Nearly 100,000 people in Florida become injured on the job each year and file for workers’ compensation benefits. Under Chapter 440, F.S., employers with four or more employees[1] (or less, depending on industry) are required to carry workers’ compensation insurance to cover lost wages and medical costs resulting from injuries sustained by employees at work.[2]
Both the employer and the injured employee are responsible to promptly report workplace injuries so that the employee may receive appropriate redress. Issues often arise from non-reporting, late-reporting, or fraudulent reporting; the manner and time of receipt of benefits; as well as the enforcement of a settlement.
Reporting
To receive workers’ compensation redress, employees must report an on-the-job-injury to their employer as soon as possible, but no later than 30 days from the date of injury, or they risk denial of their claim. An employer is required to report the injury to their insurance carrier within 7 days of the time when the employee reports their accident or injury to the employer. Penalties of up to $500 may be imposed for employer late filing. In addition, due to a late filing, the employer may be liable for penalties and interest on the late payment of compensation benefits to an employer.
Benefits
Under Florida workers’ compensation law, a worker must waive the right to sue the employer in exchange for compensation without having to prove fault. The employer’s insurance carrier is responsible for providing medical treatment and applicable compensation to the injured employee. The employee must use the employer’s insurance provider to receive medical treatment or risk losing medical benefits.
In addition to medical benefits, an injured employee is entitled to certain monetary benefits based on the impact of the injury on the employee’s ability to work. These benefits may include indemnity benefits for lost wages, if the employee lost more than 7 days of salary; temporary total disability equivalent to a designated percentage of wages based on the gravity of the injury; temporary partial disability granted when the employee can return to work but cannot earn the same wages the employee earned at the time of the injury; and impairment benefits determined by a doctor’s recommendation.
An employee is also entitled to reemployment assistance, if needed.
Dispute resolution
If the employer or employer’s insurance provider is non responsive or denies the claim, the employee may file a Petition for Benefits with the Office of the Judges of Compensation Claims (JCC).
In Florida, JCCs may consider only cases that have been mediated. For this reason, a large number of workers’ compensation cases end at settlement and do not proceed to trial.
If the case has not been settled through mediation, the JCC in charge of the case will schedule a conference to take place within 40 days of the petition. During this time, a claimant may be required to submit additional evidence regarding the claim or agree to undergo an Independent Medical Examination (IME).
During the pretrial hearing, evidence can be presented showing the extent of the claimant’s injuries and justification to receive benefits. Healthcare professionals (doctors or physical therapists) may be cited o provide expert testimony may be given by healthcare professionals.
The JCC will issue a decision within 30 days of the hearing, and if benefits are denied, the next step is to file an appeal with the First District Court of Appeals.
Enforcing a settlement
Reaching a settlement may not be the end of a dispute, as disagreements over settlements are frequent in workers’ compensation matters, and conditions for settlement may not have been met.
When the parties cannot reach an agreement as to specific terms, or the injured worker has a change of heart, this may disrupt the communication between the parties and the execution of final documents needed to complete a settlement. In addition, the enforcement of a settlement may be problematic because settlements are governed by both, contract law (requiring the elements of offer and acceptance, and agreement in essential terms) and workers’ compensation law. Further, if the claimant is not represented by legal counsel while negotiating a settlement, a requirement under F.S. § 440.20(11)(c), the JCC cannot enforce it.
Worker’s compensation fraud
According to the National Insurance Crime Bureau, workers’ compensation fraud is a large component of the annual $30 billion insurance fraud problem in the United States. In Florida, an employee filing of a false claim of on-the-job injuries or exaggerating injuries carries criminal penalties. The Division of Insurance Fraud may offer a reward of up to $25,000 to citizens for information leading to an arrest and conviction in complex fraud schemes.
Enforcement of employer’s obligations
The Florida Division of Workers’ Compensation enforces employer compliance with the coverage requirements of the workers’ compensation law. It can accomplish this through compliance investigators, who have authority to enter and inspect employer’s premises, request records, and issue stop-work orders under specific circumstances.
Employers may be subject to criminal penalties for certain activities, such as coercing employees to elect certificates of exemption, discharge or discipline an employee for filing a workers’ compensation claim, and misclassifying employees to lower premiums, among other actions.
In addition, if a minor employed in violation of any provision of the Child Labor laws of Florida is injured in the workplace, the employer may be subject to up to double the compensation otherwise payable under Florida Workers’ Compensation law.
Best Practices
To avoid liability, employers must be familiar with their workers’ compensation reporting and notice responsibilities. Similarly, workers must understand the reporting process and compliance with legal requirements to be covered by the employer’s insurance company and receive other job-related remedies. The assistance of knowledgeable counsel may be key in ensuring a successful process in a settlement situation requiring competency in both workers’ compensation law and contract law areas to secure an enforceable settlement between the parties.
Whether you are an employer, employee, or independent contractor, the Orlando employment law attorneys of Burruezo & Burruezo can assist you in assessing an workers’ compensation situation and offer competent legal representation, if necessary. Click here to contact an attorney now.
[1] Employees are defined broadly under the Workers’ Compensation Statute. For more information, see the Independent Contractor or Employee? (Part 4): The Florida Workers’ Compensation Perspective blog article.
[2] Special requirements apply to members of the construction industry, agricultural industry, out-of-state employers, the use of an employee leasing company, self-insured companies, and commercial self-insurance funds. Also, seamen injured in the course of their employment are not covered under worker compensation laws, but they have the right to sue their employer for personal injury damages under The Jones Act, a federal law.