Workers’ compensation in Florida is designed to cover a wide range of benefits for employees who suffer work-related injuries or illnesses. Here are the main types of coverage provided under Florida’s workers’ compensation law:

Medical Benefits:

• Medical Treatment:  Covers all reasonable and medically necessary medical care related to the injury or illness, including doctor visits, hospital treatment, surgery, prescription medications,, physical therapy, and more.
• Diagnostic Tests: Includes coverage for X-rays, MRIs, and other diagnostic tests required to assess the injury or illness.
• Mileage Reimbursement or transportation: Reimbursement for travel expenses incurred while receiving medical treatment (e.g., travel to and from doctor’s appointments/pharmacy).  If an injured worker cannot drive or does not have a vehicle, transportation is provided.

Wage Replacement/money Benefits:

• Temporary Total Disability (TTD): Provided when an injured worker is temporarily unable to work due to the injury. Two-thirds of the worker’s Average Weekly Wage (AWW), up to the Maximum Compensation Rate set by the State every year..
• Temporary Partial Disability (TPD): Given when an injured worker can return to work but in a limited capacity, resulting in reduced earnings or the Employer has no modified  or light duty work available to accommodate work restrictions. The benefit amount is 80% of the difference between 80% of  the worker’s pre-injury average weekly wage and current earnings while on light duty, subject to a cap.

Permanent Disability Benefits:

• Permanent Total Disability (PTD): Provided to workers who are permanently unable to work in any capacity due to their injury. These benefits are typically two-thirds of the worker’s average weekly wage, up to the state maximum, and may be paid for the duration of the disability.
• Permanent Impairment Benefits (IBs): Given for permanent injury (as defined by the Florida Uniform Impairment Rating Schedule), calculated based on the impairment rating assigned by a qualified physician using the Schedule.  A worker will get a set number of weeks of compensation based upon the rating assigned.

Death Benefits:

• Funeral Expenses: Coverage for funeral and burial expenses up to a specified limit (currently $7,500).
• Dependency Benefits: Financial support provided to the dependents of workers who die as a result of a work-related injury or illness. Dependents can include the worker’s spouse, children, and other family members (siblings, grandchildren) who relied on the worker’s income for support prior to their accident.

Rehabilitation and Retraining:

• Vocational Rehabilitation: Services to help injured workers return to work. This resources are generally provided by the State of Florida and may include job placement services, vocational counseling, or retraining for a different line of work if the worker can’t return to their previous job due to the injury.  The Workers’ compensation Carrier must pay total disability benefits while the worker attends vocational retraining courses for potentially up to 52 weeks.

The Florida Workers’ compensation law is supposed to be a “self-executing” system which means, the injured work only needs to report to their Employer (supervisor/manager) that they have been injured on the job, and the Employer and their Carrier collectively will then take the steps necessary to get them the benefits that they are entitled to and administer a workers’ compensation claim.  Unfortunately, the system does not work as it is intended to.  If you are injured at work, you should report your injury to your employer.  If it is an emergency, call 911 or seek emergency care.  If the Employer does not immediately tell you where you may go for medical care, contact an attorney.

Generally, you have 30 days to report the injury after you know or should know that you have sustained an injury.  Many employers have policies that work related injuries need to be reported immediately or the same day as the injury.  These policies are inherently unfair as many injuries do not manifest themselves for several days after the injury.  Under the law the Employee has 30 days to give notice of the injury (and the fact that it occurred on the job).    

There are some exceptions to this requirement:

• Employer’s Knowledge: If the employer or their agent already knew about the injury and that it was caused by work.
• Medical Opinion Needed: If the cause of the injury could not be identified without a medical opinion, and the employee informs the employer within 30 days of receiving that medical opinion.
• Lack of Notice by Employer: If the employer did not inform employees of the 30-day notice requirement by posting the required notice.
• Exceptional Circumstances: If there are special circumstances that justify the delay, even if they don’t fall under the other specific exceptions.

Many employees are hesitant to report an injury due to fear of being fired by their employer.  They don’t report the injury and then when it becomes clear that the injury is serious, they may jeopardize their benefits or perhaps fail to give the required 30 days notice of injury.  There is an anti-retaliation provision of the law that states, “no employer shall discharge, threaten to discharge, intimidate, or coerce any employee by reason of such employee’s valid claim for compensation or attempt to claim compensation under the Workers’ Compensation Law.”  However, many employers (especially small employers) routinely violate this provision or make things difficult.

  A “decision” made by an insurance carrier or adjuster to deny benefits can be “appealed” by filing a petition for benefits within the statute of limitations period explained in FAQ XX.  A decision of a Judge of Compensation Claims (Final Compensation Order) can be appealed to the First District Court of Appeals (exclusive jurisdiction for Florida workers’ compensation appeals) by filing a Notice of Appeals with the First DCA within 30 days of the Decision.

