Workers’ compensation in Florida is a legally required system of benefits that are available to most employees who are injured on the job. It is a no-fault system, meaning that for the most part negligence in the cause of an accident is a non-issue. You can be totally at fault or negligent in causing an accident, and this does not disqualify you from receiving benefits. Conversely your employer or coworker can be negligent in causing the accident, and this does not entitle you to additional benefits.
Sword and Shield
An example illustrates the “sword and shield” aspect of workers’ compensation. Let’s say Leroy is a careless worker. As Leroy falls down fracturing his knee cap. His boss comes to his aid, and sees that Leroy as usual was carrying way too much to be safe and his shoelaces were untied.
If the facts change slightly, Leroy trips on the broken stairs that his boss knew about, but didn’t even bother to warn him about. Leroy cannot sue his boss or Employer for negligence as a result of his manager’s careless actions. Careless Leroy has the same rights as an injured worker as careful Leroy does. That may seem unfair, but that is a consequence of fault of negligence being a non-issue in workers’ compensation.
So what benefits do you get when you’re injured on the job?
There are basically two classes of benefits. These benefits are known as indemnity benefits and medical benefits. Indemnity benefits is money that is paid to the injured worker as a result of missing time from work because of the accident. Medical benefits are the care provided to you in the way of emergency treatment, follow up doctor visits, medical testing, physical therapy, prescriptions, etc. Those are the only two types of benefits you get under workers’ compensation – lost wages and medical. Not included within the workers’ compensation benefit system is money for pain and suffering, loss of enjoyment of life, mental anguish or emotional anguish. If you can’t run, or jump, or walk like you used to there is no compensation for that. If you can’t pick your child up anymore because of your back injury, again there is no payment for that. If your marriage falls apart, your car is repossessed and you’re evicted from your apartment, you receive no compensation for these damages. Medical care and lost wages to a certain extent – that’s all. Everything else are losses that the system will not compensate you for.
So let’s say you qualify as an employee under the workers’ comp system, does that mean that you’re entitled to benefits if you suffer an injury or have an accident at work? Like many legal questions, the answer is that it depends. First, the accident or injury has to “arise out of” and be “in the course and scope” of employment. Arising out of work basically means that some aspect of the work caused the accident.
“In the course and scope of employment” is also required for an accident to be covered under workers’ comp. To be in the course of employment, you actually have to be at work. If you have a car accident either on your way to work or on your way home, most times those accidents are not going to be considered work related accidents.
Lost Wages
If you’ve cleared the hurdles of being an employee that’s injured in the course and scope of your job by an accident that arose out of work, what do you get? To be entitled to lost wages, you have to miss a certain amount of work and the disability has to last a certain period of time. If you miss less than a week from work, you’re not going to receive lost wages. Also if you have an injury that heals within three weeks, you’re not entitled to temporary benefits. If you do suffer an injury that keeps you out of work for an extended period of time, then you will receive compensation. However, this compensation is not your full salary. Rather you receive approximately two thirds of what you were making at the time of the accident. If the doctor says no work at all, then you get 66.67% of what you were making at the time of the accident. If the doctor says you can work with restrictions AND the Employer is unable to accommodate those restrictions, you will receive 64% of your salary. But if your Employer is able to accommodate those restrictions and you are making 80% of your pre-injury wages, you receive no compensation. So bottom line is that if you are missing work because of a work related accident, you will lose wages. The longer your disability, the more wages you can lose. Unless you settle your case at some point, those lost wages are gone for good and will not be recovered.
A further restriction on your ability to receive lost wages is that those benefits are only paid for a certain period of time. Once you have achieved maximum medical improvement, which is the doctors way of saying you’re as good as you’re going to get, you don’t get any more temporary benefits. Even if you have not returned to work or your job is no longer available, your temporary benefits end. If you receive an impairment rating due to a permanent injury, you will receive permanent impairment benefits, but those benefits are less than the temporary and they are very short lived. They usually just last a matter of a few weeks or months. Only very few injured workers, the most severely injured, have a chance of receiving long term permanent benefits called permanent total disability.
Medical Care
When it comes to medical care, your rights or benefits also have significant limitations. If you have an injury that requires emergency care, then you can get that care without first getting Employer or workers’ comp carrier approval. After that initial medical care, who you see for medical treatment is not your choice. Your Employer or more often its workers comp insurance carrier will tell you who you can treat with. If you don’t like the doctor they select, then you can get a one time change but that’s it. Moreover, you don’t get to select that next doctor either. Again the workers comp insurance carrier picks the doctor. You can get what is called an IME, or “independent medical doctor”, but you have to pay for that doctor out of pocket. Your health insurance won’t cover it.
If you find yourself in the workers comp system, you’re better off getting advice and possibly legal representation sooner rather than later. Mistakes made in the workers’ comp system can be difficult if not impossible to unwind. And certain mistakes can mean the end of your case entirely. So if you have a workers’ comp accident, contact us immediately. The advice is free, and you are under no obligation to hire us. If you do hire us, you won’t be out of pocket for any fees or costs. We only get paid when we get benefits for you!
