Workers’ compensation case

Workers’ compensation is available to every Florida employee who needs medical treatment for a work injury, who misses at least seven days of work because of a work injury, or who suffers from a disability caused by a work injury. A workers’ compensation lawyer can help injured employees understand the benefits they are entitled to receive.

Benefits are not provided automatically. Employees who are injured at work need to take certain steps to preserve their right to receive full benefits. Here are three of the most important things an injured employee should keep in mind.

Report Every Work Injury Immediately

Florida law generally gives workers 30 days to report a work-related accident. Workers also have 30 days after they discover that an illness is work-related to report the illness. It is never a good idea to wait until the 30-day deadline is approaching to report the accident or illness. It should instead be reported as soon as it occurs.

Delaying the report of a workplace accident is often viewed as a sign of fraud. Insurers assume that delay is evidence that the accident did not occur at work. Insurance companies are more likely to deny claims when the work injury is not reported immediately. Workers can protect themselves from accusations of fraud by reporting every accident immediately.

Delay can also make it more difficult to prove that the accident was work-related. Workers who witnessed the accident might forget how or when it happened as time passes. Making note of witnesses who saw the accident and taking photos of conditions that caused the accident can also provide protection against unjust allegations of fraud.

It is sometimes difficult to determine whether an injury or illness is work-related. A condition that develops over time, or an illness that results from repeated toxic exposures, might not have an obvious cause. As soon as a physician indicates that the condition might have been caused by work, the victim should report the condition to his or her employer. The victim should then get advice from a workers’ compensation lawyer, as insurance companies are notorious for denying coverage of conditions that are not obviously caused by a work-related accident.

Keep Medical Appointments and Follow Your Doctor’s Advice

Being injured doesn’t mean a worker’s life comes to an end. Workers still need to get their kids to school. They still need to visit the supermarket. They have a hundred chores to finish before the next day brings a hundred more.

The burden of busy lives sometimes tempts injured workers to skip a doctor’s appointment. Patients often miss physical therapy appointments because they are time-consuming. Therapy can also be painful, giving injury victims an incentive to discontinue treatment.

The temptation to skip a doctor’s appointment is particularly strong when the doctor doesn’t seem to be doing anything helpful. In Florida, workers’ compensation doctors are chosen by employers, not by patients. Since patients do not choose their own physicians, they often wonder whether the physician really has their best interests at heart. Unfortunately, how a worker feels about an assigned physician does not matter. 

Skipping even a single medical appointment or missing a treatment session can spell disaster for a workers’ compensation claim. Florida law allows employers to direct the treatment for work injuries. Employers often have the right to stop paying for treatment when employees fail to comply with a doctor’s request for follow-up visits.

Workers’ compensation insurers can also stop paying for other benefits, including temporary disability benefits, when an employee does not follow through with treatment recommendations. Employees who stop going to physical therapy might find that they are cut off from the benefits that they rely upon to replace their income until they can return to work.

Insurance companies assume that injuries have healed when employees stop following treatment recommendations. Insurers might instead assume that the claim was fraudulent, to begin with. Whether those assumptions are correct rarely matters. All that matters is that the insurer has an excuse to discontinue benefits when the injury victim fails to keep appointments or comply with treatment recommendations.

Under some circumstances, it may be possible to reschedule a missed appointment. However, the injury victim should immediately notify his or her attorney of the problem so that the attorney can contact the insurance company. Ignoring an appointment or failing to follow through on recommended treatment is a recipe for denied claims.

Be Honest

Workers may be tempted to “enhance” their compensation by pretending to have more significant symptoms than those they are experiencing. Workers’ compensation benefits in Florida and in many other states are less generous than the benefits awarded in states where labor is valued. Employees who feel they are entitled to greater benefits should express their opinions by voting against legislators whose opinions are dictated by corporate lobbyists. A perception that the law is unfair, however, justified that perception might be, cannot be an excuse for defrauding the system.

Workers’ compensation fraud can consist of:

  • seeking compensation for nonexistent injuries;
  • seeking compensation for injuries that are not work-related;
  • exaggerating the extent of an injury or the symptoms it produces; and
  • performing work at a second job that violates work restrictions.

Florida takes an aggressive approach to workers’ compensation fraud. Authorities in some counties are quick to file criminal charges against employees who make workers’ compensation claims that are suspected of being fraudulent.

That aggressive stance can lead to innocent employees being accused of fraud. Insurers look for every possible excuse to brand a claim as fraudulent so that they can avoid paying benefits.

Employees who protect themselves from accusations of fraud by being scrupulously honest. Every statement an employee about the cause or impact of a work injury should be completely true, Employees should not embellish their statements to employers or to representatives of the employer’s insurance company.

Keep in mind that insurance companies often employ investigators who maintain surveillance on injured workers. If you make a claim for an injury that impairs your ability to walk, you don’t want an investigator to record you while you’re pushing a lawnmower. If your knee injury impairs your ability to climb stairs, you don’t want an investigator recording you as you climb a ladder to clean your gutters.

If your health condition improves, tell your doctor and your lawyer about the change. You might lose temporary disability benefits if your doctor decides you can return to work, but you might lose your freedom if you try to collect benefits to which you are not entitled.