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An employee being injured on the job can cause significant business disruptions, leave you worried about workers’ compensation exposure, and even have you preparing for potential future legal battles. In Florida, the workers’ compensation system is designed to provide workers injured on the job with compensation for the losses they incur from the injury as well as during their recovery. The goal is to help injured workers recover fully and get back to work as quickly as possible. Florida has a no-fault workers’ compensation system. If an injury happened on the job or was caused by work duties, the worker will usually be eligible for benefits. The workers’ compensation process, though, is complicated and takes quite a bit of time and energy to navigate. Having an experienced attorney by your side to help navigate the Florida workers’ compensation claim process is critical to keeping your company protected after a work-related injury.

First Steps

An injured employee must report the injury within 30 days, in most cases. If the employee fails to report the injury within the designated time frame, benefits will most likely be denied. If the employee seeks medical treatment, they must use a health care provider approved by your company and its workers’ compensation insurer or carrier. If the worker’s injury constitutes an emergency, though, send them to the nearest hospital for treatment.

What Happens When A Claim Is Accepted

After the company has been made aware of the injury, it has seven days to report the incident to its workers’ compensation insurer via a First Report of Injury or Illness, commonly known as an accident report. When a workers’ compensation carrier receives this report, it will then send an information packet to the injured employee. This packet of information will contain a copy of the accident report and information on what the employee’s rights are in regards to any potential compensation. The packet should be sent within three days of the insurer receiving the accident report.

If the carrier accepts the claim, the injured employee should start receiving benefits within 21 days of the injury being reported. The amount of benefits allotted will depend on the injury’s severity. The employee should continue to receive checks until either they return to work or 260 weeks pass. Keeping in touch with the employee to see how their recovery is progressing is a good way to keep track of when they are able to return to work.  

What Happens When A Claim Is Denied

If the workers’ compensation carrier denies the claim, it will notify the injured employee within 120 days of the First Report. The employee, not the company, must then make a “good-faith effort” to resolve the dispute by speaking with an insurance adjuster. The employee also has the right to contact the Florida Employee Assistance and Ombudsman Office (EAO).

When medical benefits are involved and the initial claim is denied, the employee must then file a Petition for Workers’ Compensation Benefits. The employee must file this petition within two years of the initial injury date. The petition should be filed with the Office of the Judges of Compensation Claims (OJCC) and copies must also be served on the employer and its workers’ compensation insurer. The business and the insurer have 14 days to respond as to whether they will agree to pay benefits or file and serve a response.

Mediation and Trial

In the majority of cases, the OJCC will order the parties to mediation within 130 days of a petition being filed. If mediation is successful, the claim will be resolved, which may result in a lump sum payment of benefits or a schedule of payments. Having an experienced workers’ compensation attorney during mediation is critical to protecting the company’s financial bottom line.

If a settlement cannot be reached in mediation, a pretrial hearing will take place before the Judges of Compensation Claims. After the pretrial hearing, a hearing to resolve the benefits dispute will take place within 90 days of mediation and no later than 210 days after the Petition is filed. After the hearing, the JCC will issue a decision that either approves or denies the employee’s claim. If all parties agree with the decision, it will become final. This means that if the JCC approves an employee’s claim, they will begin to receive benefits; however, if the claim is denied, the employee can appeal the decision.

Appealing a JCC Decision

If the employee, employer, or workers’ compensation insurer disagrees with the JCC’s decision, they have 30 days from the decision date to file a notice of appeal with the Florida First District Court of Appeal. The JCC has 60 days to send the record over to the appellate court. The record will be certified and the party that filed the appeal must file a brief or written argument explaining why they are appealing the decision. The other party or parties can then file a written response. The appellate court will consider all arguments and then issue a decision. This decision can:

• Affirm the JCC decision
• Reverse the JCC decision
• Remand the case to the JCC for additional findings

Florida Workers’ Compensation Attorneys

Having an employee injured while on the job involves complex and confusing administrative and legal processes that may leave business owners wondering if their companies will be protected. False claims and faked injuries are all too frequent, so it is imperative that your business has the best team on its side. Our experienced Florida workers’ compensation attorneys routinely help businesses located in and/or doing business in Florida through the difficult process of state regulations. Call Conroy Simberg today to ensure your company is ready for a workers’ compensation claim.