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What to Expect When Filing a Workers’ Compensation Claim in Florida

What to Expect When Filing a Workers Compensation Claim in Florida

Workers’ compensation lawyers from Sternberg | Forsythe, P.A. understand the issues arising from a work-related injury or illness. For some workers, the injury or illness may result in extensive medical costs and lost time at work.

If you or someone in your family has been injured at work or developed a work-caused illness, you may have the right to recover lost wages and medical benefits by filing a workers’ compensation claim. Just like with any insurance claim, though, there are several steps in this process. Because of how complex the process can be, working with an attorney who understands the laws for workers’ compensation in Florida is recommended.

The Workers’ Compensation Process in Florida

Filing a workers’ compensation claim is just the first step in this process. Learn more about how these situations progress to know what to expect if you must file a Florida workers’ comp claim.

Report the Injury or Illness

In Florida, employees have 30 days to report the injury or illness. In some situations, though, there are exceptions. For example, you may discover work-caused illness weeks, months, or more after it occurred. In these cases, you may still be able to file a claim.

However, if your situation doesn’t qualify for this exception, you may lose your right to receive benefits or have your claim denied if the incident is not reported within 30 days of when it happened.

Seek Medical Treatment

When injured at work and seeking workers’ compensation benefits, you must go to an employer or insurance-approved doctor. The only exception to this rule is if the injury is an emergency. In that case, you are allowed to go to the nearest emergency room or treatment facility.

It’s important to seek medical treatment as soon after the incident as possible. If you wait, it may give the insurance company evidence to deny your claim. For example, they may claim you waited to seek medical treatment, so your injuries aren’t severe or were not caused at work.

Your Employer Reports Your Injury or Illness

Once you report the injury or illness to your employer, they have seven days to report it to their workers’ compensation insurance carrier. This is called an accident report or the First Report of Injury or Illness.

Once the injury or illness is reported to the insurance company, the carrier will send out an information packet to the injured worker. It’s required that this packet be sent within three days of the incident being reported to the insurer. The packet you receive should have a copy of the report filed and outline the employee’s rights.

The Claim for Benefits Is Accepted

If the insurance company accepts your claim for benefits, you should start to receive checks within 21 days after your injury was reported. The amount you receive depends on what you are entitled to – either temporary partial disability or temporary total disability. It also depends on if your injury is considered critical.

What Happens if Your Workers’ Compensation Claim Is Denied?

Not all claims for benefits are approved. If your claim is denied, you have rights and options.

The Claim for Benefits Is Denied

If your claim is denied, an employee must be notified of this decision within 120 days of the injury being reported. Once you receive this notification, you should make a “good-faith effort” to resolve the situation. At this time, you can speak to the insurance adjuster or contact the Bureau of Employee Assistance and Ombudsman Office for more help.

At this point, you can file a petition to receive workers’ compensation benefits. This must be filed within two years of your injury. The petition will be filed at the OJCC (Office of the Judges of Compensation Claims). You should maintain a copy of this and give it to your employer. Once filed, the insurance carrier for your employer has 14 days to respond. They will either grant benefits or provide a response to the petition.

In many cases, the OJCC will order mediation for the case. Mediation is an informal meeting designed to resolve workers’ compensation disputes. The mediation order is made within 40 days of filing the petition. The mediation is required to be within 130 days of filing your petition.

Once mediation is complete, there are a few things that can happen, which include:

  • Your case is settled. If an agreement is reached during mediation, you may receive a lump sum benefit payment, and this should include interest or a schedule of benefit payments.
  • Your case goes to a pre-trial hearing. If a settlement isn’t reached via mediation, you will be issued a date for a pre-trial hearing.
  • The final hearing. The final hearing is when the dispute is resolved, and a final decision is made about your workers’ compensation benefits claim.

Can You Appeal the Decision?

If the employee, employer, or insurance carrier disagrees with the decision made during the trial, they have 30 days to file a notice of appeal. At this point, the First District Court of Appeals takes over, and this is where the prior decision will be affirmed or reversed. In some cases, the situation is referred to the JCC for additional evidence and findings.

FAQs About Workers’ Compensation Claims and Benefits in Florida

Our workers’ compensation lawyers at Sternberg | Forsythe, P.A. know that people have a lot of questions about claims and benefits. We work to answer any questions, with some of the most common questions answered here.

Am I eligible for workers’ compensation benefits in Florida?

Workers’ compensation provides benefits for employees who experience an injury or illness at work. This includes injuries resulting from an accident or illnesses resulting from exposure to hazardous materials while on the job. Sometimes, workers will qualify for benefits if they travel for work.

What are the most common types of injuries reported in workers’ comp claims?

Some of the most common causes of workplace injury claims in Florida include:

  • Sprains and strains
  • Slip and fall injuries
  • Struck by an object injury
  • Scrapes, punctures, and cuts
  • Motor vehicle accidents
  • Caught between or in machinery
  • Cold or heat exposure, scalding, burns

How are your workers’ comp benefit amounts determined?

If you are injured on the job and qualify for benefits, you will start to receive checks biweekly. The compensation for claims is two-thirds of your average weekly wage. There is a cap on what you can receive. If an injury occurred recently, the calculation is based on your wages earned in the prior 13 weeks to the injury.

Will I have to pay taxes on your workers’ compensation benefits?

No taxes must be paid on workers’ compensation benefits. However, if you are cleared by your doctor to return to work on limited or light duty, even while under their supervision, you will be taxed on what you earn while working.

Don’t Wait to Hire Workers’ Compensation Lawyers in Florida

If you are injured on the job, you should not wait to hire workers’ compensation lawyers. At Sternberg | Forsythe, P.A., we have years of experience handling claims for workers just like you. You can count on our legal team to provide you with quality, effective representation to help you recover the benefits you are entitled to.

The first step in this process is to get in touch and schedule a free initial consultation. We will discuss your claim and work to ensure you get the benefits you are entitled to.

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