FAQ's: Your Questions Answered
Workplace Injuries FAQs
When an employee is injured as a result of performing their job duties the employer, through work compensation insurance, is required to provide certain benefits to the injured worker. The three (3) primary areas of compensation due to an employee are 1) medical treatment 2) lost wages and 3) death benefits. To qualify for benefits, it must be shown that the accidental compensable injury was the major contributing cause of any resulting injuries. “Major contributing cause” means the cause was more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought.
An employer or insurance carrier (employer/carrier) is obligated to provide medical benefits, or necessary medical treatment, to assist an injured worker in recovering from the injuries sustained as the result of a work-related injury. The only treatment that is deemed to be “medically necessary”, or that is any medical treatment that assists the employee in recovering or helps to improve the employee’s condition is covered under Workers Compensation. Medically necessary treatment can consist of anything from diagnostic procedures to physical therapy and may include psychiatric counseling, chiropractic care, plastic surgery, medicine, prostheses, and other medical supplies, travel expenses (for travel to obtain medical treatment), and attendant or custodial care. Physical rehabilitation benefits are covered under medical services
The employee’s choice of a physician may be by selecting from a list maintained by the employer (authorized medical provider), or the employer may designate the care provider. If care is provided through an authorized managed care arrangement, the employee selects from a list supplied by the carrier or managed care organization. Only medical providers approved by the employer or employee/carrier are authorized to treat injuries suffered in work related accidents, and only testimony and medical records generated by an authorized medical provider may be considered in determining qualification for benefits. Medical benefits must be made available free of cost to the employee until maximum medical improvement (MMI) is determined. After maximum medical improvement is reached, a $10 patient co-payment is required for all medical services. If an injured worker fails to appear for a scheduled independent medical examination, the injured worker is liable for 50% of the “no show” fee charged by the provider.
Compensation for lost wages is also available under Workers Compensation. There are four types of wage benefits you can receive under the Florida workers compensation laws. The four types are: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), Permanent Total Disability (PTD), and Impairment Benefits (IB’s).
Payments are made for temporary total disability (TTD) in an amount determined by a percentage of the worker’s wages, subject to a weekly maximum payment amount.TTD is available when the authorized treating physician provides the opinion that a person is completely unable to perform their job. Your average weekly wage is defined in Fla. Statute 440.14 as the average weekly wages earned during the 13 weeks immediately before your accident occurred. It is called Temporary because most people will return to some level of performing work after they receive medical care. Payments may continue for up to 104 weeks. Benefits are subject to Social Security and Unemployment Insurance benefit offsets.
Payments are made for permanent total disability (PTD) based upon a percentage of the worker’s wage, subject to a weekly maximum payment amount. PTD benefits are to be paid when the injured worker cannot return to any employment after they have been injured at work. If you qualify for PTD, payments will continue until the injured worker reaches the age of 65 years old. PTD is to be paid at the same rate as TTD, or 66 2/3% of your AWW. Payments for PTD continue for the duration of the disability.
TPD is paid, prior to reaching maximum medical improvement (MMI), when your doctor says that you can return to work on a light duty basis, and your employer has light duty work within your restrictions for you. TPD is also paid based on the amount of your AWW, in conjunction with the amount of money you earn on a weekly basis after you return light duty. In general, if after returning to light duty work, you are not earning at least 80% of your pre-injury AWW, the insurance company has to pay you 80% of the difference between 80% of AWW and what you are earning in a light duty capacity. For example, your AWW is $500. You return to work light duty and are only making $300 per week. The insurance company would have to pay you 80% of the difference between $300 and $400 (80% of your AWW), or an additional $80.00.
IB’s are to be paid after the authorized treating physician has placed you at maximum medical improvement (MMI). IB’s will be paid as long as the doctor gives you an impairment rating based upon the injury you suffered at work. The rate at which IB’s are to be paid can be found at Fla. Stat. 440.15(3). IB’s are to be paid at the rate of 75% of your TTD rate, and will be paid as follows: 1. 2 weeks of IB’s for each percentage point of impairment from 1-10% i.e. – a 7% impairment rating entitles you to 14 weeks of IB’s. 2. 3 weeks of IB’s for each percentage point of impairment from 11-15% i.e. – a 12 % impairment rating entitles you to 36 weeks of IB’s. 3. 4 weeks of IB’s for each percentage point of impairment from 16-20% i.e. – a 17% impairment rating entitles you to 68 weeks of IB’s. 4. 6 weeks of IB’s for each percentage point of impairment from 21% up i.e. – a 21% impairment rating entitles you to 126 weeks of IB’s.
Death benefits are payable to an employee’s surviving spouse, or spouse and children, based upon a percentage of the employee’s wages, subject to a cap. A burial allowance is also available. If an employee dies as result of a work-related injury, the employee’s dependents–spouse, children, or dependent parents–are entitled to death benefits of up to $100,000, with certain limitations.
There is no compensation for “pain and suffering” under the current Florida workers compensation law. This is an extremely simplified explanation of the Florida workers compensation wage benefits that you can receive under the Florida workers compensation laws. In order to determine whether you should be receiving workers compensation wage benefits, it is best to consult with an experienced attorney who can explain what benefits you may be entitled to. If you have any questions concerning what benefits you may have, call Dan Newlin Injury Attorneys at 800-257-1822. Our office has attorneys experienced in Workers Compensation law that can answer any questions you may have about your work related injury and help you get all the benefits and compensation you may be entitled.