The actual procedure for filing a workers’ compensation claim is generally straightforward and can be done by the injured party. However, the system has definite filing requirements and depending upon circumstances and documentation requirements, preparing the claim can become a complicated process and should not be attempted without a worker’s compensation attorney. States and cities may also have individual requirements regarding workers’ compensation, so it is important when choosing a worker’s compensation attorney to have representation from the proper state or jurisdiction. Attorneys who do not specialize in workers’ compensation law and are from outside the jurisdiction likely will not be able to properly represent your claim.

A workers’ compensation claim is similar to a claim against an auto or homeowner’s insurance company. It is a claim filed against the employer’s workers’ compensation insurance carrier and is not a law suit directed at the employer. In fact, the law provides that: (1) injured workers cannot sue employers for accidents occurring on the job and, (2) it is also illegal for employers to terminate workers for filing a workers’ compensation claim.

Under workers’ compensation, the main benefit categories are, but not limited to:

Payment of related medical bills;
Benefits paid when the worker temporarily cannot work due to the injury or illness. This is titled Temporary Total Disability (TTD) and is likely a series of ongoing payments until the worker can return to work.
Benefits paid when the worker is injured to the point that he/she cannot return to work at all. This is called Permanent Disability (PD). Based on the nature and extent of the injury, PD benefits are, very often, a lump sum settlement.
It must be understood that all insurance companies are actively reviewing cases for legitimacy and to minimize fraudulent claims and their cost of claims. Depending on circumstances and for any number of reasons, a worker’s compensation insurance carrier may deny benefit payments at the beginning of the claim or may be terminate compensation after initial benefits have been paid. Questions and positions regarding TTD and PD also are often contested as are charges of illegal firing due to the injury. Since the insurance company will employ experts in the workers’ compensation arena, in these situations, it is crucial to have an experienced workers’ compensation attorney who will advocate for you to get your legal benefits restored and the settlements to which you are entitled.

Navigating through the workers’ compensation benefit system can be a difficult task, especially if there are contested issues and/or special circumstances. It is a wise decision to engage the services of an experienced workers’ compensation attorney early in the claim to guide you and represent you through the process.

Whether you spend your days welcoming guests as a princess in a magic kingdom or loading tankers at a Florida port, you need to be protected if an injury occurs. Florida’s workers’ compensation laws exist to give Florida workers that protection. However, it is not always an easy process to get the compensation you need or deserve.

If you were, or a loved one was, injured on the job, then you should make sure you retain the services of a qualified Florida workers’ compensation attorney to help you. Doolittle & Tucker, P.A. is a firm that specializes in Florida workers’ compensation cases. Let us help you get the relief you are entitled to under Florida workers’ compensation law. Call today at 904.396.1734 to schedule a free consultation with one of our Doolittle & Tucker legal professionals. Don’t go it alone. Let Doolittle & Tucker’s Florida workers’ compensation lawyers help you.

Here are 5 important facts of Florida’s workers’ compensation law that will help you begin your workers’ compensation journey.

FACT 1: Florida Workers’ Compensation Does Not Require a Finding of Fault

Florida law requires most employers to provide workers’ compensation insurance for their employees. If you are injured, the insurance paid to you serves to replace the wages lost by your inability to work.

The amount you receive in benefits depends upon the extent of your injury and how much your ability to work has been curtailed by the injury. Significantly, an injured employee does not need to prove that the employer was at fault for the injury. Accordingly, the only proof needed is that the injury occurred in the course of your job duties.

Virtually all accidental injuries and occupational diseases occurring during the course of your employment are covered. Note well, however, that mental or nervous ailments are not typically covered unless they stem from a physical injury.

FACT 2: You Will Likely Not Get Benefits Equal to Your Regular Wages

Regardless of your wage amount, under Florida’s workers’ compensation law, disability compensation is limited to 100% of the statewide average weekly wage. That means that the maximum benefit you could receive is somewhere around $863 per week. That, however, is not quite the end of the story because disability benefits are paid in percentages based on your disability.

In addition to medical coverage for an injury, three types of workers’ compensation benefits are available:

Temporary total disability (TTD) – The TTD benefits available to you are equal to around 66% of your regular wage in most cases
Temporary partial disability (TPD) – If you are not totally disabled but cannot do the job that you were doing prior to the injury, the TPD benefits will pay you 80% of the difference between 80% of your wages before the injury and what you are currently able to earn.
Impairment benefits – These benefits pay you for a permanent disability that flows from your injury.
FACT 3: You Need To Report Your Injury As Soon As Possible
Typically, you must report a work injury to your employer within 30 days of the date of injury. With injuries that take a long time to discover (such as lung damage from long-term exposure to some type of pollutant), you have 30 days from the date of discovery of the injury to report it to your employer.

