Workers' Compensation

I want to you to be informed and understand the process involved. There are a lot of terms that are used and these pages are here to help you get a better understanding of what they mean and how they affect you.

Don't hesitate to ask questions. I am here to help you and I know this is a difficult time for you and your family.

Workers’ compensation is a system created by our legislators in Tallahassee, Florida. It became effective in July 1935 and has been changed many times since then. Politics and economics affect its provisions and I am constantly staying abreast of the changes to be certain that I will obtain the best results for my clients.

Currently, Florida is an “employer friendly” state and as such, the benefits available may not always be worker friendly.

The system is designed to provide medical treatment and wage benefits to workers who have suffered work related injuries. Your employer has contracted with a workers’ compensation insurance company to provide these benefits for you.

Workers' compensation is a No Fault system meaning the employer can’t deny treatment because you may have caused or contributed to your accident.

Conversely this system does not allow for compensation for pain and suffering and it does not allow you to pick your doctor. The insurance company chooses who will treat you and you must use their doctor(s) in order to have your treatment paid for or receive benefits.

The two kinds of benefits provided are:

1. MEDICAL BENEFITS

Payment and Designation of Doctor: The insurance company is required to “authorize and pay” for your medical treatment. They are not required to make you better and because of this they are not concerned with your recovery.

Unfortunately, you have no control over this.

The law says that the insurance company only has to recognize the opinions and recommendations of the doctors they choose. So it is important to go to their doctors for treatment. Further they will only pay for the medical bills of the doctors they choose for you to receive treatment from.

About Second Opinions: You do not get a second opinion but you can change doctors once during the life of your claim. I don't recommend this option unless you feel you have tried everything possible and you are still not satisfied with your doctor's diagnosis and treatment plan. If you choose to make the change, you are then stuck with the medical provider the adjuster picks for you.

Some adjusters will encourage you to use your one time change quickly. Please call me to discuss this option before you make this change!

Right to Exclude Insurance Representative: Sometimes the adjuster will send a nurse to your doctor's appointment. When you are called for your appointment, the nurse will walk into the examining room with you. YOU HAVE THE RIGHT TO EXCLUDE this person FROM the room; just ask them to leave.

2. WAGE LOSS/INDEMNITY BENEFITS

Indemnity Benefits: Also known as wage loss benefits, are determined on your work status set by the doctor the insurance company chooses to treat you.

These benefits are paid based on your Average Weekly Wage (AWW) which is the average of 13 weeks of your gross wages, before you were injured.

There are four kinds of indemnity benefits available to you:

  • Temporary Total Disability or TTD
  • Temporary Partial Disability Benefits or TPD
  • Impairment Income Benefits or IIB
  • Permanent Total Disability or PTD

These benefits are paid based on your Average Weekly Wage (AWW) which is the average amount of 13 weeks of your gross wages, before you were injured.

A. TTD/TEMPORARY TOTAL DISABILITY

The temporary total disability benefit is also referred to as your "comp rate".

This designation means that you are “temporarily totally” disabled. These benefits are paid to you when your doctor says you can’t work at all.

If you have these restrictions you are paid 66 2/3 % of your AWW. This is determined by multiplying your AWW by .6667.

You will be paid the above temporary benefits until the doctor either says you can work with no restrictions, and/or you have reached MMI or Maximum Medical Improvement. At this time, your workers' compensation checks will stop.

MMI or Maximum Medical Improvement means you have reached a state in your treatment when there are no further options for your improvement.

Your temporary benefit payments stop the day you reach MMI. The carrier has no further obligation to pay you any further benefits.

Your doctor may give you a PIR or Permanent Impairment Rating ( a % number). If you get a rating more than zero you are entitled to IIB or Impairment Income Benefits.

B. TPD or Temporary Partial Disability Benefits

You are “temporarily partially” disabled if you’ve been released to work but the doctor has given you restrictions on activities or movements he or she advises you to avoid.

If your employer can accommodate your restrictions you MUST work but you only are required to perform work within those restrictions. If you do not make at least 80% of your AWW the the insurance company will pay you a differential. If your employer cannot give you work within your restrictions, then the insurance company will pay you 80% x 80% of your AWW.

You will be paid the above temporary benefits until the doctor either says you can work with no restrictions, and/or you have reached MMI or Maximum Medical Improvement. At this time, your workers' compensation checks will stop.

MMI or Maximum Medical Improvement means you have reached a state in your treatment when there are no further options for your improvement.

Your temporary benefit payments stop the day you reach MMI. The carrier has no further obligation to pay you any further benefits.

Your doctor may give you a PIR or Permanent Impairment Rating ( a % number). If you get a rating more than zero you are entitled to IIB or Impairment Income Benefits.

C. IIB/Impairment Income Benefits

You have reached MMI and your doctor has given you a permanent impairment rating that is more than zero. Depending on the number given you will get at least two weeks of these benefits per percentage point assigned and this is paid at 75% of your TTD or comp. rate. When these benefits are paid out, the carrier’s obligation to pay you is over unless you are determined to have become permanently and totally disabled.

D. PTD/Permanent Total Disability

You are “permanently and totally” disabled and are unable to engage in sedentary work within a 50 mile radius of your home. You are then paid your No Work benefit.

Written and provided for your use by:

Kelly A. Cambron
Law Offices of Kelly A. Cambron

Tel: 772-696-6012

Search