Workers’ compensation is a form of insurance with many rules and formulas that can be daunting to anyone except those immersed in it. Oftentimes, those injured on the job face uncertain financial futures and significant medical costs.
If an issue arises in claiming workers’ compensation benefits, discuss it with our workers’ compensation lawyers at a free, no-obligation consultation. An adept and determined Boca Raton workers’ comp lawyer can assess the situation and explain the process and the rules involved. Attorney fees are not charged unless the lawyer wins the case.
Workers’ Compensation Coverage
Florida law requires all employers with four or more employees or at least 12 seasonal workers employed for 30 or more days to provide workers’ compensation coverage. Contract workers are not provided workers’ compensation coverage.
Benefits include payments for a percentage of lost earnings and medical care for the job-related injury. For example, strokes and heart attacks are covered if they were pre-existing conditions exacerbated by physical efforts from activity that was not usual to the employee’s type of work.
Employees do not need to prove that the employer was at fault in causing injury or illness, nor does it matter if the employee was at fault for getting hurt or sick.
Workers’ Compensation as a “No-Fault” Insurance
Workers’ compensation is often referred to as “no-fault” insurance. As the name implies, it will pay regardless of who is at fault, including the injured party. For example, while an insurance company will want to investigate whether the injury was received while at work or performing work duties, it is inconsequential whether the injured party accidentally caused their injury.
Common Causes of Workplace Injuries
Some of the most common causes of injuries in the workplace include:
- Failure to follow safety procedures
- Defective parts or tools
- Inadequate training or supervision
- Poor maintenance and housekeeping
- Poor working conditions
- Violence between coworkers
Common Types of Workplace Injuries
Some of the most common workplace injuries include:
- Overexertion: This includes non-impact injuries resulting from lifting, holding, carrying, turning, throwing, pushing, pulling, lowering, cranking, bending, and other physical activities. These injuries can be from one exposure, such as lifting an object that is too heavy, or it can be from repetitive motions, such as injuring one’s wrists from years of typing.
- Contact with objects and equipment: This includes a worker being struck by a moving object; a worker getting caught in the gears or other parts of equipment; a vibration injury from equipment; being crushed by falling objects.
- Burns: Fires and hot equipment are common in many work environments, with some jobs like working in a kitchen or operating a blowtorch on a construction site potentially leading to severe burns. Serious burns are potentially catastrophic injuries.
- Violence: Unfortunately, conflicts at work can become violent, and many people are injured intentionally at work, either by coworkers or by their employer’s customers. Injuries from a fight may be covered by workers’ comp, depending on the circumstances.
- Exposure to harmful substances: This includes a broad range of environmental hazards, such as toxic chemicals, high levels of noise, asbestos or other dust that can affect the lungs, and many other potentially harmful elements at work. Proper personal protective equipment is essential, as is training and maintenance of the job site.
- Slip and fall accidents: Another prevalent type of injury is slipping, falling, or tripping on the job site while working within the scope of employment. These injuries can result from a specific hazard, such as falling off a ladder while working as a roofer or slipping on spilled coffee at an office. While accidents can happen regardless of safety precautions, this particular type of accident can be significantly reduced by cleaning spills, keeping stairwells clear, providing safety equipment for those at risk of falls while working at dangerous heights, and other maintenance measures.
- Head trauma: Many hazards at the workplace can lead to head trauma, such as a slip and fall, falling equipment, or even a violent or reckless coworker. There are many types of head trauma, i.e., concussions, contusions, and hematomas. These injuries can have vastly different symptoms and recovery times.
- Back injuries: Back injuries can range from strains and discomfort from sitting in one position for too long at the office to complete paralysis after a car accident while on a delivery. Catastrophic injuries to the back that include damage to the spine are some of the most severe injuries an individual can suffer, requiring a long rehabilitative process to restore whatever function is possible.
Third-Party Negligence Claims
If an employee accepts a workers’ compensation settlement, they are not permitted to sue their employer for negligence it covers their liability. However, this does not exonerate third parties from liability if they contributed to the injury. Some common examples include:
- Defective equipment from a third party: A piece of equipment may fail on the worksite, causing an injury on the job that qualifies for workers’ comp. Suppose the manufacturer was negligent in producing the equipment, which caused the injury, or the distributer created the defective condition by not properly maintaining it. In that case, the manufacturer may still be sued for negligence after workers’ compensation is collected.
- Motor vehicle accident: A driver or pedestrian acting within the scope of their employment, such as making a delivery, may collect workers’ comp if injured. If a third-party driver caused the accident, they might still be sued for negligence.
- Structural collapses: A wall, floor, or scaffolding can collapse and cause an injury. Engineers and architects, along with their supervisors, who are responsible, may face liability for these injuries despite a workers’ compensation settlement.
- Premises liability: The property owner is legally obliged to make that property reasonably safe for visitors. The owner can be sued if an injury is caused on their property through negligence. For example, allowing an unsafe condition that injures a worker making a delivery on their property.
- Subcontractors: A subcontractor’s liability is not discharged through workers’ compensation. Subcontractors can be sued for reckless or negligent acts that cause or contribute to an occupational injury or illness.
