Chapter 3: An Overview of the Workers’ Compensation System in Florida (Satisfies Workers’ Compensation Requirement)
Learning objectives Given the course materials, the learner will be able to: Identify the primary responsibilities of the Florida Division of Workers’ Compensation. Identify the departments of the Division of Workers’ Compensation and their duties. Many people in the U.S. have heard the term “workers’ comp,” and many understand it’s foundational principle: it protects the worker when injured or ill as a result of working on the job or being in their work environment . However, only some people understand what it truly is, what it does, and how the system works. Unless an individual has had previous experience with a claim or knows someone who has, little is known about the rights of workers within this system, the benefit delivery process, and the necessary time requirements when filing a claim. Workers’ compensation (WC) sometimes referred to as "workman’s compensation" or "workers’ comp", is the name given to a system of laws meant to protect injured workers. These WC laws are designed to ensure that employees who are injured or disabled on the job are provided with fixed
Identify the Bureau tasked with the responsibility of assisting, educating, and informing injured workers. Discuss the benefit rights of the injured worker. Summarize the process of how to file a claim and how to resolve a dispute regarding a workers’ compensation claim. monetary awards, eliminating the need for litigation . These laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses. Some laws also protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of co-workers in most accidents. State statutes establish this framework for most employment. Federal statutes are limited to federal employees or those workers employed in some significant aspect of interstate commerce. The WC system is administered on a state-by-state basis, with a state governing board overseeing varying public/private combinations of WC systems. The names of such governing boards, or "quasi-judicial agencies," vary from state to state, many being designated as "WC commissions."
INTRODUCTION
FLORIDA’S WC
Each state legislature enacts statutes and laws to regulate the process, the employers, workers, health care providers, insurance agencies, and other stakeholders involved in WC. In Florida, the entity responsible is the Division of Workers’ Compensation located in Tallahassee. The Division is accountable for the execution of the WC delivery system, educating all stakeholders of their rights and responsibilities, and analyzing data obtained to deliver timely services and benefits. The Florida Division of Workers’ Compensation has a specific mission statement: “To actively ensure the self-execution of the workers' compensation system through education and informing all stakeholders of their rights and responsibilities, leveraging data to deliver exceptional value to our customers and stakeholders, and holding parties accountable for meeting their obligations.” In order to effectively achieve this mission, the Division created six departments, each with their respective duties and obligations. These are categorized as follows: 1) Bureau of Compliance – investigates employers to determine civil compliance along with other responsibilities. 2) Bureau of Data Quality and Collection – collect and analyze data and reporting of medical data provided under WC; also establish and implement rules, requirements, and processes for electronic reporting of first report of injury, along with subsequent reports as well as other duties. 3) Bureau of Employee Assistance and Ombudsman Office – assist, educate and inform system participants, investigate disputes and facilitate resolutions. Reviews claims if injured workers benefits are denied or stopped; advises workers and provides re-employment services. 4) Bureau of Financial Accountability – accountable for WC assessment rate calculations, assessments collection unit, financial accountability section, among other tasks. 5) Bureau of Monitoring and Audit – regulate individual self- insurers to ensure financial resources are available to pay
employee’s claims; monitor and audit carrier performance, benefit payment accuracy, assess penalties for late reporting benefit payments or medical payments; provide technical assistance to customers through telephone contacts, training, and audit workshops. 6) Medical Services Section – Expert Medical Advisor certification and database management; reimbursement dispute resolution; investigate and determine healthcare provider utilization patterns, billing practices, or violations of law or rules that may require penalties. Later in the chapter, we will review the Employee Assistance and Ombudsmen Office responsibilities as they pertain to employees/workers. This bureau was created by the Florida legislature to inform and educate injured workers and help resolve any issues or disputes that may arise between any of the parties involved. For now, the big picture is needed to understand each of the parts of the complete WC delivery system model in Florida. The WC law in Florida can be found in Chapter 440, Florida Statutes and the Workers’ Compensation Rules in Florida’s Administrative Code, under Department of Financial Services, Division 69L. Florida also provides a Workers’ Compensation Guide (Guide) with guidelines and resources to assist workers, employers, healthcare providers, and insurance companies involved in the process of a claim. Employers are required by law to report a worker’s injury to the insurance company within 7 days of when the accident or injury was first reported . The Florida statutes, laws, and resources protect all entities involved in the WC system. The goal of the Division of Worker’s Compensation is to ensure that anyone interested or involved in the Florida WC system has the tools and resources needed to participate in the process, while following the rules and laws. The Division is not responsible for adjusting claims and/or reimbursement; they are a resource to help ensure the appropriate responsibilities are completed by each party.
Page 21
Book Code: EFL1024
EliteLearning.com/Cosmetology
Powered by FlippingBook