In addition, within two years of the date of the injury, or discovery of the injury, you must file a petition for benefits.

Remember, you should not wait to report an injury to your employer or to the State of Florida. If you do, you may lose the ability to obtain benefits entirely, even though you have a legitimate work-related injury.

FACT 4: You May Need to Wait For Workers’ Compensation Benefits to Kick In

Under Florida law, the date your benefits start depends on how long your disability remains. If you are disabled for less than 22 days, then your benefits do not begin payment until the eighth day of your disability. If, however, you are disabled for longer than 21 days, then you may receive benefits dating back to the first day of your disability.

For TTD and TPD benefits, you are allowed to receive such benefits for up to 2 years (104 weeks). If you are receiving 80% of your regular wages because of critical injury, however, the amount of time you are allowed to receive benefits is only 6 months.

FACT 5: You May Have Limits on Choice of Doctor, and You May Not Have a Job When You Are Ready to go Back to Work

Florida workers’ compensation law puts some restrictive limits on injured employees. First, the workers’ compensation insurance company your employer chooses must authorize your treating doctor. So, you may not be able to go to your regular doctor for medical treatment under Florida workers’ compensation law. In addition, the State of Florida does not require your employer to keep your job open for you while you are out on disability. Your employer may do so for you, but it is not required to do so.

Exclusive Remedy & Employers’ Liability

Although each state’s regulations differ, they all share a common purpose. They provide an “exclusive remedy” in the form of a “no-fault” program for compensating employees in the form of medical benefits and lost wages in connection with injuries that arise in the course and scope of their employment. While Workers’ Compensation insurance responds to the “no-fault” consequences of workplace injury, Employers’ Liability insurance, which is typically joined with Workers’ Compensation policies, provides coverage for common law claims against the employer by the employee, their family or third-parties, if the claimant or plaintiff can meet the legal standard in their jurisdiction for establishing that the injury was caused by the employer’s negligence, gross negligence, recklessness or willful conduct.

The Broad Landscape of Special Funds and State Programs

Many states provide special funds to pay workers’ compensation benefits to injured workers employed by companies that failed to purchase insurance. Assigned risk pools or insurers of last resort are also available for employers that commercial insurers consider too risky.

Monopolistic States

There are currently four monopolistic states: Ohio, North Dakota, Washington and Wyoming. Puerto Rico and the U.S. Virgin Islands also operate under a monopolistic structure. These states legislated requirements that Workers’ Compensation insurance be provided exclusively by the state’s compulsory program. Commercial insurers may not offer Workers’ Compensation insurance in those four states, yet at least two of the states do allow limited opportunity for self-insurance for well-capitalized employers.

Competitive State Funds

In contrast to monopolistic state programs, Competitive State Funds are state-owned and operated insurance facilities that compete in the open market with commercial insurers to underwrite Workers’ Compensation insurance solely within their respective state.

Arizona, California, Colorado, Hawaii, Idaho, Kentucky, Louisiana, Maine, Maryland, Minnesota, Missouri, Montana, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Utah, and West Virginia operate Competitive State Fund programs.

Second or Subsequent Injury Funds

In most states it’s illegal for an employer to refuse to hire a prospective employee or terminate an employee if they have previously filed a workers’ compensation claim. To reduce the possibility of this form of discrimination, some states established a Second Injury or Subsequent Injury Fund. The purpose of these funds is to limit an employer’s (and their Workers’ Compensation insurer’s) exposure by reimbursing or covering the Workers’ Compensation benefits paid because of an aggravation or recurrence of a previously existing injury. Reimbursement eligibility requires that the injury must result from a qualifying permanent partial pre-existing disability, illness or congenital medical condition that may hinder person from obtaining employment.

Insurance Premium Calculation – The Loss Experience Mod Factor

This is a complex and often misunderstood concept that has a major effect upon a company’s Workers’ Compensation insurance premiums. On a general level, it is essentially a comparative analysis of your company’s Workers’ Compensation loss history for the prior three years against companies within the same or similar industries.

The standard Experience Mod, which is explained below, is calculated by the National Council on Compensation Insurance (NCCI). Employees are classified by standard identification codes depending upon their occupation. Depending upon an employer’s size and diversity of operations, many classification codes may be involved in the analysis.

Simply stated, the neutral point in the rating curve is 1.0. If a company’s Experience Modification Factor (“Mod”) is greater than 1.0, the employer is issued a “Debit Mod” meaning the premium will be increased by a certain mathematical factor. Alternatively, if the loss history is better than expected or lower than 1.0, the employer receives a “Credit Mod” factor that will decrease the Workers’ Compensation premium.