At Kogan & DiSalvo, our Boca Raton personal injury lawyers can advise on any elements of third-party negligence that may be present in your workers’ compensation case and file a separate negligence claim.
Benefits Under Florida Workers’ Compensation Law
In Florida, workers’ compensation disability benefits can meet several different needs–partial or total, temporary or permanent, and they include:
- Total disability benefits will compensate for a complete loss of wages from time out of work
- Partial disability benefits will cover a worker’s pay decrease while they have a disability. This can include an individual who must accept a lower-paying job or who will need to work fewer hours and see a reduction in wages resulting from their injury.
- Medical care is covered by workers’ compensation and pays for any health care prescribed by a doctor and authorized by insurance. In addition, it covers trips to the emergency room and other immediate treatment, as well as physical therapy for rehabilitation.
- Death benefits If a worker dies due to a work-related injury or illness, the spouse, children, and other dependent relatives may be eligible for death benefits.
- Vocational rehabilitation is also included in workers’ compensation for those who may no longer be able to continue their careers due to their injury. This can consist of placement services, vocational counseling, and additional training or education to obtain a suitable job.
How Much Workers’ Compensation Will Cover
Temporary total disability benefits are paid at two-thirds of the average weekly wage of the temporarily disabled worker and are capped at a maximum established by year. For example, the maximum weekly payout is $1,099 for injuries in 2022, $1,011 for injuries in 2021, and $971 for injuries in 2020. However, serious injuries, such as paralysis or blindness, will receive a higher benefit rate of 80% of the injured workers’ average pre-injury wages with no cap.
Temporary total disability will continue until:
- a doctor says that an injured worker can return to work
- your doctor has indicated that you are at the maximum medical improvement
- or a worker has reached the maximum amount of time to receive temporary disability benefits.
Temporary partial disability benefits can be received if an injured worker has not yet reached maximum medical improvement–but the doctor has indicated that the worker can return to work with some restrictions. If the worker earns less under these restrictions, they will receive 80% of the difference between the current and pre-injury earnings.
Although Florida law states that temporarily disabled workers can only receive benefits for up to two years, Florida’s state supreme court found that they can go for as long as 260 weeks if the injured worker has not met maximum medical improvement. Once temporary benefits are near their end, permanent impairment benefits or permanent total disability benefits will be determined.
Permanent Impairment in Workers’ Compensation Law
A permanent impairment is when a worker will be able to work but has some level of disability that will not improve. To determine these benefits, the treating doctor will evaluate the worker to diagnose whether there are continuing medical conditions or impairments resulting from the injury. After assessing a worker’s impairment rating, it will be used to calculate the “scheduled loss of use” to determine how long permanent impairment benefits will last. This impairment income calculation can be done on the Impairment Income Benefit Calculator from Florida’s Division of Workers’ Compensation.
- The weekly benefits for a permanent impairment will be 75% of the temporary total disability rate, which will be adjusted based on what a worker earns.
- If the treating doctor determines that a worker is permanently disabled from their injury or illness and cannot do any work, they will be eligible for permanent total disability benefits. This will be the same amount as temporary total disability benefits and will cover a beneficiary until they are 75. Some severe injuries, such as a traumatic brain injury or amputation, may automatically qualify as a permanent total disability.
Reporting Injury or Illness Within the Reporting Deadline
Employees must report the injury or illness to their supervisor or employer within 30 days from the time it happened, and the employer is allowed seven days to report the issue to the insurance carrier.
Missing the reporting deadline can make the employee ineligible to receive workers’ compensation benefits or delay the claim’s processing and the employee can be fined from $100 to $500. A Boca Raton Workers’ compensation lawyer can help individuals file their claim within the alotted period of time.
Employees must see a physician chosen by the employer as soon as possible. Mileage to the doctor’s office may be expensed. Under Florida law the employee can change doctors, but only once.
Filing a Claim Before the Statue of Limitations Ends
The employee is required to file a claim with the Florida Division of Workers’ Compensation at the earliest time possible. However, an employee has up to two years to do so under law. Failing to act in time risks losing benefits.
The claim requires when information pertaining to when and where the incident occurred, the names of any witnesses, and what caused the injury or illness. A Boca Raton Workers’ compensation lawyer can help the injured party fill in the necessary information.
The insurance carrier can deny a claim by alleging that the employee’s injury is from a pre-existing condition, the injury did not happen at work, or the employee is attempting fraud.
A worker is entitled to a hearing before a board of appeals if the claim is denied, benefits issues are unsatisfactory if the employee wants a second medical opinion because the insurance carrier’s doctors incorrectly released an employee to work, or even if an injury occurred.
The dispute may also be settled through mediation, which is a flexible and informal procedure presided over by a neutral mediator that is allowed more alternatives, such as modifying work assignments.
Consulting a Boca Raton Worker’s Compensation Attorney
Employees are entitled to represent themselves without any legal representation. However, they are certain to be at a disadvantage because of unfamiliarity with the procedures and because the insurance carrier will have an experienced attorney representing the opposition.
Hire experienced Boca Raton workers’ compensation lawyers that can present evidence, challenge medical opinions, and use other strategies that could help you recover the benefits you deserve. If you have been injured while at work, consult a compassionate attorney that can advocate for you.