Worker’s Compensation

Workers’ compensation refers to a system of laws outlining specific benefits to which injured employees are entitled, and the procedures for obtaining such benefits.



List of Workers’ Compensation FAQ’s: 1-25 | 26-50 | 51-75 | 76-101


Workers’ Compensation FAQ’s Cont.

76. Are heart attacks covered under Florida Workers’ Compensation Law?
Heart attacks can be covered under workers’ compensation, if there is proof that the work performed in one’s employment is the major contributing cause of the heart attack. Like sickness and diseases, this is a very technical part of the law and every case is different, especially if one is a firefighter, police officer or first responder, which has its own set of rules and presumption in favor of the employee.

77. Does the workers’ compensation insurance company owe penalties if my workers’ compensation check is late?
Yes and lateness has to be defined in very strict technical means. Generally, if the check hasn’t been paid, but, is due for more than 7 days, a 20% penalty is owed.

78. What happens if my company goes out of business while I am receiving workers’ compensation benefits?
Your employer can go out of business while you are getting workers’ compensation benefits, but, their insurance carrier will have to continue to make the payments. If the insurance company goes out of business, that state’s guarantee program has to take it over and pay.

79. What is a compensable injury?
One in which the employer/Carrier/Servicing agent agrees or a Judge of Compensation Claims decides that you have suffered an injury while in the course and scope of your employment and your injures/conditions are caused by that accident/injury.

 
80. Are pre-existing conditions covered under Florida Workers’ compensation law?
The law on pre-existing conditions is very complicated, but, you can have a pre-existing condition that is aggravated and get treatment for same, depending on certain things. The employee must prove that the injury sustained in the course and scope of employment is the major contributing cause of need for treatment. Like sickness and diseases, this is a very technical part of the law

81. What is an occupational disease? Occupational diseases are covered by section 440.151, and the statute creates several distinctions between occupational disease and other injuries. Occupational disease claims require a four-prong test:
  1. 1. The disease must be actually caused by employment conditions that are characteristic of and peculiar to a particular occupation;
  2. The disease must be actually contracted during employment in the particular occupation;
  3. The occupation must present a particular hazard of the disease occurring so as to distinguish that occupation from usual occupations, or the incidence of the disease must be higher in the occupation than in usual occupations; and
  4. If the disease is an ordinary disease of life, the incidence of such disease must be substantially higher in the particular occupation than in the general public.
82. What is temporary partial disability?
Temporary Partial disability (TP) applies when the doctor states you can return to work with restrictions, you may be eligible to receive Temporary Partial Disability Benefits if you are unable to earn 80% of the wages you were earning at the time of your accident. For an estimate of your benefits, please click here.

83. What are Employee Earnings Reports?
These are called DWC-19’s. It is your duty to return these reports which list your earnings or lack of same every month that they are sent to you. Be sure to complete them accurately and within 21 days of receipt .

84. What is permanent and total disability?
If after reaching Maximum Medical Improvement your injuries are so severe, as defined by law, that you are left permanently unable to work, you may receive permanent total disability benefits. This is essentially a designation where you are determined, either administratively of by a Judge of Compensation Claims, to be unable to work (for lack of a better and more technical description) and it is permanent in nature. This is a bi-weekly benefit that can be discontinued under certain circumstances.

85. What are permanent impairment benefits?
When your doctor states you are at Maximum Medical Improvement, your condition is not expected to improve significantly, and the doctor will have you evaluated for possible permanent work restrictions and an impairment rating. If you receive a permanent impairment rating greater than 0%, you will receive money based on that rating. For an estimate of your benefits, please click here.

86. What is a permanent impairment rating?
Injured workers sometimes are left with some physical impairment that can carry a percentage (there is a rating book for a list of these ratings) number. That number is assigned by a doctor or doctors and results in benefits being owed.

87. Can the workers’ compensation insurance company reduce my compensation if I failed to wear my seatbelt or follow a safety rule?
Yes, they can, but, there are also reasons why they cannot reduce the compensation (a 25% reduction will be applied, if correct). For instance, if you are never required to wear a hard hat at work or are not provided with one by your employer and you suffer a head injury it can be argued the your employer did not enforce the requirement and no reduction should apply.

88. Are Chiropractors covered under Florida workers’ compensation law?
You can get chiropractic treatment paid by workers’ compensation. This is limited to 24 visits unless certain exceptions apply.

89. Is the workers’ compensation insurance company responsible for medical care that they did not authorize first?
Perhaps, if they wrongfully denied the treatment or other reasons.

90. Where can I report an employer for not carrying workers’ compensation insurance?
Contact The state department of compliance at Phone: (850) 413-1609.

91. Do I have to have a valid social security number to make a claim for workers’ compensation benefits?
Not necessarily. If you do not have one, you can apply for the assignment of a number under which you can file for workers’ compensation or you can apply for a pin from the IRS.

92. What is an independent medical evaluation or IME?
Either party can, generally, have an evaluation or examination with a neutral doctor. The right for the employer/Carrier/Servicing Agent to submit to one is under very strict circumstances and you should never appear for one unless you speak to an attorney first.

93. What is an Expert Medical Advisor or EMA?
Expert Medical Advisors are called upon in cases where there is a conflict of medical opinions and the Judge orders that a impartial doctor examine the Claimant and give his or her opinion.

94. Are workers’ compensation claims public record?
Partially, except for medical information.

95. What is Maximum Medical Improvement or MMI?
This is the point at which no further significant improvement can be reasonably expected. In other terms “you are about as good as you are going to get.”

96. Now that I have had an injury will the insurance company hire private investigators to conduct surveillance?
They very well may and you should always be prepared to be truthful about any and all activities. The truth will set you free, and if you are observed and are untruthful about those activities, it can not only terminate your rights to benefits, but, it is a crime, if proven.

97. I was working 2 jobs before my accident and now cannot perform either due to my accident. How does this affect my benefits?
You should immediately advise the workers’ compensation carrier or your attorney that you were working two jobs and provide you pay records. If you do, you can get wages from both included in your lost wages.

98. How does my receipt of Social Security disability affect my workers’ compensation benefits?
This is a very technical/difficult question. It depends on the type of workers’ compensation benefit you are receiving and is a question best answered by a workers’ compensation expert.

99. Can I collect Long Term Disability benefits while I am receiving workers’ compensation?
Again, this is a very technical/difficult question and is best answered by a workers’ compensation expert.

100. Can the workers’ compensation insurance company send a “nurse case manager” to be present at my doctor’s visits?
Then can and often do so. Do not think that the nurse case manager is your friend as he/she has been hired to control costs of your medical and limit your benefits in many instances. You should object to his/her appearance during the visit.

101. Do I have to provide a medical release to the insurance company so that they can obtain all of my medical records?
That depends on the relevance of which medical records and when you are asked.



Next List of Workers’ Compensation FAQ’s: 1-25 | 26-50 | 51-75 | 76-101


Workers’ Compensation FAQ’s Source: www.floridaworkers.org




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