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The Facts About Florida Workers’ Compensation

As the owner of the Law Offices of Kelly A. Cambron, I want you to be informed and to understand the process involved. A lot of terms are used, and these pages will help you get a better understanding of what they mean and how they affect you. I am here to help you, and I know this is a difficult time for you and your family. Call 772-617-4587 to get your questions answered promptly by an attorney with decades of experience.

What Workers’ Compensation Is

Workers’ Compensation is designed to provide medical treatment and wage loss benefits to workers who have suffered work-related injuries. Your employer contracts with a Workers’ Compensation insurance company to provide these benefits for you.

Workers’ compensation is a no-fault system. This means the employer can’t deny treatment because you may have caused or contributed to your accident.

You cannot get compensation for pain and suffering or pick your doctor, however. The insurance company chooses who will treat you, and you must use their doctor(s) in order to have your treatment paid for and receive benefits.

Two Types Of Workers’ Compensation Benefits

1. Medical Benefits

The insurance company is required to “authorize and pay” for your medical treatment. It is not required to make you better, and because of this, it is not concerned with your recovery.

The insurance company only has to recognize the opinions and recommendations of the doctors it chooses. So, it is important to go to the providers they authorize treatment. The insurance company only pays for the services of the providers they authorize.  Likewise, they only pay attention to the recommendations of these providers they authorize.

About second opinions: The Florida Workers’ Compensation statute does not allow you to get get a second opinion unless an authorized treating physician recommends one.  However, 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 the providers recommendations for treatment. If you choose to make the change, you are then stuck with the medical provider the adjuster picks for you.

Most 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: These are also known as wage loss benefits. These are determined on your work status set by the doctor the insurance company chooses to treat you.

There are four kinds of indemnity benefits available to you:

  1. Temporary total disability, or TTD
  2. Temporary partial disability, or TPD
  3. Impairment income benefits, or IIB
  4. Permanent total disability, or PTD

These benefits are paid based on your average weekly wage (AWW), which is the average of the 13 weeks of your gross wages earned in the 13 weeks immediately before you were injured.

Four Types Of Indemnity Benefits

A. Temporary total disability (TTD)

The temporary total disability benefit is paid to you when your doctor says you can’t work at all.  This designation means that you are “temporarily totally” disabled. These benefits are paid based on your compensation rate which is 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 restrictions, you can work with no restrictions, and/or you have reached maximum medical improvement (MMI).

  • MMI means you have reached a state in your treatment where nothing further can be offered to make you better.
  • Your temporary benefit payments stop the day you reach MMI. The carrier has no further obligation to pay you any further temporary benefits.  They may be required to pay you Impairment Income Benefits (IIB) based on an impairment rating your doctor will assign which will be paid at 75% of your no work or TTD  or comp. rate.

Once you reach MMI, your workers’ compensation indemnity or temporary benefits checks will stop.

B. Temporary partial disability (TPD)

You are “temporarily partially” disabled if you’ve been released to work, but the doctor has given you restrictions on activities or movements they advise 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 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 not work, you can return to work with no restrictions, and/or you have reached MMI, or maximum medical improvement. At this time, your workers’ compensation checks will stop.
  • MMI means you have reached a state in your treatment where nothing further can be offered to make you better.
  • Your temporary benefit payments stop if you are taken out of work or on the day you reach MMI. The carrier has no further obligation to pay you any further benefits.

Your doctor may give you a permanent impairment rating (PIR, a % number). If you get a PIR more than zero, you are entitled to IIB, or impairment income benefits paid at 75% of your no work or TTD or comp. rate.

C. Impairment income benefits (IIB)

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 no work, TTD or comp. rate.
  • When these benefits are paid out, the carrier’s obligation to pay you money is over (they still have to pay for your medical treatment) unless you are determined to have become permanently and totally disabled.

D. Permanent total disability (PTD)

You are “permanently and totally” disabled and are unable to engage in even sedentary work within a 50-mile radius of your home. You are then paid your no-work or comp. benefit. For answers to other workers’ compensation questions, visit the frequently asked questions page.

Get Answers To Your Florida Workers’ Compensation Questions

Navigating the Florida Workers’ Compensation system can be frustrating and confusing. It often requires knowledge and experience to understand how to answer the questions correctly. I am here to help you get the information and answers you need to attain success. I offer a free consultation so that you can get your questions answered.

Call 772-617-4587 so that we can discuss what you need to be successful in your application. You can also reach me via my website contact email form.