I’ve been hurt on the job – now what do I do?
There is typically a mad scramble by both the employer and the injured worker after being injured on the job. While there is no single “correct” way to handle workplace injuries, if you are the injured worker the following can provide you with a checklist to make sure that the claim is accepted compensable and you receive both medical care and indemnity or lost time benefits you deserve.
First, try to make sure that a Notice of Injury (NOI) or First Report of Injury (FROI) is completed by your employer as soon as possible. Ideally, if the injury is not life-threatening this should be done immediately following the accident and before you leave to receive medical treatment. This is important because the filing of the NOI is what gets the process started with the Employer’s workers’ compensation carrier and without their immediate involvement, the provision of benefits can be delayed. Ask for a physical copy of the NOI or take a picture of the Notice on your phone for future reference. The statute requires that Notice of the accident be reported within 30 days but many employers have internal policies that require 24-hour notice so sooner is always better. While it is obviously possible to get the Notice of Injury filed after the fact, it inevitably causes problems and can lead to litigating things that don’t really need to be litigated. In the event your employer doesn’t or won’t complete the NOI, you should immediately contact HGR so that we can initiate the process for you.
Second, if possible take pictures of the accident scene or where the accident occurred. While Florida is a “no-fault” state for workers’ compensation injuries, photographs can be extremely helpful in determining whether there might be a third-party claim or other benefits available to you stemming from the accident.
Third, it is critical that you understand that your employer and/or the workers’ compensation insurance carrier control what medical treatment you receive and which physicians are authorized. You cannot use your personal physician or PCP. You also need to understand that it is the opinions contained in these medical records that determine your entitlement to indemnity or lost time benefits. Typically, with most injuries, you will initially be sent to a walk-in clinic or acute care center. If your injury is more severe, you may be directed to a stand-alone emergency room. Obviously, if you are transported by EMS you’ll go to the closest hospital. The good news is that in a workers’ compensation claim until you are placed at MMI (maximum medical improvement) near the end of your case, there are no co-pays or deductibles that need to be met so all of this care should be covered. If you have taken a picture of the NOI on your phone, use it to show the receptionist or nurse the information contained in the Notice. The Notice helps establish that it is a workers’ compensation claim and has the necessary billing information that allows the medical provider to bill the insurance company directly. Using your personal health insurance card should be avoided if at all possible as correcting the billing information can be extremely time-consuming and frustrating. Getting it initially set up as a workers’ compensation claim from the beginning is much easier. You should obviously save any receipts that you are required to pay so that they can be submitted for reimbursement but understand that this process can easily take 90+ days to accomplish. Most walk-in clinics, facilities, and doctors who routinely treat workers’ compensation injuries know that they need to complete a DWC-25 form as part of the examination. These forms determine your entitlement to indemnity or lost time benefits and are critical in the ongoing administration of your claim. Typically you can request a copy of these forms at the conclusion of the examination. Please forward a copy of these forms to HGR at your earliest convenience. In the event the nature of the injury requires a diagnostic test or referral to a specialist, remember this request must be made by the walk-in clinic or emergency room. Making a request directly to the adjuster will not make it happen. Again, the scheduling of the diagnostic test or the selection of the specialist is under the control of the insurance company. It is not uncommon for these to take at least 2-3 weeks but in the event things drag out longer than that, please contact HGR so that we can help push getting them set.
Fourth, try to keep a simple diary. It doesn’t have to be anything elaborate but noting the dates and what doctors you saw helps ensure that we have a complete set of your medical records and enables us to reach out and request office notes or a DWC-25 form in the event you were unable to obtain one. Also, since the statute requires that you be paid for your medical trips to/from the authorized doctors, diagnostic tests, physical therapy, etc., having a record of where and when you went allows you to submit a form requesting reimbursement. Typically, there are blank mileage forms in the informational packet you receive following the injury but in the event you run out or they were not included, please let us know.
Finally, although not really a checklist item, you need to understand that your failure to disclose a prior injury or provide a complete and accurate past medical history to the authorized treating providers following your accident can result in a complete denial of benefits to an otherwise compensable claim. Specifically, in what is typically referred to as the “fraud” provision, the statute provides that all benefits can be denied if statements concerning past medical history, prior accidents, or the extent of current injuries made for the purposes of obtaining workers’ compensation benefits are knowingly false, fraudulent, incomplete or misleading. While it may not be necessary for you to report that you had previously fractured your hand as a teenager when you are currently being seen for an injury to a completely different body part, your failure to disclose or affirmatively represents that you have never sustained a prior fracture opens the door for the insurance company to assert that you have made a fraudulent, incomplete or misleading statement. Many forms that you will be asked to complete during the course of the claim contain the following statement immediately above the signature line.
“Any person who, knowingly and with the intent to injure, defraud, or deceive any employer or employee, insurance company, or self-insured program files a statement of claim containing any false or misleading information commits insurance fraud punishable as provided in section 817.234. Section 440.105(7), F.S. I HAVE REVIEWED, UNDERSTAND AND ACKNOWLEDGED THE ABOVE. THIS INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.”
The bottom line here is that it is better to acknowledge a prior injury or accident to the healthcare provider and allow us to argue that the new accident and injury made things significantly worse than completely denying the prior injury altogether.
