What Employees Need to Know About Workers' Compensation in Florida


TABLE OF CONTENTS

INTRODUCTION

This article gives you general information about the Florida Workers' Compensation Program. You will receive information about your rights, benefits and responsibilities. You will also learn how the Division of Workers' Compensation' can help you through the process so you can return to work as quickly as possible

If you have any questions about workers' compensation, please call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Division of Workers' Compensation Employee Assistance Office at this toll free number: (800)342-1741, or call any of the field offices listed at the end at this article. TDD (800)955-8771-Voice (800)955-8770

Please be advised that:

"Any person who knowingly and with intent to injure, defraud or deceive any employer, employee, insurance company or selfinsured program or who tiles a statement of claim containing any false or misleading information commits a felony of the third degree."

BASIC FACTS ABOUT WORKERS' COMPENSATION

Workers' Compensation coverage is paid by your employer at no cost to you.

  • It is your responsibility to report a workrelated accident as soon as it happens!
  • This coverage will pay for the most reasonable and necessary medical care if you get hurt or get sick because of an injury on your job.
  • Your employer or its workers' compensation insurance carrier has the right to choose the doctor who will treat you.
  • Workers' compensation coverage will also replace part of your lost wages it your doctor says you must be out of work for a certain length of time because of a workrelated injury or illness.
The intent of the law is to ensure that you return to work as soon as the doctor says you are able. If your workplace has more than 50 employees, your employer should make a good faith effort to return you to work within your restrictions after you reach maximum medical improvement (MMI). It your employer does not make a good faith effort to do this, it may have to pay a tine. Your employer's workers' compensation insurance carrier's name and telephone number should be posted at your worksite. It not, ask your supervisor for your employer's carrier or call the Employee Assistance Office (EAO) of the Division of Workers' Compensation (800)342-1741 or the closest EAO field office listed in the back of this article.

You should know That If you are caught reporting a workrelaled Injury when you know you were not injured at work, you could be convicted of a felony of the third degree.

HOW TO GET MEDICAL CARE AND BENEFITS

Follow these simple rules:

  • Report your job-related injury or illness to your supervisor as soon as possible.
  • Go to the doctor chosen by your employer or your employer's workers' compensation insurance carrier.
For you to begin getting benefits, your employer must report the injury to its workers' compensation insurance carrier either by telephone or by completing a First Report of Injury or Illness. You should complete all forms when asked. Your employer or the workers' compensation insurance carrier must provide you a copy of your First Report of Injury or Illness. To keep receiving benefits during the time you are unable to work (or working at a reduced salary), you must complete forms when asked. If you have any questions about those forms that are not answered by your employer or carrier, please call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office (EAO) at the Division of Workers' Compensation for assistance at 18003421741 or call any of the EAO field offices listed at the end of this article.

Be sure you do everything possible to cooperate with your employer and its workers" compensation insurance carrier. If you do not, your benefits may stop or be delayed.
Be sure you:

  • Complete all workers' compensation forms in a timely manner
  • Keep all appointments
  • Report any earnings to the workers' compensation insurance carrier (including social security and unemployment compensation benefits) that you get after your injury
  • Get approval from the insurance carrier before receiving treatment. If you are not satisfied with the doctor first assigned, ask your workers' compensation insurance carrier to approve another doctor
  • Return to work as soon as the doctor says you can
  • Keep all records in a safe place for future reference
Be aware that your right to receive benefits and medical care may end if there has been no payment for lost wages made or necessary medical care provided for a one year period.

WHAT TYPES OF BENEFITS CAN YOU GET?

