FAQ - Workers' Compensation
What is workers compensation?
Workers compensation is a system designed to compensate workers injured on the job regardless of fault.
What is the Statute of Limitations in a workers compensation case?
A statute of limitation is a time limit that ends a person’s right to a file a claim for benefits for compensation unless an injured worker meets certain criteria by filing a claim before a certain date or their claim may be forever barred.
For accidents that occur before 12/31/1993, a claim or petition for benefits must be filed within two years of: (1) the date of injury, or (2) the last payment of compensation, or (3) the last day authorized medical treatment or rehabilitative care was provided by the insurance company or the employer.
For accidents after 01/01/1994, a claim or petition must be filed within: (1) two years of the date of injury, or (2) after the initial 2 years, within: (a) 1 year of the last payment of compensation or (b) the last day of provisions or remedial medical care or attendance.
What is a deposition?
Under the law, the opposing counsel has the right to take your statement under oath. The opposing attorney will ask you questions and your answers will be taken down by a court reporter. Your lawyer will be present during your deposition.
If my injury makes me lose time from work, will I be paid for my lost time?
The law requires an injured worker to receive temporary total disability benefits if the medical evidence shows the injured worker is unable to do any gainful work. The injured workers entitlement ends when the first of any of the following four events occur:
- When the injured workers doctor says he or she can do some type of work.
- When the injured worker returns to work.
- When the injured worker reaches maximum medical improvement.
- When the carrier has paid the maximum weeks (104) of benefits.
Injured workers may be entitled to temporary partial disability benefits if they:
- Are not totally disabled.
- Have not reached MMI.
- Are medically able to do some work but not the pre-injury job.
- Are earning less than 80% of pre-injury wages.
- Have conducted an unsuccessful job search.
What injuries are covered?
The insurance company must provide benefits to an injured worker if the worker sustained (1) an injury, (2) by accident, and (3) that arose out of, and (4) and occurred in the course of employment
When will I receive my first benefit check?
The earliest date the injured worker can expect to receive the first check is within 3 weeks of the injury. This can only happen if the injured worker reports the accident immediately. For injuries that occur prior to 06/01/1990, an injured worker is not entitled to compensation for the first 7 days of disability unless the injury results in disability that lasts more than 14 days.
For injuries occurring on or after 07/01/1990, an injured worker cannot collect compensation benefits for the first 7 days of disability unless the injury results in a disability that lasts more than 21 days.
The insurance company must issue the first payment no later than 14 days after the employer receives the notice of injury or death. Insurance companies must issue subsequent checks at 14 day intervals after the first payment. There are exceptions to this rule.
Where do the injured workers compensation benefits come from?
It comes from the employer’s workers’ compensation insurance company (the carrier).
Are workers’ compensation benefits taxable?
No.
What are impairment benefits?
These benefits are paid after an injured worker reaches maximum medical improvement for accidents offering after 01/01/1994. They are paid every two weeks at ½ the compensation rate for a period that equals to 3 weeks for each percentage point of impairment.
What are death benefits?
Generally, if a worker dies because of a compensable accident, the workers dependents are entitled to certain fixed benefits. Such benefits may include funeral expenses, monetary benefits to pay for lost income, and educational benefits for the spouse. To be compensable the death must occur within 1 year of the injury. If death occurs after one year, benefits may be awarded only if the death follows continuous disability.
What should I do if I am injured on the job?
An injured worker must report the injury arising out of and in the course of employment within 7 days after the date of or initial manifestation of the injury to his or her employer. Failure to report the injury to the employer within 7 days of the injury shall automatically bar a petition or claim. If an issue relating to notice arises it is essential to consult with competent legal counsel.
What should the employer do?
The employer must give a copy of the First Report of Injury or Illness to the employee. If the accident is reported via a telephone, the insurance company must complete the necessary forms and send a copy of the form to the employer and injured worker within 3 business days.
Can the employer terminate an injured worker for filing a workers' compensation claim?
An injured worker has certain legal rights if he or she is fired in retaliation for filing a worker's compensation claim. However, the workers' compensation law does not require your employer to hold the injured workers position for open until the injured worker returns to work.
If an injured worker is unable to return to work to his or her former position, what should the injured worker do?
The injured worker must provide his or her employer with a copy of the work status slips to their employer to determine if their employer has a position available within the restrictions.
Does the injured worker have to pay for any of his or her own medical costs?
Your employer or its workers' compensation insurance company must pay for all approved and medically necessary care. If you are injured on or after 01/01/1994, you are required to pay a $10.00 co-payment per visit for medical treatment after you reach Maximum Medical Improvement.
Does the injured worker get to select his or her own physician?
In general, the answer is no. The employer or its workers' compensation insurance company initially choose the doctor to treat the injured worker. If the worker is unhappy with the doctor chosen by the insurance company or wants to request a second opinion, we must ask the insurance company to provide the worker with another doctor. As a general rule, the injured worker cannot go to a doctor the insurance company has not approved. If an injured worker goes to his or her own doctor, he or she will probably end up responsible for payment of the bills.
How are the doctors and other health care providers paid?
All authorized health care providers must bill the injured worker's compensation insurance company directly. If an injured worker receives a bill, they are to mail it to the insurance company. The injured worker is not to pay it.
How much will it cost to pursue an injured worker's compensation claim?
Costs may include but are not limited to such things as postage, telephone, photocopies, facsimile, medical records, paralegal, research, transcription, expert witnesses, office expenses and mileage. Costs vary from case to case.
Will the injured worker be responsible for anything if her or she loses their workers' compensation case?
The injured worker will be responsible for all costs associated with the prosecution of his or her worker's compensation claim to the extent that the costs are not recovered from the employer and the insurance company regardless of the outcome of the claim.
What is mediation?
A mediation is an informal dispute resolution process. An injured workers lawyer will be present at mediation.
A mediation conference must take place within 90 days after the date the injured worker files a Petition for Benefits. The judge may grant a continuance if the requesting party can demonstrate that the continuance is required for reasons beyond the requesting parties control.
How long will it take to resolve my case?
Benefit entitlement can last a lifetime. A lump-sum settlement can be reached resolving issues or the entire case if an agreement can be agreed to by the parties.
Am I entitled to a lump sum settlement of my case?
A lump sum settlement is allowed but is not mandatory. Any negotiations are strictly voluntary to both the injured worker and the insurance company. A judge cannot force the insurance company or an injured worker to settle a case unless an agreement has been reached.
If an injured worker is already receiving Social Security Retirement Benefits can he or she also receive worker's compensation benefits or Social Security Disability Benefits at the same time?
Yes. However, the law provides for a reduction or offset in worker's compensation benefits if an injured worker is also receiving social security retirement benefits. The offset applies differently for social security retirement then for social security disability benefits.
If an injured worker is receiving both social security disability benefits and workers compensation benefits simultaneously, the compensation benefits may not exceed 80% of the injured worker's average weekly wage.
At age 62, the Social Security Administration converts disability benefits to retirement benefits.
If an injured worker is receiving both social security retirement benefits and worker's compensation benefits simultaneously, the social security retirement benefit is primary and the workers' compensation benefit is supplemental only. The two benefits together cannot exceed the basic wage loss benefit.
If an accident occurred prior to 01/01/94, the insurance company cannot take the disability offset after the injured worker reaches the age of 62.
Our Fort Myers injury law firm is prepared to answer your questions and help you with your case.
