your claim, please feel free to call us to discuss such.

 

What will I receive for lost wages?

To be entitled to lost wages, your authorized medical provider must say that you are unable to work, or that you can only work in a restricted capacity.  In addition, there is a waiting period of 7 days, for which you are not paid initially, before the carrier has to pay lost wage benefits.  To be paid for the first 7 days of missed time, you must miss time for more than 21 days.

Any lost wages are calculated based upon an average of your earnings (average weekly wage or AWW).  Your AWW can be calculated many different ways.  However, the most common way is to use an average of your 13 week earnings prior to the accident, not including the week of the accident.  If you have not worked substantially the whole of 13 weeks, then alternate methods, such as using your contract of hire, may be used to calculate your AWW.

If you are unable to work at all, per your authorized medical provider, you may be entitled to 2/3 of your average weekly wage.

If you are able to work, but only in a restricted capacity, per your authorized medical provider, a formula is used to derive your lost wages.  However, you are not entitled to any lost wages unless your current earnings are less than 80% of your average weekly wage.  The formula used to calculate your lost wages is:

                        80% * (80% of your AWW - your current earnings)

Example:
AWW = $1,000.00
80% AWW = $800.00
You work on restricted duty and make only $500.00
The carrier would pay 80% * ($800.00 - $500.00) = $240.00

It should be noted, however, that there is a maximum that you can be paid per week.  The maximum amount changes annually.  Therefore, the maximum amount that you can be paid weekly will depend on the year in which you were injured.

 

For how long can I receive lost wages?

Your lost wages are limited to a maximum of 104 weeks unless you are accepted as or found to be permanently and totally disabled.  In addition, your lost wages will end once you reach maximum medical improvement (MMI) as determined by all authorized medical providers with which you are treating.  Once you reach MMI, you are no longer entitled to lost wages.  However, you may be entitled to impairment benefits.

 

What is maximum medical improvement (MMI)?

MMI is reached when your providers have done all they can for you and do not expect you to improve further.  At that point, your medical providers will state whether or not you have a permanent impairment rating, and your lost wage benefits will end. 

 

Can I continue to treat after I reach MMI?

Yes, you can and you should, if you are continuing to have problems.  In addition, once two years has passed since your accident, you must have received authorized medical care at least once every 12 month period, or the Statute of Limitations may run out, and you may lose entitlement to any further benefits.

You will have to pay a $10.00 co-payment when you see the authorized medical provider after MMI.

 

What are impairment benefits?

Impairment benefits are monetary benefits to which you are entitled if you have a permanent impairment rating.  The amount of the benefits will depend on the date of your accident.                      

 

If I am not happy with the medical provider that the employer/carrier referred to me, can I see another doctor?

As noted above, you cannot go to just any doctor or medical provider on your own.  If you do, the carrier may not be responsible for payment for such.  However, if you are unhappy with your medical provider, you can request an alternate physician.  You should be very careful in asking for an alternate physician, however, because you are typically entitled to only one change of physician during the life of your claim, and, in most cases, the carrier, not you, gets to choose the alternate physician.  Once you change physicians, you may not go back to the prior physician, and, in most instances, you may not choose to change physicians again.  Therefore, you will be stuck with the alternate provider, regardless of whether or not you’re happy with them.

Please note also, that the one-time change in physicians applies regardless of the medical provider’s specialty.  Therefore, for instance, if you are seeing both a neurologist and an orthopedic physician, and you ask for a change in neurologist, which is provided, you cannot later ask to change your orthopedic physician as well.

 

If I have been injured on the job, how long do I have to report it?

In most cases, you must report an on-the-job accident or injury to your employer within 30 days.  Failure to do so may result in a denial of benefits.  However, there are some instances where the period for reporting an injury may be extended, such as in the case of a repetitive type injury.  If you have been injured due to repetitive trauma, you may have up to 90 days to report the injury.  However, it is always best to report an injury as soon as possible.

 

What happens once I report the injury to my employer?

Once you report the injury to your employer, they should complete a Notice of Injury and notify their workers’ compensation carrier of the accident.  You should then receive information from the carrier.  In addition, your employer and/or carrier should set you up to see a medical provider to treat the injuries.

 

What do I do if my employer refuses to complete a Notice of Injury or provide me with medical treatment?

If this happens, you can call the workers’ compensation carrier and report the accident directly to them, if you know who the workers’ compensation carrier is.  Otherwise, you should contact the Division of Workers’ Compensation Employee Assistance and Ombudsman Office at 1-800-342-1741 or by email at wceao@myfloridacfo.com and advise them of the situation and ask for assistance.  It is important that you do this as soon as possible so that it is documented that you reported the injury within 30 days or other applicable time frame.

 

What do I do if my employer tells me to just treat under my health insurance?

You should never do this.  You should insist that the employer complete a Notice of Injury and report the accident to their workers’ compensation carrier.  Failure to do so within 30 days of the accident could jeopardize your benefits.

 

Do I have to take a drug test?

If you are asked to take a drug test after your accident/injury, you must submit to one within 24 hours.  Failure to do so could jeopardize your benefits, include complete denial of your claim.

 

What if the drug test comes back positive?

A positive drug test does not always result in a denial of benefits, but it could.  However, if the accident would have happened regardless of whether or not you were under the influence of drugs, the employer/carrier may be responsible for the accident/injuries.