MEDICAL BENEFITS

Workers' Compensation insurance pays for all reasonable and necessary medical care related to your on-the-job injury or illness including:

  • visits to an approved doctor (chiropractic visits may be limited)
  • surgery (and home nursing services when necessary)
  • hospital care
  • dental care
  • prescription drugs
  • braces and crunches
  • other medical supplies when ordered by your approved physician.
Before being treated, be sure you have the approval of your employer's workers' compensation insurance carrier. You are not responsible for the doctor bills as long as the carrier approves the doctor you are seeing. If you see a doctor without the workers' compensation insurance carrier's approval, you will probably be responsible for the bill. When you receive approved treatment, the doctor will bill the workers' compensation insurance carrier directly. If you are billed, send the bill to your carrier. There is one exception. If you were injured on or after January 1, 1994, your doctor is responsible for collecting directly from you a $10 copayment per visit after you reach maximum medical improvement (MMI).

If you need copies of any medical reports, you can get them from your doctor or workers' compensation insurance carrier, but there may be a charge for these copies.

PAYMENT FOR LOST WAGES

If your earnings are lower because of a workrelated injury or illness, you may be able to receive some cash benefits (indemnity benefits). You may be eligible for these benefits if you have been out of work for more than seven (7) calendar days on the advice of your approved doctor and one of the following is true:

  • You are unable to return to work as a result of the accident.
  • You are able to work but because of your injury you earn wages less than 80% of what you earned before your injury.
  • Your doctor says you will have a permanent loss of a bodily function as a result of your injury. (This is called permanent impairment).
These payments can help you through the period of time you are disabled from your workplace injury or illness. These cash benefits begin on the eighth day of partial or total disability. You will be paid for the first seven (7) days only if you are disabled for more than twenty-one (21) days. These days do not have to be continuous calendar days.

To help the workers' compensation insurance carrier calculate the benefits that are due, your employer is required to send the workers' compensation insurance carrier and you a report of your wages and certain fringe benefits for the 13 weeks immediately before you were injured. The carrier will use this information to calculate your average weekly wage and your workers" compensation benefits. It you have a second job, your average weekly wage may include both incomes. Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office of the Division of Workers' Compensation at 18003421741 (or any EAO field office listed at the end of this booklet) for more details.

REEMPLOYMENT SERVICES

If, as a result of your work injury or illness, you cannot earn wages similar to those you earned before your injury, you may qualify to receive reemployment services. The goal of these services is to help you return to work as soon as you can. The types of services you may receive will vary depending upon the date you were injured or became ill. They may include:

  • Help in writing resumes
  • Vocational testing and counseling to help identify employment options
  • Help in finding a job
  • Training and education if needed for you to be able to return to work
For more information about reemployment services, please contact the Rehabilitation and Medical Services Office closest to you. There is a listing of these offices at the end of this article.

PREFERRED WORKER PROGRAM

If you have a permanent disability and are unable to return to your regular job because of a workplace injury or illness, you may be eligible to receive a Preferred Worker Card. The card will tell a future employer about financial benefits for the employer that come from hiring you. This may make it easier for you to get a job.

To find out if you qualify for a Preferred Worker Card, call the Rehabilitation and Medical Services Office closest to you [phone numbers are listed at the end of this article].

Questions and Answers

RETURN TO WORK QUESTIONS

Q: Can my employer fire me if I am out and receiving workers' compensation

A: You should not be fired in retaliation for filing or attempting to file a workers' compensation claim. However, the workers' compensation law does not require your employer to hold your position for you until you can return to work.

Q: Must I be released to full duty before I can return to work?

A: No. Your doctor may release you for modified or light duty work before you have reached maximum medical improvement (MMI). The law is written so that it is beneficial to both you and your employer for you to return to work as soon as possible.

INSURANCE QUESTIONS

Q: Is my employer required to have workers ' compensation insurance?

A: Employers with four or more employees, part-time or full-time, are required to have workers' compensation coverage. An employer in the construction industry with one or more employees is required to have insurance.

Q: Do I have to pay for coverage under this insurance?

A: No. Your employer pays the premium. Your employer cannot require you to pay any part of the premium.

BENEFIT PAYMENT QUESTIONS

Q: Where does my workers' compensation benefit check come from?

