The Florida workers compensation system is a "no fault" system which means that a person injured in the course and scope of their employment is not required to prove negligence on the part of a third party or their employer. The sole issue is whether or not an individual was injured while performing functions that were part of their employment, thereby giving rise to the term "in the course and scope of their employment". It is very important for a person injured on the job to immediately report the accident and/or injury to their employer or supervisor as soon after the injury as possible. Failure to provide notice within a reasonable period of time may very well jeopardize a person's ability to receive benefits under the workers compensation system.
Generally, the employer has purchased workers compensation insurance coverage from an insurance company dealing with these matters. Once someone is injured on the job, the employer has the responsibility to report it to their insurance carrier so that it gives the insurance company an opportunity to investigate the accident and begin providing benefits. Once the case is reported to the insurance company, an insurance adjuster is normally assigned to the case and their purpose is to represent the insurance carrier and to provide the benefits they are required to by law but otherwise, to limit the financial exposure of the insurance company. This issue in and of itself gives rise to a need for legal representation when the insurance company is not providing the benefits that are due to the injured worker.
An attorney specializing in workers compensation on behalf of an injured employee must then file a Request for Assistance which is a document outlining the basis for the disagreement between the employee and the insurance company and must file it with the division of Workers Compensation as well with the employer and insurance company. The insurance company has thirty days to either provide the benefits or deny the benefits which results in the employee's attorney filing a Petition for Benefits which outlines in detail the problems that the employee is experiencing and acts much like a complaint would in a civil law action. It should be noted that the workers compensation attorney is only paid if the issues litigated are actually won and then the insurance company pays the fee.
There are several different kinds of benefits that may be provided under the Florida law: TTD, temporary total disability benefits. These are benefits that are paid to an injured employee that amounts to 66 2/3 of their average gross weekly wage to include fringe benefits. This benefit is paid when the treating physician determines that the individual is not able to work in any capacity and that this condition is temporary in nature; TPD, temporary partial disability - Equates to 64% of a person's average gross weekly wage and is provided when an individual is not completely disabled on a temporary basis from working but may work in some limited capacity; PTD - permanent total disability is paid when the individual is permanently and totally disabled from any type of gainful employment.
The key here is that the individual is unable to work in any capacity in any type of job on a regular uninterrupted basis. Many people become confused regarding this term when they believe that they can not return to the job that they had when they were injured. Unfortunately, this is not the requirement. For example, a highly skilled cabinet maker who is injured severely but can still perform some types of functions is not permanently and totally disabled if they are able to work in a much lower skilled job such as a toll booth attendant if they are able to do so on an uninterrupted basis. Clearly, this provision in the law severely affects a person's earning capacity.
The law is written such that as long as they are able to work in some capacity, they do not qualify for these benefits. It should be noted that there are many time deadlines involved in workers compensation, along with the adversarial process between the insurance company and the injured employee. Many insurance companies will go to great lengths and expense to attempt to limit the recovery of an injured worker by conducting under cover surveillance and attempting to make the entire system a very difficult one by delaying payment of claims and delaying or refusing to provide necessary medical treatment. The insurance company's number one goal is to frustrate a person to the point of abandoning what should rightfully be provided to them and therefore, giving up on the entire process. Our firm specializes in handling difficult cases where the insurance company has regularly denied benefits to which you are lawfully entitled.Copyright ©1999 by Hardesty & Tyde, P.A.. All rights reserved.