How to File a Workers’ Compensation Claim in Florida
Learn the Steps to Filing a Workers’ Compensation Claim in Florida
If you have been injured on the job, you aren’t alone. Each year, thousands of Florida employees file workers’ comp claims for injuries and job-related health conditions. Workers’ compensation is a state-regulated insurance program that pays medical bills and replaces some lost wages for employees who are injured at work or who contract work-related illnesses, and it provides benefits for dependents of workers who die as a result of job-related injuries. However, more than half of these claims are denied by the employer and/or insurance carrier, who are out for profit and want to pay out as little as possible. To improve your chance of success with a workers’ compensation case, it is important to take certain steps, follow specific rules, and meet required deadlines.
Fortunately, you do not have to deal with navigating the system alone. The Tampa workers’ compensation lawyers at the Feldman Legal Group understand the difficulties facing injured workers and can help make sure you take the steps that will increase your chances of receiving workers’ comp. Our personal injury and labor law attorneys assist workers’ comp claimants in Florida as well as in Georgia, to protect their rights, making sure everything is done properly and according to the law. In this post, you’ll learn how to file a workers’ compensation claim in Florida, one step at a time.
How Long do I have to File a Workers’ Comp Claim in Florida?
You must start the process by reporting your injury or illness issue to your employer within 30 days of the time you are aware of your injury or the date your doctor tells you that you have a work-related condition. Failure to report your injury or illness within 30 days may result in your claim being denied.
How do I Start a Workers’ Compensation Claim?
Why You Should Understand How to File a Workers’ Compensation Claim in Florida
If you believe you have a worker’s comp claim, you have to move quickly and do things correctly from the start to avoid problems. There are a wide variety of physical and mental injuries and illnesses covered by workers’ compensation, which can provide medical treatment, replacement for lost wages, and other benefits. You are likely eligible for benefits if you have been hurt on the job (or while engaged in work-related activity off site). You may also be eligible for workers’ compensation in Florida if you are experiencing a new or aggravated health condition related to your job duties. The first thing you should do is make sure your employer is covered under workers’ comp.
Your employer should be participating in the state insurance program if any of these circumstances are true:
- The employer is an agency of state or local government.
- The business has four (4) or more employees, either full- or part-time.
- If in the construction industry, the employer has one (1) or more employees (which includes the owner if he or she works in the business).
- A farming employer has more than five regular workers (or 12 or more seasonal employees working 30+ days).
Steps to File a Workers’ Compensation Claim in Florida
Below, you will find detailed instructions on steps to take to file a workers’ comp case in Florida to help you ensure your best chance at obtaining your due benefits.
STEP 1. Write Down Details of What Happened and Obtain Available Evidence
To win your case, you need to be able to show that your injury was work-related. Therefore, the first step to take is to write down or record the details of the incident or circumstance so the facts of what happed are clear in your mind. If you are involved in an accident, such as a work-related car accident, take pictures (if possible) to gather detailed information about the accident. In addition, get the name and contact information of anyone who witnessed the accident in which you were injured, particularly if you were injured while on the job but outside of your typical work environment.
STEP 2. Get Medical Treatment
In case of an emergency, get medical treatment right away. Otherwise, wait until you have reported the injury or illness to your employer — you will need to see an insurance-authorized physician. When you do see a doctor, be thorough in your description of your symptoms as well as what you believe to be the work-related cause of the problem(s). Ask the doctor to document and include any details she or he thinks are necessary so you can prove that your workplace accident is directly responsible for your injury.
STEP 3. Report Your Injury to Your Employer
The next step is to alert your employer immediately after your injury, in writing or orally, even if you have not taken any time off of work, and you must do so within the required 30-day period.
Check to see if your employer has special procedures and deadlines for reporting injuries. If your employer does not report the injury, you can report it yourself to the insurer using the correct form on the Florida Division of Workers’ Compensation website. Your employer should have the workers’ compensation insurance carrier information posted in the workplace. If so, you may contact the insurance carrier and report the claim yourself. If your employer does not have the insurance information posted, you should contact the Employee Assistance and Ombudsman Office for assistance with obtaining that information.
STEP 4. Follow Up
Follow up with the insurance company to ensure your claim was reported. The employer should provide you with a First Report of Injury or Illness form to fill out and sign. Your employer should submit it to the insurance carrier within seven days.
The purpose of this form is to gather details about the injured employee, the employer, the accident, and the injury sustained in the workplace accident. You will have to list the following details on your workers’ comp claim forms:
- Types of injury and the damaged areas of your body
- Day, time, and address where your injury took place
- Witnesses involved in the injury
- How the accident happened
- All medical treatments you received.
