If you were injured or became ill because of an incident that happened while you were on the job, you are probably facing lost wages, medical bills, and anxiety about what comes next. Luckily, if you can provide qualifying evidence linking your injury to your employment, then you are most likely eligible for workers’ compensation benefits to help mitigate costs and financial losses. In order to make the most of workers’ compensation, you must first understand:
- What workers’ compensation benefits are
- What is required to qualify for workers’ compensation
- What is covered by workers’ compensation
- What may disqualify you from workers’ compensation
- When you should hire a workers’ compensation attorney.
Depending on the cooperation you receive from your employer (and their workers’ comp insurance adjuster) and the complexity of the case, an applicant’s attorney (also known as a workers’ comp attorney) may be needed to represent your work injury case.
What is workers’ compensation & who enforces it?
Workers’ compensation, sometimes called “workers comp” or “workmans’ comp,” is a specific type of insurance that offers wage replacement and medical cost coverage to employees who become injured or ill in the workplace as a result of their job duties. Workers’ compensation is typically required by most businesses with varying requirements and coverages on a state-by-state basis.
In Florida, workers’ compensation is handled by the Division of Workers’ Compensation in the Florida Department of Financial Services. This agency provides helpful information such as proof of coverage, FAQs, and workers’ comp benefits calculators. The federal government also has a separate workers’ compensation program, the Office of Workers’ Compensation Programs (OWCP), in the U.S. Department of Labor.
Workers’ compensation insurance is held and paid for by the business, not by the employee. In exchange for accepting this compensation, employees sacrifice their right to file a lawsuit against their employers for negligence around the circumstances leading to their injury. An employee can only sue a business if it doesn’t have proper workers’ compensation coverage as required by the law, if the injury was intentional, or under very specific, limited circumstances.
What are the qualifications for workers’ compensation benefits?
In order to be eligible for workers’ compensation benefits, you as the employee must meet four basic requirements:
1. Your employer must carry workers’ comp insurance
To meet the first requirement, your employer must carry appropriate and valid workers’ compensation coverage in order for you to receive benefits. If you are injured on the job and learn that your employer does not carry appropriate coverage, they are violating Florida law and you may have grounds for a lawsuit.
2. You must be a payroll employee
In order to meet the second requirement, you must be on the company’s payroll with a valid W4 form, whether full-time or part-time. If your employment relationship is that of an independent contractor working on a 1099, you likely do not qualify for workers’ compensation benefits. That said, there have been several cases where 1099 employees have been able to argue their employment relationship is misclassified and successfully qualified for workers’ comp benefits. In these cases, the dispute will likely end up in court and you will need an attorney to guide your case through pleadings, discovery, trial, and if necessary, an appeal.
3. Your injury or illness is work-related
The third requirement is that your injury or illness must have occurred in the workplace or as a direct result of working conditions. In most cases where an accident occurs and a clear physical injury is sustained, workers’ compensation is straightforward. Not all cases are this way, however. That’s when you need a knowledgeable workers’ comp attorney who understands classification codes for work types, benefit structures for employer insurance policies, and the ratings schedules for temporary and permanent work-related disabilities.
4. You meet the statute of limitations
Finally, you must file your claim for workers’ compensation within the appropriate time frame, as designated by your state. In Florida, a workers’ comp claim must be filed within two years of the injury or one year of the last provision of compensation. Typically this filing deadline is not a major issue, as most people who are injured on the job are looking for quick assistance with medical bills and lost wages.
If your illness is cumulative or your injury is chronic or compounded over time—such as lung disease from asbestos exposure or carpal tunnel syndrome from typing—this can complicate the reporting window. Extensions are also available in certain cases, such as if your injury resulted in a coma, quarantine, or extended medical treatment leading to incapacitation—such as severe burns.
What does workers’ comp cover?
There is a wide array of injuries that qualify for workers’ compensation benefits. The primary requirement is that the injury or illness occurs at work or is a direct result of working conditions. Workers’ compensation also applies to any complications of work-related injuries—for instance, if a wound becomes infected, treatments for the bacterial infection, such as antibiotics, should also be covered by workers’ compensation.