Workers’ compensation benefits for lost wages typically fall into a few categories, based on the nature and extent of the injury or illness. In Florida, the payments are generally calculated as a percentage of the employee’s Average Weekly Wage (AWW), subject to state-defined maximums.   The Average Weekly Wage is generally a 13 week average of what the injured worker earned (gross wages) during the 13 weeks directly preceding the week in which the accident occurred (subject to some exceptions if the worker did not work substantially the whole of the 13 week period).   Benefits are a percentage of this AWW as follows:

Temporary Total Disability (TTD):

Amount: Generally, 66 2/3% (two-thirds) of the employee’s AWW.

Duration: Paid until the employee is able to return to work or reaches maximum medical improvement (MMI), up to a maximum of 206 weeks. (The 104 week limitation that is in the statute was found unconstitutional and does not apply.)

Temporary Partial Disability (TPD):

Amount: 80% of the difference between 80% of the employee’s pre-injury AWW and their earnings after the injury.

Duration: Paid until the employee reaches MMI or can earn their pre-injury wage, up to a maximum of 104 weeks.

Impairment Income Benefits (IIB):

Amount: Based on the impairment rating assigned by a physician. 75% of the TTD comp rate (turns out to be 50% of the AWW unless the maximum compensation rate is used for TTD).  However, if the Employee is back to work and earning in excess of the AWW the Carrier can further reduce the impairment benefits by 50%.  Whether the injured worker is earning in excess of the AWW is determined on a weekly basis, assessing gross earnings for each week impairment benefits are due.  (Employee benefits for PTO, sick pay or vacation pay do not count as gross earnings for this particular calculation to determine if the employee is earning over the AWW.)

Duration: Paid for a set number of weeks according to the impairment rating.

Permanent Total Disability (PTD):

Amount: 66 2/3% of the employee’s AWW.

Duration: For the duration of the disability, potentially up to age 75 and depending upon whether the Employee was injured after age 70 or has insufficient credits to qualify for Social Security, it could be longer than this.

Some of the most common denials asserted by Florida workers’ comp adjusters are:

• the industrial accident is not the major contributing cause of the need for medical treatment or disability;
• the injury is idiopathic, pre-existing or unrelated to the accident and therefore the employment is not the major contributing cause of the injury
• The employee failed to give timely notice of the accident or injury within 30 days its occurrence;
• benefits are not due because the employee knowingly made false, fraudulent, or misleading oral or written statement for the purpose of obtaining workers’ comp benefits;
• the accident or injury was occasioned primarily by the intoxication as the employee’s post-accident drug test has a positive confirmation of a drug as defined by the workers’ compensation law;
• indemnity benefits are not due as the employee voluntarily limited his income by not accepting an offer of suitable light duty work;
• medical bills or expenses are not payable as the treatment was not authorized in advance by the adjuster;
• benefits are not due as the statute of limitations has run;
• indemnity benefits are suspended as employee failed to timely complete and return Employee Earnings Reports (DWC-19);

If you have received a denial such as the above or any other denial asserted on a DWC-12 or DWC-4 form, please contact us for a free consultation and analysis.  We will be happy to review your denial and give a free legal opinion on its validity and options to contest it.

 Unfortunately under Florida workers’ compensation law, the employee does not have the right to choose the doctor.  Generally, the Employer/Carrier has the right to select the doctor and is only responsible to pay for medical care that was provided by authorized doctors or medical providers.  Most physicians who handle Florida workers’ compensation claims will not provide any services without authorization from the Carrier in advance of the appointment.  Furthermore, the medical opinions of any non-authorized physician are not admissible in any proceedings before a Judge of Compensation Claims.

There are a few notable exceptions to the general rule that the Employer/Carrier selects the doctor. First, if the employee makes a written request for a one time change of physician and the Employer/Carrier fails to timely provide a doctor (within 5 calendar days), the right to select the physician transfers to the employee.  Second, if the Employer/Carrier fails to provide initial medical care within a reasonable amount of time of receiving the employees written request for such care, the employee can utilize “self-help” and seek their own care.  The Employer/Carrier will be responsible to reimburse the employee for out of pocket medical care or expenses up until the time that the Employer/Carrier actually authorizes medical care.

There are a few things to note about the settlement process.  First, any written contract between the Employer/Carrier and employee/claimant (including emails back and forth) can be enforceable by the Judge of Compensation Claims.  This means that although formal settlement releases and paperwork may be anticipated, a brief set of emails or a short mediation settlement agreement can be binding and enforceable.  Second, the Judge of Compensation Claims will need to approve a workers’ compensation settlement agreement involving an unrepresented Employee/Claimant and may conduct a hearing.  In an accepted case the Judge of Compensation Claims must find that the settlement “will definitely aid the rehabilitation of the injured worker or otherwise is clearly for the best interests of the person entitled to compensation”.  If the employee has a lawyer, the Judge of Compensation Claims only approves the settlement to make sure that it whether the settlement allocation provides for the appropriate recovery of child support arrearages and that the attorney’s fees being paid are reasonable given existing case law.