There are three sections of the form used by the Florida Division of Workers’ Compensation. The top section collects information about the injured employee, including a description of the accident and the injury. The middle section captures information about the employer, including information about the wages of the injured employee. These two sections must be filled in, then the form should be sent to the insurer. In case of a serious or long-term injury that lasts for eight or more days, the insurer should fill in the bottom section of the form and send it to the Division of Workers’ Compensation.
If you are eligible to receive benefits, you will start receiving repayment within 21 days after your reported injury.
STEP 5. Document Everything
Keep a complete record of the details of your injury, medical records, and associated medical costs such as parking fees, medications, and gas bills. Make copies of all forms and paperwork regarding the accident and injury. This documentation can be used as proof of your injuries and be useful to help fight for maximum compensation.
STEP 6. Be Careful when Talking to the Insurance Company
Insurance companies will attempt to get information from you to try to show you are not really disabled or that you can do increased work, and they will use this information against you. Be aware that you do not have to provide insurance companies with a recorded statement about your injuries or how they occurred, even if requested. Tell the insurer that you will speak with your workers’ comp attorney first, and let our attorneys handle it.
STEP 7. Try to Resolve Any Disputes, Then File a Petition
If your efforts to resolve disputes with your employer and its insurer have not worked out, your next step is to file a Petition. The Petition requires contact information for you, your employer and its workers’ compensation carrier including a . . .
- Summary of your job responsibilities and what you were specifically doing on the date your injury arose
- Detailed description of the accident and a listing of body parts injured
- Listing of all medical, lost-wage and other benefits you claim are “due, ripe and owing” to you, including the rates and dates of denied coverage
- Claim for interest/penalties on unpaid benefits and a claim for attorney fees and costs.
You have only two years from the date of your injury in which to file the Petition with the Office of the Judges of Compensation Claims (OJCC) Clerk’s Office. Your attorney can file the Petition using the OJCC’s electronic filing system. You can also file the Petition at 1180 Apalachee Parkway, Suite A, Tallahassee, FL 32301-4574, or by fax at (850) 487-0724.
You must also serve a copy of the Petition by certified mail to your employer and the employer’s workers’ compensation carrier and their attorneys, if known.
STEP 8. Appeal If Your Claim Is Denied
Employers and their insurance companies will find reasons to deny claims, but that doesn’t mean you should give up. Fight the denial by having your attorney file an appeal for the court to reconsider your original claim, and you may win the benefits you deserve.
If your workers’ compensation claim was denied, there is a process accompanying that denial.
Here are the three parts of that process:
NOTIFICATION OF DENIAL
Your workers’ compensation insurance carrier should contact you within a few days after the report of your accident, usually through the mail. The company will investigate the claim and should provide a decision within 30 days. Many claims are initially denied. If your claim is denied, this is not necessarily the end of the road.
APPEALING A DENIED CLAIM
To appeal a denied claim, injured workers can petition the Office of Judges of Compensation Claims (OJCC). You have two years from the date of the incident to file a Petition of Benefits, which will be forwarded to the insurance carrier. The insurance company may then agree to pay benefits or may file a response justifying their reasons for denying the claim. (A company’s initial agreement to pay benefits does not necessarily mean it will not later deny the claim again.)
After this, a mediation is scheduled to resolve any dispute, and then a judge makes a decision. If there is no agreement or there is an unfavorable outcome, it can be questioned again in an administrative hearing before a Judge of Compensation Claims (JCC). The hearing is similar to a trial, and you (or your attorney) can present evidence and testimony about how your injury occurred, the nature and extent of your injury and how it has kept you from working to back up your claim. The judge issues a decision within 30 days of a final hearing. Even this “final” decision can be appealed to the First District Court of Appeals. The appellate court will affirm the JCC’s decision, reverse it or send it back to the JCC for more proceedings.
Enlist the Help of a Florida Workers’ Compensation Lawyer
An Experienced Attorney Can Make a Difference in the Benefits You Will Receive
Though we outline here the steps for how to file a workers’ compensation claim in Florida, the process can be complex, and making mistakes can be costly. It is not unusual for employers and insurance carriers to try to manipulate injured workers out of their entitled benefits.
To ensure that you and your family are taken care of, seek counsel from the Feldman Legal Group today. When you have our attorneys on your side, we will:
- Make sure everything is filed correctly and according to deadlines
- Ensure that you get proper medical help and that everything is documented
- Help prove your injuries were job-related.
- Negotiate with your employer’s insurance providers.
- Handle all hearings and appeals.