An injury does not have to be a one-time incident to qualify for workers’ compensation. Progressive illnesses that develop gradually as a result of working conditions, as well as repetitive stress injuries from physical labor, can qualify for workers’ compensation benefits.
Workers’ compensation covers any complications or additional conditions that result from the initial injury—for instance, if a wound becomes infected, treatment for the infection should also be covered by workers’ compensation. The same is true for any medical devices required for recovery, such as a wheelchair or crutches. Sometimes medical benefits depend on the agreed medical evaluation (AME), which is a medical-legal report completed by a doctor whom both sides (your workers’ comp attorney and the claims adjuster) agree on.
What is not covered by workers’ comp?
Not all workplace accidents qualify for damages. Workers’ compensation does not cover injuries if the incident:
- Was self-inflicted or caused by the injured employee starting a fight
- Occurred while the employee was under the influence of drugs or alcohol
- Was suffered while the employee was committing a crime
- Was the result of the employee’s negligence or willful ignorance of company policy—for instance, not wearing a hard hat or ventilator in circumstances where the company requires employees to do so.
Any “pain and suffering” claim or stress, fright, or anxiety as a result of working conditions is also not covered by workers’ compensation.
When should you appeal a denied workers’ comp claim?
Workers’ compensation is designed to protect the company from liability for injuries to employees. It is not designed to pay workers who were hurt as a result of their own negligence or noncompliance with safety regulations. That said, not all denials by claim administrators are correct or fair.
If your workers’ comp claim because of one of the above circumstances and you feel this was done in error, you can dispute the denial. Seeking assistance from an experienced workers’ comp lawyer can increase your chances of a successful appeal An attorney can help you throughout the process, such as gathering evidence or writing a declaration of readiness (DOR), which is used to request a hearing before a workers’ compensation judge.
What type of settlement can I expect from workers’ compensation?
Workers’ compensation benefits should directly cover any medical treatment related to your injury, including emergency care, diagnostic visits, and ongoing treatment. In cases other than emergency care, the doctor will likely require prior authorization from the insurance provider before administering treatment. Additionally, workers’ compensation may cover lost wages that result from an injury, depending on the length of work absence and level of disability.
If your injury leaves you partially or completely disabled, you likely qualify for workers’ compensation disability benefits. For temporary disabilities, these benefits pay up to two-thirds of your wages for a temporary disability period. For permanent disabilities, payment terms can be more complex. A permanent partial disability that impairs your ability to work will have a limit on the payment term. A permanent full disability, whether it impacts your ability to work or not, should be eligible for long term payments.
If your injury requires rehabilitation or retraining to completely recover and regain the skills necessary for your job, workers’ compensation should cover these costs as well. If your injury prevents you from returning to your old job, workers’ compensation may cover vocational training for a new position. Your employer could also offer you a modified job (mod work) with new duties that fit your capacity. Any modified job must last at least 12 months and have the same wages and benefits as before.
What other parties can I pursue for my injuries?
If you were injured while working and another person or entity caused your injuries, under Florida law you can pursue workers’ compensation benefits through your employer while simultaneously pursuing a claim against the at-fault person or entity. For example, if you are driving for work and you are involved in a car accident, you are entitled to workers’ compensation benefits while also making a claim against the at-fault party’s insurance coverage.
An experienced workers’ comp and personal injury attorney can analyze these types of circumstances and discuss your options with you. Our Team is uniquely qualified to handle these types of cases, as we have been handling workers’ compensation and personal injury claims throughout Florida for more than 15 years.
When should I hire a workers’ comp lawyer?
No two workplace incidents are identical, so there is no single solution to get the best possible resolution to your claim. An attorney can be useful in many ways, such as interpreting the benefits structure of your employer’s workers’ comp insurance, dealing with the claim adjuster, and for working with an audit unit should you need to appeal a denied claim.
If you have any questions or concerns about a work-related illness or injury, you should contact an experienced workers’ compensation lawyer to review your case and determine a course of action. If you need legal assistance when filing a workers’ compensation claim, providing a proof of claim statement, or negotiating compensation, contact Matthews Injury Law to schedule a free consultation with one of our workers’ comp attorneys in Tampa and Sarasota