Every state, with the exception of Texas, has some sort of workers' compensation system which provide workers with medical care and lost wages if they are injured on the job. The system is a no fault system, which means that an employee does not have to prove that the injury was caused by the employer's negligence. In fact, it does not matter at all who is to blame for the accident and in some cases, there may be no one to blame at all. Most injuries that occur while in the course and scope of employment are covered. The insurance company can raise defenses though, and attempt to deny an injury. Examples include, allegations the employee's intoxication caused the injury or if there was a preexisting injury or simply arthritis. The original reason that Florida set up a workers' compensation system was to provide quick and efficient delivery to injured workers to provide them with medical care to get better, and lost wages so that an injured worker is not financially devastated. However, in the last twenty years, the Florida Legislature has methodically cut down on the amount and types of benefits and made it so difficult that even the Florida Supreme Court stated in April of 2016, that no seriously injured worker can make it through the system without representation. In cases in which benefits are denied, or cases with serious injuries, it is very important that the employee hires a aggressive board certified workers' compensation attorney to prosecute the claim in front of a WC Judge.
Additionally, not all injuries are caused by trauma. Some injuries can be caused by being exposed over time to certain work conditions. For examples, some experts believe that typing for hours a day can cause carpal tunnel syndrome. Driving a bumpy bus everyday can cause back injuries. These types of claims are called repetitive trauma and may entitle you to benefits. But the claims are tricky and require an aggressive well experienced workers' compensation expert to litigate your claim.
There are two types of benefits available; medical care and wage loss. When the system works, all medical care is provided to the injured worker at no cost. This includes, but is not limited to, visits with a walk-in clinic; specialty care such as care with an orthopedic or neurologist, prescriptions; diagnostic tests like X-Ray's, MRI's and CT scans; physical therapy; pain management including injections: hospitalizations; and surgery. Injured workers are also entitled to reasonable mileage to and from their doctors and the pharmacy. An injured worker may also be entitled to lost wage benefits if their authorized doctor says that they can't work or that they can't work their normal position because of medical restrictions. These benefits are paid at 2/3 of the injured workers average wages that were taxed and are calculated using the last 90 days of wages before the injury. Under Florida's very restrictive laws, these lost wage benefits are capped unless the injured worker can prove that they are unable to perform any job within 50 miles of their home.
Unfortunately, in almost all cases, the insurance company gets to pick the doctors. There are some exceptions though, and you should call me to discuss those options. But unless your claim fits into some sort of loophole, the insurance company has almost complete control, and make no mistake, they try and choose doctor that are favorable to them and use nurse case managers to talk to the doctors without you being there. Having practiced in this community for 25 years, I know all of the doctors and am not afraid to go toe to toe with them while litigating a claim. This is another reason why a workers' compensation lawyer is a good idea. You need someone to look out for you.
Hire An Expert To Get The Benefits You Deserve!
Make no mistake, workers' compensation carriers make money by taking in premiums and paying out less in benefits. It's a business and their business is to make money. They do not have your best interests in mind. They treat you like a number and it is their job is to get you back to work even if you are not ready, while providing the least amount of medical care possible. Call me for a free consultation today!
Important Things To Know:
You must report your injury to your supervisor immediately. If you wait more than 30 days, you will not be entitled to any benefits!
You must be honest with the insurance company and your doctors. If you fail to tell them of a prior injury, you will lose benefits permanently! If you have a good attorney and you are honest, it won't matter if you had a prior injury so long as the new injury made the condition worse. In fact, if your injury was from a prior workers' compensation claim, it won't matter at all. It will matter if you fail to tell people!
Don't give a recorded statement to the adjuster without an attorney!
Don't let an adjuster or nurse case manager bully you into signing a medical records release form. Talk to an attorney first!
Be careful of nurse case managers. Some are great but many seek to talk to the doctor behind your back to reduce benefits.