This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured on the job, you should notify your employer as soon as possible. You have thirty (30) days from the date of your accident or thirty (30) days from when your doctor has informed you that you are suffering from a work-related injury to notify your employer. Failing to notify your employer within these time frames may deprive you of the opportunity to file a claim or increase the chances of your claim being denied.
Your employer is then expected to contact his workers' compensation insurance provider and inform them of your injuries within seven days of you notifying your employer about the accident. If your employer does not contact the insurance provider, you may contact the insurance provider yourself. This information should either be readily available at your workplace or you may request the information from the Employee Assistance and Ombudsman Office.
Your employer and your employer's insurance provider should complete the First Report of Injury or Illness (DWC-1).
After you have notified your employer about your injury, you are expected to utilize the services of the medical provider authorized by your employer. Your employer's insurance provider will pay for all authorized medical bills.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer is expected to partake in an insurance coverage program when:
- Your employer, who is not in the construction industry, has four (4) or more full or part-time employees.
- Your employer, who is in the construction industry, has one (1) or more employees, your employer included.
- Your employer is a state or local government.
- Your employer is a farmer with more than five (5) regular employees and/or twelve (12) or more seasonal employees who work for thirty or more days.
Your employer should post information about your employer's insurance coverage plan and provider somewhere readily accessible at your place of work. If you have difficulty obtaining information about your employer's insurance provider, you may contact the Employee Assistance and Ombudsman Office.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Under Florida state law, you are not entitled to receive wages for time lost from work if your injury prevents you from working for fewer than seven (7) days. Should your injury prevent you from returning to work for over twenty-one (21) days, you may be able to receive wages for the first seven (7) days you were unable to return to work.
4. What benefits might I be eligible to receive?
If your employer and/or your employer's insurance provider choose to accept your claim, you may be entitled to medical benefits and partial wage replacement benefits.
Medical benefits include all medically necessary treatment and care required for the process of recovery related to your injury. This may include medications, medical supplies, durable medical equipment and prosthetics. In order to receive medical benefits, your work-related injury must be the major contributing cause for medical treatment. The extent to which you receive medical treatment will be determines by your treating physician. He will establish when you have received Maximum Medical Improvement.
You may be entitled to monetary benefits, in the form of partial wage replacement as well. This will come in the form of either Temporary Total Disability or Temporary Partial disability. Temporary Total Disability benefits are paid when your disability is total in character, but temporary in quality. Your benefits will be calculated and paid to you as two-thirds (66.67 %) of your average weekly wage. Temporary Partial Disability payments are paid to you if you are able to return back to work but earn less than eighty percent (80%) of your pre-injury wage.
You may receive Temporary Total or Temporary Partial Disability payments for no more than 104 weeks.
If you are unable to return to work in the same capacity as you were employed prior to your accident, you may seek the assistance of Florida reemployment services to help you return to work. These services include vocational counseling, job-seeking skills, job placement, and job training or retraining. You may contact the Department of Education, Division of Vocational Rehabilitation, Bureau of Rehabilitation and Reemployment Services to learn more about different opportunities they may offer.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You have thirty (30) days from your accident or thirty (30) days from your doctor's diagnosis that you are suffering from a work-related injury to notify your employer that you plan to seek workers' compensation. Your employer has seven (7) days from the time you notify your employer of the injury to contact the insurance provider. If your employer and/or insurance provider deny your claim for workers' compensation you have two (2) years to file a petition for benefits with the Employment Assistance Office. You may elect to be represented by an attorney, however, it is not required.
To begin the petition process, you must file a Petition for Benefits form with the Office of Judges of Compensation Claims. Once the Petition is filed, the carrier must either pay the requested benefits without prejudice to its right to deny within 120 days of receiving the petition or file a response. The response will provide the insurance provider's justifications for why each requested benefit was not paid.
A Judge of Compensation Claims reviews the Petition as well as the response, scheduling a mediation date to resolve the issues.
6. If I am not happy with the determination, how do I appeal?
If you are not happy with the determination made during the mediation with the Judge of Compensation Claims, you may pursue an administrative hearing. This will include a pre-trial hearing and then a final hearing. These proceedings resemble proceedings in a trial, where you and your attorney on your behalf present evidence and expert testimony related to your case and claim. The judge will issue a decision within thirty (30) days of your final hearing. If you remain unsatisfied with the determination, you may appeal to the First District Court of Appeals.