Learn the steps in how to file 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. The fact is, though, more than half of these claims are denied by the employer and/or insurance carrier. To improve your chance of success with a workers’ compensation case, it is important to follow specific rules and keep track of deadlines.
Below, you will find detailed instructions to help you ensure your best chance at obtaining your due benefits.
How to File a Worker’s Compensation Claim in Florida
If you believe you have a worker’s comp claim, here are the steps you should take:
What’s Included in the First Report of Injury or Illness Form?
The purpose of this form is to gather details about the injured employee, the employer, the accident, and the injury sustained in the work place accident.
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 cases of 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.
Are You Eligible for Worker’s Comp Benefits in Florida?
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.
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
- 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)
- The business has four (4) or more employees, either full- or part-time
- A farming employer has more than five regular workers (or 12 or more seasonal employees working 30+ days).
How to Handle a Denied Claim
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 reasoning 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. An unfavorable outcome can be questioned again in an administrative hearing. The hearing is similar to a trial, and you (or your attorney) can present evidence and testimony 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.
An Experienced Attorney Can Make a Difference
Though we offer the steps for how to file a workers’ compensation claim in Florida, the process can be complex. Also, it is not unusual for employers and insurance carriers to try to manipulate injured workers out of their entitled benefits.
To ensure you and your family are taken care of, seek counsel from an experienced employment law attorney. If you need help, please reach out to Feldman Williams today.