workers compensation claim

Workers’ compensation provides benefits to employees who are injured while working. Those benefits are normally available regardless of fault. 

Workers’ compensation law requires an employer to provide and pay for an injured employee’s medical treatment. When injured employees miss work, a temporary disability benefit replaces a significant part of their lost wages. When a work injury causes permanent impairment, workers’ compensation pays a disability benefit.

Workers’ compensation is supposed to be a user-friendly system. In reality, it is easy for injury victims to make mistakes that jeopardize their ability to receive all benefits to which they are legally entitled. Understanding those mistakes is the key to avoiding them.

Mistake 1: Not Reporting the Injury Immediately

In a workers’ compensation claim that is governed by Florida law, an injured employee has 30 days to report the injury. In some cases (such as a disease caused by repeated exposures to a toxic chemical), the 30 days begins to run when the worker knows or should have known that the condition is related to work.

Waiting more than the 30-day deadline will usually make it impossible for injured employees to bring a workers’ comp claim. Injury victims can ask a lawyer if their circumstances provide a legal excuse for not reporting the injury earlier, but justifiable excuses are not common.

While employees have 30 days in which to report an injury, the safest practice is to report the injury as soon as it occurs. Waiting creates a couple of problems. First, the workers’ compensation insurance company might use the delay to claim that the injury did not occur at work. The insurance company might say that you hurt yourself at home and are blaming the injury on an earlier work accident.

Second, you need to prove that your injury was work-related. When you report the injury immediately, witnesses will be able to tell your employer how the injury occurred. As time passes, witnesses are less likely to remember what they saw. Injured employees should always notify employers of a work injury as soon as they can.

Mistake 2: Not Asking to See a Doctor Immediately

Most injuries that involve Florida employers are governed by the state’s workers’ compensation law. Only a few Florida employers (primarily maritime businesses that employ longshoremen and harbor workers) are governed by a federal workers’ compensation law.

State law in Florida allows employers to choose a healthcare provider. Workers’ compensation insurance companies have contracted with certain doctors and clinics to diagnose and treat work injuries. When an employee asks for permission to see a doctor for a work injury, the employer (or the insurance company) will send the employee to a designated doctor or clinic.

Employees only receive free healthcare if they see the designated doctor. Employees are free to see other physicians but must do so at their own expense.

To take advantage of employer-provided healthcare, the employee must receive an authorization to visit the doctor. An exception to that rule allows employees to go to the nearest hospital emergency department if they have a true emergency — the kind that is life-threatening or will result in a serious impairment if the injury is not treated immediately. In other cases, the employee must ask for authorization to see a doctor and must see the doctor chosen by the employer’s insurer.

It is important to ask for permission to see a doctor as soon as the injury is reported. Even if the injury seems minor, visiting a doctor will make a record of the fact that the injury occurred at work. If the injury worsens over time (as is often true with muscle and joint injuries), seeing a doctor immediately creates a paper trail that ties the injury to employment. An employee who tries to “walk off” an injury and waits a week to see a doctor invites the insurance company to claim that some new event caused an injury that is unrelated to work.

Mistake 3: Not Following Through with Treatment

Busy people living busy lives sometimes miss doctor’s appointments. They might even stop going to the doctor when they start to feel better, only to resume treatment when pain returns. Taking a break from treatment, or even missing a doctor’s appointment, can be disastrous to a Florida workers’ compensation claim.

The Florida legislature has given insurance companies authority to discontinue benefits even before an injury is healed if the injury victim does not follow through on recommended treatment. Injury victims jeopardize their right to receive full benefits if they miss even a single doctor’s appointment.

Mistake 4: Letting the Deadline Pass for Filing a Claim

When injuries do not cause a permanent disability, most cases can be resolved without filing a formal workers’ compensation claim. Employers are supposed to refer injured workers for treatment and to pay temporary disability benefits without being ordered to do so by a workers’ compensation judge. When they neglect that duty, however, it may be necessary to commence formal proceedings.

When injuries cause a permanent disability, insurance companies often dispute the payment of permanent disability benefits. When a reasonable resolution cannot be achieved, injured employees must file a formal workers’ compensation claim with the state.

A formal claim is known as a Petition for Benefits. It must usually be filed within 2 years of the date of the injury, although that deadline may depend on when the insurance company last approved treatment or paid a disability benefit. Injury victims who miss the filing deadline will probably lose the right to obtain benefits.

Mistake 5: Not Recognizing When a Lawyer Is Needed

Work injury victims should always feel free to ask a workers’ compensation lawyer for advice. Florida law prohibits employers from retaliating against employees because the employee obtained legal advice or hired a lawyer to pursue a workers’ compensation claim.

When insurance companies provide treatment and temporary disability benefits without quarreling, work injury victims probably don’t need a lawyer. When the insurance company balks at providing benefits, lawyers often force the company to be more cooperative.

Injury victims usually benefit from legal advice when they suffer a permanent injury. Insurance companies make money by settling those claims for less than they are worth. Experienced lawyers understand how to value a permanent work injury. A lawyer equalizes the playing field and helps injured employees obtain the full benefits that the law allows.