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.
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 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, they will assign them a permanent impairment rating. This impairment rating is determined by using established medical guidelines. The injured worker will receive money Medical treatment With WC claims, the employer is responsible for providing medical treatment. The Employee Assistance and Ombudsman Office The Employee Assistance and Ombudsman Office (EAO) will assist the injured worker, at no cost, with questions or concerns they may have about their WC claim. The EAO relies on a team structure to successfully accomplish its mission. Each team focuses on a specific area of statutory responsibility in order to effectively assist injured workers. The EAO distributes WC information; proactively contacts injured workers to inform them of their rights and responsibilities and educates them about its services; and works to resolve disputes between injured workers and carriers to avoid unnecessary expenses, costly litigation, or delay in the provision of benefits. The First Report of Injury Team identifies and contacts injured workers with more than seven days of work lost due to the job injury. This contact takes place within two business days of the Division’s receipt of a First Report of Injury. This team will advise the injured worker of their responsibilities and inform them of EAO’s various services. The Ombudsman Team is responsible for assisting injured Re-employment assistance If an injured worker on WC is unable to return to work because of permanent work restrictions resulting from on- the-job injury, they may obtain information or assistance from the Bureau of Employee Assistance and Ombudsman
benefits for a certain number of weeks based on the percentage of their impairment. In certain instances, an 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. The injured worker should not delay in getting a doctor’s appointment from the employer or insurance company. The injured worker cannot simply go to their private doctor or a doctor of their choice; instead, the insurance company must authorize the doctor who is to treat the injured worker. workers to resolve complex disputes. The team conducts fact-finding reviews, analyzes claim files, researches case law, promotes open communication between parties, and generally helps parties to understand their statutory responsibilities. In the fiscal year of 2014-2015, the First Report of Injury Team contacted 29,116 injured workers by telephone and 3,511 employers/carriers when the team was unable to reach injured workers. In the same fiscal year, out of the 373 disputes received, 94% were resolved by the team. During the same fiscal year 2014-2015, the Ombudsman Team was involved in resolving 91% of the 754 disputes received. The medical bill disputes totaled $22,995 in previously unpaid medical bills. These statistics illustrate the commitment of the department to help injured workers and resolve disputes between parties. Several offices are located around the state and EAO’s website is http://www.myfloridacfo.com/division/ WC/employee/default.htm.
Office/Reemployment Services Section, by phone (1- 800-342-1741), email (wcres@myfloridacfo.com, or at the following website: http://www.myfloridacfo.com/division/ WC/employee/reemployment.htm
DISPUTES BETWEEN PARTIES
Judges of Compensation Claims. The injured worker may wish to hire an attorney to represent them in this action. The following graphic depicts the flow of a WC claim in Figure 1. The second flowchart describes the process of dispute resolution, Figure 2.
If a dispute arises with the insurance company, it is wise to talk about the problem with the adjuster or their supervisor. If the dispute is not resolved, the WC hotline can be contacted. If the insurance company still will not agree to pay the benefits that the worker believes they are entitled to, they can file a Petition for Benefits with the Office of the
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