Once the injured worker has seen the medical doctor authorized to treat them, they will need to give the doctor’s note to the employer to inform them of the worker’s status . At this time, the authorized doctor will be able to inform the worker if they can return to work, and if so, if they have a full release to return to original job responsibilities. If the release is limited, the employer will either find a job the injured worker is capable of performing or release the employee if they do not have another position available.
It is important that the injured worker contact the insurance company to let them know what the doctor said about the injury or illness and inform them of their work status. If the injured worker is unable to work for more than seven (7) days, they should receive money to partly replace what they were not able to earn after the accident. There are several types of disability benefits related to the status of the injured worker. The next section will discuss this further. The following graphic illustrates the claim process from the point of injury through acceptance or denial. The complete process will appear later in this chapter.
WORKER’S COMPENSATION BENEFIT RIGHTS
EMPLOYER Injury report to employer ASAP or within 30 days of injury/accident.
INJURY
The insurance company must pay the 1st installment of compensation, if injured worker misses more than 7 days from work that is immediate and continuous with 14 days after the employer has knowledge. Additional payment made bi-weekly until employee returns to work or benefits are exhausted.
INSURANCE COMPANY Employer required to report to insurance company within 7 days of knowledge.
INSURANCE Company pays claim.
YES
NO
DENIAL The Insurance Company must deny a claim within 120 days. The insurance company is required to pay benefits until the date the claim is denied.
Accept denial of the claim
Case closed
YES
NO
Temporary partial disability benefits If the authorized doctor states the injured worker can return to work with some physical restrictions, the worker is entitled to receive temporary partial disability benefits (TPD). Restrictions may include not lifting more than 15 lbs., no prolonged standing or walking, etc. The amount of benefits received depends upon the work status of the employee. If an injured worker returns to work but earns less than 80% of their average weekly wage, they are entitled to receive benefits equal to 80% of the difference between 80% of their average weekly wage and the weekly salary they earn when going back to work. Example : If you are on a restricted work status and your average weekly wage is $500 and your employer has a job for you licking stamps that pays $200 per week, your TPD would be calculated this way: ● $400 (80% of $500)-$200 (amount earned licking stamps) = $200 ● 80% of $200 = $160 ● Weekly TPD benefit = $160 It is important to note that these benefits can be terminated from post-injury employment for misconduct or if found to be voluntarily limiting your income. Permanent and partial disability benefits Permanent partial disability benefits, also known as impairment income benefits (IBs), are based on the percentage of the injured worker’s total body that is impaired, as determined by the authorized doctor. When their doctor determines that they have reached MMI, he will assign them a permanent impairment rating. This impairment rating is determined by using established medical guidelines. The injured worker will receive money benefits for a certain number of weeks based on the percentage of their impairment. In certain instances, the on-the-job injury may be so severe that the worker is unable le to return to the work force. If this occurs, the worker is entitled to permanent total disability benefits. There are criteria to meet under Florida’s WC law. These injuries are labeled catastrophic.
Employers are required to pay for medical treatment necessary to treat the condition related to the workplace injury or illness. This includes doctors’ visits, physical therapy, hospital visits, prescription medication, and diagnostic tests. The Florida WC law entitles the injured worker to receive certain benefits (money) to replace their lost time while recovering. These benefits usually do not reimburse the worker for lost wages; the amount received depends on past earnings and work restrictions placed on the worker by the physician authorized to treat them. Under Florida law, an injured worker is not paid for the first seven (7) days of the injury unless the injury results in a disability for more than 21 days. In that case, the worker will be paid back for the first seven (7) days after the injury. The money (benefit) received is tax-free and a check is usually paid 21 days after the accident or injury. Amount of money The amount of money to be paid to the worker will be based on their average weekly wage. This is calculated by using the wages earned in the 13 weeks before the date of injury, not counting the week the worker was hurt. If a WC claim is allowed, the worker will be eligible for WC benefits. These benefits include medical benefits, compensation for lost wages, and compensation for permanent partial or total disability. Total temporary disability benefits If the authorized doctor places the injured worker on a “no work” status while they recover, the worker is entitled to a check for 66-2/3% of their weekly wage which is paid: 1) The worker reaches overall maximum medical improvement (MMI) . The authorized doctor determines that there are no other treatment options that will improve the condition. 2) Under Florida law, the worker is entitled to a maximum of 104 weeks of temporary benefits ; when the 104th week is reached, the benefits are cut off, regardless of the medical condition.
Book Code: CFL1024
Page 14
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