A workplace injury can be devastating. Not only could your injuries leave you unable to perform your job in the short term, but you may have doubts about when and if you will ever be able to get back to work. Along with an uncertain future, you are likely facing the financial strains of keeping up with your household bills, rent or mortgage, and car payments, while at the same time the costs associated with your injury – doctors, medication, rehabilitation – are mounting.
Unfortunately, recovering benefits can be an uphill battle. Employers sometimes shirk responsibility by insisting that a worker’s injuries are not actually work-related. Furthemore, workers’ compensation insurance companies may dispute that the injury is covered or disagree with the amounts being claimed. For these reasons, it is imperative that anyone attempting to file a claim or who has already been denied benefits contact an experienced workers' comp lawyer in The Villages as soon as possible.The Villages Workers Comp Lawyer: Helping Injured Workers File a Claim
The workers’ compensation rules in Florida govern who must carry workers’ compensation insurance, whether someone is covered under the insurance, what types of injuries or illnesses an employee can claim, and how much an injured or sick employee can receive under the program. The Villages workers comp lawer handling your case at Whittel & Melton understands these rules and can help you apply them to your case so you have the greatest chance of receiving fair compensation for your injury.Requirements for Workers’ Comp in Florida
The Florida Department of Financial Services and the Office of the Judges of Compensation Claims regulate workers’ compensation, and there are certain requirements that must be met in order for you to receive compensation under Florida’s workers’ compensation laws.Employer Requirements
In order to receive benefits under an employer’s Florida’s workers’ compensation insurance policy, your employer must obtain and pay for workers’ comp insurance. If your employer is not required to carry the insurance in Florida, you cannot collect under the program.
Sometimes employers who are legally obligated to purchase Florida workers’ compensation insurance neglect to do so. If those instances, you may still be able to recover the payments that would have been made by the insurance carrier had your employer properly obtained insurance. Furthermore, if your employer does not have workers’ comp insurance, you may be able to sue for damages in a personal injury lawsuit.
So, the first question to ask is whether your employer is required to carry workers’ compensation insurance. According to Florida law, employers in almost every industry who have four or more part-time or full-time employees must carry workers’ compensation insurance. However, there are slightly different rules for the construction industry, and farmers.
The construction industry is particularly prone to on-the-job injury. Therefore, under Florida law, construction-related companies must carry workers’ comp insurance even if they only have one employee. Farmers with five or more regular employees or twelve or more seasonal workers must provide workers’ comp coverage.Recovering Workers’ Comp Benefits
Once it is determined that your employer is required to purchase workers’ comp insurance, it is up to you to show that the circumstances of your injury or illness are covered under the Florida law. In general, in order to collect workers’ comp benefits in Florida:
- You must have been injured while performing a regular, routine task while working within the scope of your employment, and
- You must have been injured while on the job, rather than while traveling to or from work on your own time, although injuries that occur while traveling on a business trip or operating a company vehicle may be covered.
It is important to understand that your workers’ comp claim is not like a civil lawsuit, regardless of if you hire a Villages workers comp lawyer. You are not suing your employer for negligence or an intentional or reckless act, so you do not have to show that your employer did something that caused your injuries. A workers’ comp claim is not dependent on fault. It does not even matter if the injury was your fault. Further, there is no requirement that the injury happens all at once. Many successful claims for workers’ comp are for injuries that developed over time because of repetitive use.What Does Workers’ Compensation Insurance Pay for?
Workers’ comp insurance usually will pay for medical expenses and lost wages. In addition, in some cases you may be eligible for additional cost reimbursement. Examples of additional expenses that might be covered include:
- Job retraining and/or job-related re-education
- Compensation for a permanent impairment
- Travel expenses to and from doctor’s appointments
- Hospitalization and in-patient services
- Physical therapy and other kinds of rehabilitation
- Prescription drugs
In order to collect workers’ comp benefits, you must notify your employer of your injury within 30 days of the incident you are claiming gave rise to your injury. If you are dealing with a condition or illness that develops over time, you must notify your employer within 30 days of discovering that an injury or illness is related to your job. The time frame for reporting is very important, as missing the 30-day window to report could result in a loss of benefits.
Make sure you include all the details that you can in your notification. For instance, if you were injured in an accident, you need to explain when the accident happened and how it happened. If you are claiming some type of repetitive stress injury, you must provide the details of how your work contributed to the problem. You also need to thoroughly list all of your symptoms and explain in detail how they impact you.
It is then up to your employer to notify the workers’ compensation insurance carrier within seven days. The insurance company will review all the information and will issue an approval or denial of your claim.The Workers’ Comp Appeals Process
Just because you filed a claim for workers’ comp does not mean that the insurance company is going to approve it. It is in the insurance company’s best interest to pay out as little as possible, or nothing at all. The insurance carrier and your employer might dispute your claim based on a variety of reasons ranging from dismissing your account that the injury happened at work to claiming you are overstating the severity of the injury or illness. You claim could even be denied simply because of a claim that you did not meet some of the technical filing requirements.
If you are denied benefits, a The Villages worker’s comp lawyer can review the circumstances of your case and help you approach the insurance company to work out a better result.Alternative Dispute Resolution for Workers Compensation Claims
If efforts to work out a solution directly with the insurance company fail, you have the option of a formal appeal of the decision. In Florida, this appeals process will begin with a form of alternative dispute resolution (ADR) called mediation.
While mediation seems less adversarial than going to court, the reality is that the insurance company will have strong advocates on its side and you will need to make sure you put your best case forward. You should consider having an attorney for proceedings.
Hopefully, mediation will result in an outcome that is favorable to your case, but if the results of the ADR process are unsatisfactory, your case will be assigned to a workers’ compensation judge. Your case will then be scheduled for an administrative hearing with evidence presented by both sides. The judge will then make a ruling.
Should the administrative judge fail to rule in your favor, you still have one more appeal to the District Court of Appeals. It is always desirable to reach a favorable result before this phase, however, as it can take a year or more for a case to be heard by the appellate court.Consult With The Villages Workers Comp Lawyer at Whittel & Melton to Discuss Your Rights
If you have been injured at work in Lake County, Sumter County or Marion County, meeting with The Villages workers comp lawyer at Whittel & Melton can help. Whether you need assistance filing an initial workers’ compensation claim, negotiating with the insurance company, or are headed for mediation or an administrative court proceeding, we will represent your workers’ compensation interests aggressively. In addition, we can assess your case to determine the likelihood of recovery from a third party or if circumstances support a suit against your employer for pain and suffering.