A Premium Calculation Illustration Using a simple example, suppose the employer only has one classification code for all employees, all of whom work in the same state, and the Workers’ Compensation expected loss rate or base premium rate (as established by the state in which the company’s employees are located) is $3 for every $100 of payroll.

If the employer has a Mod factor of 0.70, the premium will be calculated as 0.70 x $3 = $2.10. This means the employer is paying $2.10 per $100 of payroll, while its competitor peer group, on average, is paying $3 per $100 of payroll.

Assume the annual payroll for this employer is $2 million, the result is the employer would pay $42,000 in premium versus its competitors with a Mod of 1.0 paying $60,000 for the same coverage. Conversely, if the employer in this example had a Mod of 1.5, the premium would be 1.5 x $3= $4.5 per $100 of payroll. Using the same $2 million annual payroll, the employer in this case would pay $90,000 in annual premium while competitors with a 1.0 Mod would be paying $30,000 less for the same coverage. It’s easy to appreciate how these Credit or Debit Mods will have a significant impact upon a company’s bottom line, particularly as annual payrolls reach significant levels.

Many factors go into the actual calculation of a Mod including the company’s loss frequency (number of losses), loss severity (the cost of the losses), and an estimate of losses that are characterized as Incurred But Not Reported (IBNR), meaning expected losses that have not yet materialized into actual workers’ compensation claims.

Medical-Only vs. Lost-Time Claims

When calculating an experience Mod, Medical-Only claim reserves are generally factored at about 30% of ultimate value. Lost Time or Indemnity claims are treated very differently. The literature on calculating experience modification factors states that the first $5,000 of a Lost Time claim ultimate reserve is factored in at 100% with discounts applying above $5,000, including a catastrophic claim cap limit. Therefore, the frequency of Lost Time claims is a real driver of adverse experience. If a company has one Lost Time claim valued at $50,000, it will have less of an adverse affect upon the Mod factor than twenty Lost Time claims valued at $2,500 per claim.

The difference between how these two types of claims affect the Mod should be a strong incentive for employers to implement modified duty programs, with particular attention given to getting employees back to work during the mandatory benefit waiting period, whenever possible. This will cause the claim to be reclassified to “Medical Only” thereby reducing the multi-year adverse impact upon the company’s Workers’ Compensation insurance premiums.

Claim reserve management is critically important as having over-reserved claims will exponentially affect your Mod factor and correspondingly increase your premium. Having under-reserved claims is also no benefit, as the insurer’s audit may result in an unexpected assessment and, of course, increased premiums going forward. Periodic reserve evaluation by a qualified professional should ensure that over-reserved cases are negotiated downward to a reasonable level and under-reserved cases are reserved properly.

Loss Prevention

Loss Prevention is the best way to keep insurance premiums in check. The process can take many forms but essentially involves identifying potential areas of work injury risk and applying techniques to eliminate or substantially reduce the risk that an injury will occur.

Identification of potential causes of risk through performance of a workplace risk assessment is the first step. This process includes critical analysis of procedures as well as physical inspection of facilities and work environments, and discussions with operational personnel and key managers.

Once the causes of potential loss have been identified, modifications can be implemented to operational and business practices in order to reduce the associated risks. The assessment process should be performed by qualified consultants, combining qualitative elements and quantitative metrics including specifications of the physical requirements of each function and the associated loss costs.

Findings should be reviewed with key stakeholders. After agreed upon modifications to operational programs and/or safety programs have been implemented, it’s important to monitor results and make adjustments to the preventive measures. Periodic re-testing is important to ensure optimal results are consistently achieved as the company develops. This process has unique relevance in an acquisition scenario.

Loss Control

Loss Control is the process of reducing or mitigating the effect of losses once they occur. Similar to loss prevention safety programs, loss control should encompass well-formulated procedures to respond to various loss situations. The most common examples of loss control are obtaining immediate medical attention for injured workers and having a limited duty return to work program. Employers should conduct a post-loss analysis of the factors that precipitated the loss to determine whether modifications to the loss prevention plan are appropriate. Any post-loss control program should include a process for coordinating medical care to ensure that appropriate medical treatment is received timely so as not to exacerbate a condition while managing medical costs to avoid any unnecessary expenses. Additionally, developing a close working relationship with insurers to deal with potentially fraudulent claims, and implementing an early return to work or modified return to work program all factor into keeping losses at their lowest possible level.

OSHA Focuses On Ergonomics

The Occupational Safety & Health Administration (“OSHA”) publishes a variety of guidelines on the topic of workplace ergonomics for various industries and jobs. OSHA has announced plans to heighten its enforcement of ergonomics under the General Duty Clause which requires employers to “…keep their workplaces free from recognized serious hazards, including ergonomic hazards.”

