What Does Workers’ Compensation Insurance Cover in Florida?

Workers’ compensation insurance is paid by employers to provide medical benefits and monetary compensation to employees that become ill or are injured while working. Florida requires employers to pay workers’ compensation, also called workers’ comp, without cost to employees. In exchange, employees relinquish their right to sue employers for their injuries. What exactly does workers’ comp cover in Florida?

Coverage for Work-Related Injuries

Worker’s compensation is insurance, and it covers necessary medical expenses such as:

  • Visits to a doctor
  • Hospitalization
  • Medical tests
  • Prescription drugs
  • Physical therapy

Additionally, workers’ comp covers lost wages if you are unable to work for a certain length of time. Sometimes an injury occurs that does not result in missing more than a day of work. In this instance, worker’s compensation would pay for necessary medical treatment, but it would likely not cover any lost wages.

Workers' Compensation InsuranceThere are also degrees of injury including a partial disability or a permanent disability. Both would make you eligible for compensation for lost wages. If you are unable to go back to the same type of work due to restrictions from the injury, you could be eligible for rehabilitation assistance. This may be provided by the Worker’s Compensation Vocational Rehabilitation Section of the Florida Department of Education depending on your situation.

Not all injuries that occur on the job will be eligible for workers’ comp. Some employees are covered by other plans such as the Federal Employer’s Liability Act (FELA). This covers railroad workers that are injured on the job. Maritime workers are covered under the Jones Act, and harbor workers that are injured while performing their job may be entitled to compensation under the Longshoreman’s and Harbor Workers Compensation Act.

Workers’ comp may or may not be paid if an employee was injured while under the influence of alcohol or drugs that were not prescribed by a doctor. If the employee intentionally injured himself to obtain workers’ comp benefits, they will not be eligible for compensation. An employee that was injured because they did not follow safety guidelines or use safety equipment provided by the employer may not be eligible for workers’ compensation. There are exceptions.

Being under the influence of drugs or alcohol, not following safety guidelines, or using safety equipment may not necessarily disqualify an employee for workers’ comp. If an employee has a blood alcohol level of 0.08, the presumption is that the injury was caused due to use of alcohol. Depending on the level of intoxication and the employee’s ability to provide evidence that alcohol or drugs did not cause the accident, they may be able to receive compensation.

The proof must be clear and convincing and something other than just the employee’s statement that intoxication or drug use did not cause the injury. When an employee refuses to use safety equipment provided by the employer and had prior knowledge of the availability of the equipment or safety rules adopted by the company, they may be eligible for reduced compensation. Consult with your Florida workers’ compensation lawyer to determine exactly what rights you may have and if you are eligible for reduced compensation.

What Should You Do if You Are Injured on the Job?

When you are injured on the job, there are certain things that you must do to protect your rights. If you do not, you may be putting your chances of qualifying for workers’ compensation in jeopardy.

The first thing that you should do, even if you think you are fine, is to report the accident to your supervisor. Merely slipping and falling can cause serious injury that may not show symptoms until later. You may not think you need medical attention, but if you do not report the incident, an employer can refuse to pay for treatment or lost time from work. They can claim your injury was caused elsewhere.

Most employers require that an accident be reported within a certain timeframe. If you fail to do so, it is possible that you could be placed on suspension without pay. Therefore, it is always advisable to report all accidents that occur in the workplace.

Seek medical attention for your injuries. The failure to seek medical treatment can cause you to lose compensation. As with reporting the accident, it is best to be seen by a physician even if you think you are not injured. Many times, symptoms of a serious injury could appear in the days following the accident. If you fall and do not go to the doctor, back pain could flare up within the next day or two. This pain could be caused by an injury to nerves or ligaments or even vertebrae damage.

Contacting the insurance company before seeing a doctor is preferable, but if it is an emergency, a visit to the nearest hospital emergency room will be covered if treatment you received was for the injuries due to the accident. Make sure that you submit all bills for this treatment to the insurance company. If a visit to a doctor is warranted, workers’ comp will generally send you to the doctor of their choice.

In addition to the payment for your medical bills, prescriptions, or physical therapy, there are five types of money benefits available. They include:

Temporary Total – This is paid while treatment is ongoing, and the injured employee is restricted from returning to work by a doctor. This amount is two-thirds of the employee’s average weekly wage.

Temporary Partial – This may be paid to the employee while they are still being treated by a doctor but can return to work with limitations. If the employer does not accommodate the employee, they will be paid 64% of their average weekly wage.

Permanent Total – Florida laws change frequently and until 2003, a worker that was permanently and totally disabled due to an injury on the job could collect workers’ comp for the rest of their life. The law now allows for the worker to collect until age 75 if they qualify for social security.

Permanent Impairment – Once an employee has reached maximum medical improvement (MMI), it must be determined if they have a permanent impairment. The degree of the impairment must be calculated, and benefits will be received two weeks after the employee reaches MMI, and the insurance company has been informed. This amount depends on whether the employee is working and how much they are making. If it is the same as their average weekly wages, the amount will be approximately one-half of their average weekly wages.

Death – If within a year of the work-related accident, the employee dies due to injuries sustained, workers’ comp must pay death benefits to family that were dependents. This amount and how it is paid is governed by Florida Statute 440.16. Funeral expenses up to $7500 are the responsibility of the employer and his/her insurance company. A spouse may also receive payment for training or education up to a certain amount.

Employees that are injured on the job do not qualify for workers’ compensation for pain and suffering caused by the injury. However, if a third party is responsible for the injury, you may be able to sue for damages. If this is the case, contact Scott J. Sternberg, your Florida workers’ compensation lawyer for help getting the compensation you deserve.

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