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If you have sustained an injury in an on-the-job incident, you may be entitled to file what is known as a worker’s compensation claim against the employer. Worker’s compensation is a type of insurance that provides employees with medical care for injuries sustained on the job as well as a portion of their income for the time they are unable to work due to the injury.
The Lopez Law Group is experienced with Florida laws that cover worker’s compensation claims and what your employer can and cannot do if you suffer an injury during your employment. If you suspect your employer is not acting within the boundaries of the law, give us a call to schedule a consultation. We want you to know your rights, and we will help you hold an employer accountable for an on the job injury.
Worker’s compensation claims have rigorous guidelines that must be followed, and if these steps are not completed, it could result in the denial of your claim. Like any insurance company, worker’s compensation has a goal of paying as few claims as possible. Knowing how worker’s compensation claims work is essential to ensuring that your employer honors your claim. It is also crucial that you know your legal rights if the claim is denied.
How does the claim process work?
After an injury, you only have a limited amount of time to submit the paperwork for a worker’s compensation claim. Your first step is to notify your employer that an injury happened, the date and time it occurred, and what the injury was and the circumstances under which it happened. You may be directed to visit a doctor provided by the employer unless it is an emergency situation.
Under Florida law, you have thirty days to report your injury to your employer, though there are limited exceptions. You have up to two years to file a petition for benefits, but that is not a good idea to wait that long. Waiting hurts your chance of proving the injury is work-related, and it hurts your chances of proving that you are unable to work as a direct result of the injury.
If your injury was an emergency, seek medical attention immediately at the nearest facility. Your employer has no right to dictate where, when, or how you access emergency medical treatment. You can fill out paperwork for a worker’s compensation claim later, but the most important thing is having your injury assessed and treated as soon as possible. Make sure to requests all medical records from your initial visit.
Your employer, once notified of the injury, has an obligation to provide the employee with the paperwork and guide them about the necessary steps to filing a claim. The employers must submit the claim to their insurer, and they have to comply with the state laws concerning the reporting of injuries.
When should I file a worker’s compensation claim?
An employee should file a claim if they were injured on the job while performing any duties related to their job. This can include injuries that occurred as a result of performing the work or injuries or illnesses that the employee got from chemicals or other exposures on the job. The following must be true to file a worker’s compensation claim in Florida:
- You must work for an employer who offers worker’s compensation
- You must be an employee who works for the company, not a contractor
- You must have sustained the injury or illness while on the job
To be clear, there are some things that worker’s compensation will not pay for, and it is unlikely the employer will be held responsible for payment under other legal remedies. Worker’s compensation will not cover things like stress-related illnesses, intentionally harming yourself, injuries caused by confrontations with other employees, or injuries that occur on the way to work or after you leave work for the day. Worker’s compensation will also not pay for injuries that occur if you are under the influence of drugs or alcohol when the injury happens or if you are violating company policy when you get hurt.
How do I file a claim?
Once you have notified your company of the injury, the next step is for your doctor to submit a medical report. The medical report will detail your injuries and the current status of your recovery. The insurance carrier for worker’s compensation will then decide whether they will pay the claim or not. If they choose to pay the claim, you will be contacted to arrange payment for lost wages during your recovery.
If the insurer does not think that the injury is covered under their policy, they will deny the claim. If the claim is denied, you have a set period of time to appeal the decision. If you feel the claim was rejected in error, you can file an appeal and submit additional medical records or other documentation that you think may help your case.
If your claim is ultimately approved, you can choose to accept the offer of payment, or you can negotiate for a larger lump sum number. After you have reached maximum medical improvement, which will be determined by a doctor usually chosen by the insurance company, you must notify the employer and the insurance company of your intent to return to work. If you disagree with the assessment that you have reached maximum medical improvement, you can appeal this decision as well. You are entitled to have a full evaluation done by a doctor of your choosing to appeal the maximum medical improvement status.
What benefits can I draw from worker’s compensation?
The benefits from worker’s compensation are calculated based on your wages earned before the injury. Currently, the maximum weekly benefit amount is $971 a week, and the minimum is $20 per week.
Worker’s compensation should also pay for all medical costs associated with your injury and the associated rehabilitation. If there expected ongoing medical costs associated with your injury, worker’s compensation would pay those medical costs as they arise, even after your case is closed.
Another relevant term you will hear when discussing worker’s compensation is the impairment rating. The impairment rating happens after you have reached maximum medical improvement. You will be assessed by a doctor, usually of the insurance company’s choosing, who will use a complicated system of guidelines to determine your overall impairment after the injury.
An impairment rating of 20% or higher indicates that you may be permanently disabled and eligible for social security disability insurance. If your impairment rating is less than that, you may be offered a one-time lump sum, which will be based on your previous earnings and the percent of impairment determined by the examining doctor.
The guidelines that go into determining your impairment rating are over a hundred pages long, so it is a complicated process. Florida Statute 440.1 (3)(g) spells out how the impairment benefits are to be paid. You can use this online calculator to determine the potential payment for any given impairment rating.
If you feel your impairment rating was grossly wrong, then you have a right to appeal that decision. However, Worker’s Compensation does not have to pay for a second assessment, so the cost of the full evaluation may be your responsibility. Consult with a worker’s compensation attorney if you think your impairment rating is off by more than a few percentage points. The Lopez Law Group can talk you through how impairment ratings are decided, and what your rights are once you have been given an impairment rating.
I was offered a worker’s compensation settlement. Should I take it?
The worker’s compensation insurance provider might offer you a lump sum, known as a settlement, instead of ongoing payments. A settlement might be a favorable option, especially if you are in dire financial straits because of your injury.
However, remember, an insurance company is always going to do what is best for them, and that means taking the cheapest way out. If they are offering a settlement, it means that their risk-assessment shows that your ongoing needs might exceed the cost of a one-time settlement. That does not mean you should never accept a settlement offer, but you should seek sound legal advice before you agree to a settlement offer.
The Lopez Law Group is experienced in dealing with insurance companies, and they know that insurance companies rarely make their best offer the first time around. With skilled legal counsel, you can negotiate a fair settlement, and have confidence that an insurance company is not trampling your rights. We will fight to obtain the highest settlement possible, and it is almost always significantly higher than the initial settlement offer.
The insurance carrier is under no obligation to offer you a settlement, and doing so is entirely at their discretion. However, the final decision about settling always rests with you, and you can refuse any settlement offer if you choose. We will walk you through any settlement offer and give you an honest assessment of whether the offer is in keeping with previous settlements for similar injuries.
Should I get an attorney involved in my worker’s compensation claim?
If you were injured on the job and you feel as though you are not being treated fairly by your employer or the insurance company when it comes to compensation, you should get a skilled worker’s compensation attorney involved.
The attorneys at The Lopez Law Group will help you stand up for your rights and make sure you get the compensation you deserve. Our team of attorneys can step in on your behalf if you feel your benefits were wrongly denied. Call us at (727) 933-0015 for a fair and honest assessment of your case. The initial consultation is always free, and we strive to make sure we have answered any questions you might have about your case.
Our attorneys are standing ready to assist you. When you sustain an injury on the job, you have a right to expect your employer to take care of you in your time of need. It can be a devastating blow when they refuse to do the right thing.
When you are injured and unable to work, you have enough to worry about without fighting your employer and the insurance company. Let The Lopez Law Group take on the battle for you so that you can focus on healing and getting back to your life.
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