What is Workers Compensation Insurance?

Workers Compensation Insurance is a special insurance system that pays all sorts of benefits to workers who are injured while on their jobs. The aim of the insurance is to cover the medical costs that may be involved, permanent disability and loss of salaries or wages. The insurance scheme also protects employers as they do receive immunity from any kind of civil lawsuit that may filed by injured employees. The insurance scheme is available in most states of the US. For instance, the California Compensation Insurance is mainly for California workers who may be injured while working in their various companies in the state.

The State Agencies Involved in the Scheme

In most states in the US, there are agencies that administer the compensation insurance scheme. The Department of Labor and Industrial Relations is usually the agency that looks into the compensation scheme in most states in the US. This agency usually receives diverse notification of injuries from workers as well as reports from their employers. The main duty of the agency is to mediate on issues concerning the benefits workers claim in the scheme. It also monitors the insurance company involved in order to make sure that the process of compensation is followed according to rules.

How to Obtain the Insurance Coverage

In order to benefit from the insurance scheme as a worker, you need to purchase the workers compensation insurance from a private insurance company that deals on that. Then, you need to meet all the requirements needed in the scheme. Once this is done, you can partake of the benefits of the scheme. If for any reason you are unable to locate a good insurance company that deals on compensation insurance, you can as well purchase the scheme from the state agency that handle such issues.

Benefits of the Insurance Scheme

Workers Compensation Insurance scheme comes with diverse benefits especially for the workers injured while on duty. You can receive proper coverage for medical treatment. Your salary or wages are covered. In situation where there’s a permanent disability, you’ll also be adequately compensated by the insurance company. If for any reason the injury results in death, the compensation is also paid to the next of kin or the employee’s dependents.

The Employer’s Responsibility under the Scheme

As an employer whose worker gets insured while on the job, you have the responsibility of filing appropriate report to the agency and the insurance company involved. You have to send the notice in time without any form of delay. If the injury is too much and demands urgent care, you and your company have to provide immediate medical care for the worker before the compensation procedure begins. This helps in saving the life of the employee before any other claim could be made.

In all, every worker must be conversant with the details of the California workers compensation insurance in his or her state and also be ready to follow the scheme to its logical conclusion whenever there’s an injury while on duty.

Like all attorneys, you must first attend college and then become accepted into law school. Choose a school that offers a thorough selection of electives or specialty courses in workers compensation. A strong workmans’ compensation curriculum will give you a good start to becoming a highly-trained workers compensation attorney.

Once you’ve entered law school and have worked your way through some of the prerequisite courses, start concentrating in workmens’ compensation classes. Familiarize yourself with the professors of those classes and get to know them. A good attorney is always building contacts and networking for the future. Let the faculty know of your desire to become a workers’ compensation attorney and use their expertise and guidance to help navigate through your studies. Additionally, pay attention in classes and keep in mind how workmans compensation can apply to the world around you, in and out of law school.

As many as there are, classes do not make the man, or in this case, the attorney. Most law schools require internships in a law firm before you may graduate. Search for internships in with a firm that specializes in workers compensation. Summer internships or associate programs are a wonderful way to network and find another workmens compensation attorney who can lend you advice in the field. Internships will also help you decide if worker’s compensation is truly the right field of study for you.

Upon graduation, there is one hurdle left: the Bar Exam. All attorneys of any specialization must pass the Bar Exam in their states before being allowed to legally practice. To be a workers compensation attorney requires an enormous amount of time dedicated to studying, and all general law as well. Buckle down and study hard to pass the first time.

Finally, the day has come and you’ve passed the Bar Exam. You are now ready to begin working. Target firms where you interned; if you are lucky, a workmans’ compensation attorney in one of those firms may be able to help you get a job. If a position with one of those firms is not available, use the workmens’ compensation networking and contacts you developed in school to apply for jobs at firms that specialize in workers compensation. Be sure to emphasize your education, your experience, and of course, your enthusiasm for becoming a workmans compensation attorney.

As you become more experienced you will begin building your client base. When you first begin practicing law, you may not necessarily be practicing only workers compensation law; you may be receiving all sorts of cases in many areas. Work those cases and begin to let your associates and colleagues know that you are specifically interested in working on workers compensation cases. Additionally, search your area for a local Bar Association and join the branch for workmens compensation attorneys. This will help you network and build a solid base of clients who are specifically looking for a workers compensation attorney. Apply all your knowledge acquired from school, internships, and legal practice, and become a successful and knowledgeable workmans compensation attorney.