 In Florida, the average weekly wage (AWW) is usually calculated by taking the employee’s total gross earnings (including wages, bonuses, commissions, etc.) plus the employer’s contributions to group health insurance or housing (if these benefits have ceased) during the 13 weeks immediately preceding the injury (excluding the week in which the accident occurred) and dividing by 13. If the employee has not worked substantially the whole (75% of customary hours) of the  13 weeks, the wages of a similar employee or what the employee would have earned if the employment had continued may be used.   If there is no “similar employee”, the actual wages earned are used to determine an average weekly wage. If there is seasonal employment or none of the foregoing methods can fairly be applied, the Judge of Compensation Claims has discretion to determine the AWW.  In summary, there are many nuances and gray areas and an attorney should be consulted to determine the AWW.

Generally, when an employee reaches the point of maximum medical improvement, there are benefits available for permanent and total disability if the employee is incapable of at least sedentary work within 50 miles of their residence.  If a worker is entitled to PTD benefits they can receive compensation up to age 75. Cost of living supplement (PTD supps) are paid at 3% of the compensation rate multiplied by the number of years post accident and are available only up to age 62.

The following conditions give an injured worker the presumption of permanent and total disability which means the burden is shifted to the Employer/Carrier to demonstrate that the worker is capable of performing at least some type of gainful employment.  The presumptive PTD conditions are

•  Spinal cord injury involving severe paralysis of an arm, a leg, or the trunk
• Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage
• Severe brain or closed-head injury as evidenced by: 

1. Severe sensory or motor disturbances;
2. Severe communication disturbances;
3. Severe complex integrated disturbances of cerebral function;
4. Severe episodic neurological disorders; or
5. Other severe brain and closed-head injury conditions at least as severe in nature as any condition provided in sub-subparagraphs a.-d.;

• Second-degree or third-degree burns of 25% or more of the total body surface or third-degree burns of 5% or more to the face and hands;
• Total or industrial blindness: Defined as statutory blindness, meaning vision that is 20/200 or worse in the better eye with the best possible correction, or a visual field limitation in the better eye with the widest diameter of the visual field subtending an angle of no greater than 20 degrees.

Permanent impairment benefits, under Florida workers’ compensation law, are designed to compensate employees who have sustained a permanent physical or mental impairment due to a work-related injury or illness. These benefits are provided when the injured worker has reached Maximum Medical Improvement (MMI) and is left with a permanent impairment to the body as a whole as determined by their treating physician using the Florida Uniform Permanent Impairment Rating Schedule.  

Amount.  75% of the TTD comp rate (turns out to be 50% of the AWW unless the maximum compensation rate is used for TTD).  However, if the Employee is back to work and earning in excess of the AWW the Carrier can further reduce the impairment benefits by 50%.  Whether the injured worker is earning in excess of the AWW is determined on a weekly basis, assessing gross earnings for each week impairment benefits are due.  (Employee benefits for PTO, sick pay or vacation pay do not count as gross earnings for this particular calculation to determine if the employee is earning over the AWW.)

Duration. The duration of benefits is based on the impairment rating:

• For impairment ratings of 1% to 10%, 2 weeks for each percentage point.
• For impairment ratings of 11% to 15%, 20 weeks plus 3 weeks for each percentage point between 11% to 15% .
• For impairment ratings of 16% to 20%, 35 weeks plus 4 weeks for each percentage point between 16% to 20% .
• For impairment ratings of 21% or higher, 55 weeks plus 6 weeks for each percentage point 21% or higher.

How paid.

• Impairment benefits should begin within 20 days after the insurance carrier receives the impairment rating from the treating physician.
• Payments are typically made biweekly.

If you feel that the adjuster or worker’s compensation Carrier is incorrectly paying your impairment benefits or that the impairment rating is inaccurately calculated, please contact Just Comp, PLLC for a free consultation.  We have been successful in getting physicians to correct ratings based upon their misinterpretation of the guide and have been successful in litigation over incorrect payment of impairment benefits.

Many adjusters fail to timely authorize the medical treatment or diagnostic studies that an injured worker needs to receive in order to recover from their injuries.  At Just Comp, PLLC we aggressively pursue medical claims for our clients by filing a petition for benefits after making a good faith effort to get the Carrier to do what they should be doing.  A petition for benefits will bring the adjuster’s immediate attention to the claim because if they fail to timely provide these necessary benefits, they will be responsible for paying for your attorney’s fees and costs related to this.  If you have not received the medical care that has been recommended, you should contact Just Comp, PLCC as soon as possible for a free consultation regarding this.

If you have been released to work with restrictions and your employer makes you an offer of light duty work that falls within the restrictions, you could lose your right to compensation during the periods when you failed to accept the light duty work.  The law says that “If an injured employee refuses employment suitable to the capacity thereof … shall not be entitled to any compensation at any time during the continuance of such refusal unless at any time in the opinion of the judge of compensation claims such refusal is justifiable.

The work that the employer offers must be “suitable” meaning that it is actually within the doctors restrictions.  These situations can be difficult if there is ambiguity about what the doctors restrictions are and whether work tasks are actually within the capacity of the employee.  Consultation with an attorney is always recommended in these situations.