A: It comes from your employer's workers' compensation insurance carrier or from your employer if it is individually self-insured.

Q: Are workers' compensation benefits taxable?

A: No.

Q: Can my benefits be lowered for failure to use safety appliances or follow safety rules?

A: Yes, your cash benefits may be lowered by 25% if your injury occurred while you were not following safety rules or using safety appliances provided by your employer.

Q: When will I get my first check?

A: The earliest date you can expect your first check is within three weeks of your injury. This can only happen if you report your injury immediately to your employer and the First Report of Accident or Illness is completed and sent to the workers' compensation insurance carrier shortly after that. The carrier is required to send a check within fourteen days after learning you will be disabled for more than seven days (the carrier will gather information from you, your employer and your doctor).

Q: How long can I collect workers' compensation benefits?

A: There are limits on how long you can receive benefits. These limits vary depending upon the dale you are injured, how serious your injury is, and what benefits you are receiving. Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office of the Division of Workers' Compensation to get information specific to your case.

Q: What can I do if I am not receiving my benefits?

A: Call your employer's workers' compensation insurance carrier first, then, if you are not satisfied or do not understand why your benefits have stopped or not provided, call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office at the Division of Workers' Compensation at 1-800-342-1741 or any of the EAO field offices listed at the end of this booklet.

The Employee Assistance Office will provide assistance to you in resolving your disagreements with your workers' compensation insurance carrier. This assistance is provided free of charge. If this office is unsuccessful in resolving your problems, then you probably need an attorney. Please note, the Employee Assistance Office will help you through the workers' compensation system; however, they cannot represent you before a Judge of Compensation Claims.

MEDICAL BENEFITS QUESTIONS

Q: Do I have to pay any of the medical costs?

A: Your employer or its workers' compensation Insurance company must pay for all approved and medically necessary care.

If you are Injured on or after January 1, 1994, you are required to pay a $10 copayment per visit for medical treatment after you reach maximum medical improvement (MMI).

Q: How are the doctors and other health care providers paid?

A: All authorized health care providers must bill your employer's workers' compensation insurance carrier directly. It you receive a bill, mail it to the carrier. Do not pay it yourself. if you know the claim number the carrier has assigned to your case, write it on all bills and correspondence.

Q: Can I choose my own doctor?

A: No. Your employer or its workers' compensation insurance carrier can choose the doctor to treat you. If you are unhappy with the doctor chosen by the carrier or want to request a second opinion, you must ask the carrier to provide you with another doctor.

Q: If I think I need one type of treatment and the workers' compensation insurance company disagrees, is there anything I can do?

A: Possibly. Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office at the Division of Workers' Compensation at 18003421742 or the field office nearest you about available options.

Q: When is an impairment rating assigned?

A: When you reach maximum medical improvement (MMI), your treating doctor must give you an impairment rating if you have a permanent loss of function of a part of your body.

GENERAL QUESTIONS

Q: How long do I have to report the accident to my employer?

A: You should report the accident immediately to your supervisor in order not to cause a delay in receiving any workers' compensation benefits.

Q: What can I do if my employer refuses to complete a First Report of Injury or Illness for my accident or illness?

A: Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or your employer's workers' compensation insurance carrier, or the Employee Assistance Office of the Division of Workers' Compensation (18003421741), or the Employee Assistance Office near you (see list at the back of this booklet).

Q: If my employer has a Drug free Workplace Program, can I still get workers' compensation benefits?

A: It depends; if you test positive for drugs or alcohol al the time of accident, you could lose your workers' compensation benefits.

Q: Where do I get help if I think my employer or workers' compensation insurance carrier is not treating me fairly?

A: Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581, or the Employee Assistance Office of the Division of Workers' Compensation at 18003421741 or the Employee Assistance Field Office near you.

Q: Am I entitled to a lump sum settlement of my case?

