If you find yourself in the unfortunate circumstance of having to initiate a workers’ compensation claim in Florida, it’s vital to understand what to do and NOT to do. The Workers’ compensation statute in Florida is a “no-fault” system designed to compensate employees who suffer an injury or illness while in the course and scope of their employment. It provides both lost time or indemnity benefits as well as medical care. There are, however, a handful of things the injured worker needs to keep in mind to minimize delays in receiving these benefits. The following steps are key:
Document and Report the Incident to Your Employer
As soon as the injury occurs, it should immediately be reported to the Employer. Typically, this is the direct supervisor or the head of the HR/Personnel department. Request that a Notice of Injury (NOI) be completed so that there is a paper or electronic trail of what happened, including the date, time, location, and circumstances surrounding the accident. Florida law mandates that workers’ compensation claims be filed within 30 days from the date of the incident, but many Employers typically require that the report be made within the first 24 hours. The lack of timely notice can bar your claim. If possible, take photographs on your cell phone. The completion and submission of the NOI is the only way that the employer’s insurance company is notified of the accident. If the Employer declines to complete the NOI, you should immediately contact our office.
Seek Medical Treatment
Your health is the top priority. In addition to completing the NOI, you should also request that the Employer send you for medical attention so that the extent of your injury can be documented. It is critical to understand that the Carrier is only obligated to accept the opinions and treatment recommendations from authorized providers. This means that you can’t simply go to your own PCP or family physician. While some Carriers may accept an initial visit from these types of doctors under certain circumstances, it is better to have the Employer or Carrier initially authorize care and treat only with those doctors.
You should inform the healthcare provider that your injury is work-related. They will document your condition and provide the necessary paperwork to the Carrier to help administer the claim. It is this paperwork that determines whether you qualify for indemnity benefits. Remember to ask for copies of medical records, prescriptions, and/or DWC-25 forms at the end of each appointment. You should not be required to pay for the treatment, tests, or prescriptions that are written by the authorized treating doctor stemming from the accident. The statute allows for the physician to collect a $10 co-pay after you’ve reached Maximum Medical Improvement (MMI) but that only occurs near the end of your claim. In the event you are required to pay or receive billing statements, you should immediately forward copies to this office so that we can take action to get you reimbursed or have them paid.
Follow Up to Avoid Delays
Stay in touch with your employer and the workers’ compensation carrier. They may require additional information or documentation from your doctors so that they know if you are on a “no-work” status or are supposed to be working in a light or modified duty capacity. Again, your work status is determined by the authorized treating physicians and not your own assessment of whether you can work. Cooperate fully during this process to ensure a smooth claim experience. The first seven (7) days of any disability period are considered “waiting” days. In other words, if you are only out five (5) days you don’t qualify for benefits, and if you are out ten (10) days you only qualify for three (3) days. It is only if you are out more than twenty-one (21) days that the Carrier is required to go back and pick up the initial seven (7) day waiting period.
Document Everything
Maintain as much of a detailed written or electronic record of all interactions related to your claim. This includes conversations with your employer, medical providers, and insurance representatives. Keep track of dates, names, and any relevant correspondence.
Be Cooperative But Careful When Talking to the Insurance Company
The adjuster with the workers’ compensation carrier should contact you to discuss your claim. Although this is standard and part of the routine administration of your claim, be cautious during this interaction. Try to stick to the facts and avoid becoming emotional during these conversations. Avoid speculating or making statements that could come back to harm your case. If you have concerns, consult with this office.
Try to Resolve Any Disputes, Then File a Petition
If disagreements or disputes arise regarding your claim, we can file a Petition for Benefits (PFB) with the Office of the Judges of Compensation Claims (OJCC). Once a PFB has been filed, the statute requires that it be set for a Mediation, Pre-Trial Conference, and a Final Merits Hearing (FMH) before the Judge. Mediation typically occurs within 130 days from the date the PFB was filed and the FMH is required to occur within 210 days from the date of the PFB.
Settlement of Your Claim
Virtually all workers’ compensation cases settle at some point in time. Typically, this occurs once your injuries have resolved and you have been placed at maximum medical improvement (MMI) by the authorized treating physician. It is important to understand, however, that unlike a personal injury (PI) case, a judge can only award past-due benefits that should have been paid and there is no requirement that the insurance company settle the claim. By the same token, the insurance company cannot force you to settle your claim either. In other words, any settlement is a mutual and voluntary agreement by both parties. If you do not settle your claim and opt to continue receiving medical care, you must be seen by the authorized physician at least once a year in order to keep the Statute of Limitations from running and closing your claim. Each case is unique and there are other critical deadlines and factors that need to be considered once you’ve been placed at MMI if you don’t want to settle so it’s important to discuss those with this office before too much time passes to avoid having the case close by operation of law.