A: A lump sum settlement is allowed but is not mandatory. Any negotiations are strictly voluntary between you and your employer's workers' compensation insurance carrier, and must be approved by a Judge of Compensation Claims.

Q: Should I hire an attorney?

A: You are not required to have an attorney, but I strongly recommend it. The laws in this area are quite complex. Most insurance companies have lawyers standing by to help them, shouldn't you?

Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581.

GLOSSARY

Average Weekly Wage (AWW):
The wage used to calculate payments for lost wages. It is the average weekly wage earned by an injured worker during the 13 weeks before injury. Depending on the date of accident, the AWW may or may not include income from jobs other than the one where the injury occurred.

Compensation Rate (Comp Rate or CR):
66 2/3% of the average weekly wage up to a maximum benefit established by the Division of Workers' Compensation.

Disability:
Incapacity, due to the injury or illness, to earn the same wages as before the injury.

First Aid Treatment:
Treatment provided at the workplace for which there are no medical charges.

Impairment Rating:
A determination of an injured worker's loss of physical function as a percentage. This percentage represents the extent a workrelated injury has permanently impaired the injured worker.

Indemnity Benefits:
Cash benefits paid to an injured worker to replace part of wages lost as a result of a work injury.

Injury:
Personal injury, illness or death by accident arising out of and in the course of employment.

Maximum Medical Improvement (MMI):
The point in time when the treating physician believes the injured worker has recovered as much as he or she is going to.

Modified or Light Duty Work:
Employment that is within the physical capabilities of the injured worker as defined by the doctor. It may include a change in duties consistent with physical capabilities, number of hours worked or break schedule.

Safety Program:
A comprehensive program designed to provide a safe work environment, including but not limited to: an active safely committee, safe working practices and procedures, employee training on equipment, job specific safety rules and personal protective equipment.

Temporary Partial Disability (TPD):
A disability that temporarily prevents an injured worker from performing his/her normal job duties. The injured worker has some capability to work but with changed duties or with reduced hours.

Temporary Total Disability (TTD):
A disability that completely prevents an injured worker from returning to work for a temporary time period.

IMPORTANT PHONE NUMBERS

EMPLOYEE ASSISTANCE FIELD OFFICES

DAYTONA BEACH 904-238-3161
FT. LAUDERDALE 305-467-4686
FT. MYERS 813-278-7091
GAINESVILLE 904-955-2017
JACKSONVILLE 904-798-4372
MIAMI 305-377-5965
ORLANDO 407-423-6458
PANAMA CITY 904-747-5424
PENSACOLA 904-444-8555
SATELLITE BEACH 407-984-4979
TALLAHASSEE 904-922-6390
TAMPA 813-930-7545
WEST PALM BEACH 407-640-2850
REHABILITATION AND MEDICAL SERVICES FIELD OFFICES
DAYTONA BEACH 904-254-3761
FT. LAUDERDALE 305-467-4612
FT. MYERS 904-955-2019
GAINESVILLE 904-955-2019
Jacksonville 904-359-6101
MIAMI 305-377-5379
ORLANDO 407-423-6450
PENSACOLA 904-444-8667
SARASOTA 813-361-6022
SATELLITE BEACH 407-984-4923
ST. PETERSBURG 813-570-3052
TALLAHASSEE 904-488-8720
TAMPA 813-930-7546
WEST PALM BEACH 407-640-2850
MEDICAL MILEAGE- IT REALLY ADDS UP!

Although you may not be reimbursed for the time you spend at doctors' appointments and therapy sessions, you are entitled under Florida Statutes to be reimbursed for travel expenses to and from these appointments. Most insurance companies won't volunteer this benefit to you; however, under current law, you are currently entitled to be reimbursed at a rate of $.29 per mile in both workers' compensation and personal injury claims. It may not seem like a lot, but it really adds up!!!

Call Jeffrey W. Hensley, P.A. (727)786-5000 or (800)226-6581.


The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.