Frequently Asked Questions
Frequently Asked Questions
Q: Why do I need a lawyer?
A: Long-term disability insurance law can be complex to prosecute, particularly in cases where the wording of your own policy is unclear. Florida has long been known for its unusually high number of disability cases, particularly where physical work is concerned. It is no surprise that insurance companies tend to seize upon any loophole they can find to deny your claim. It is your responsibility when this happens to seek and retain aggressive counsel that can help you get the benefits you are owed.
Q: How long do I have to report an injury to my employer?
A: According to the Florida Workers’ Compensation Statute, you have 30 days in which to report an injury to your employer. However, it is best to report the injury at the time that it occurs. There are some exceptions to this.
Q: What if my employer refuses to complete a notice of injury?
A: If your employer refuses to send you to a physician or refuses to complete a notice of injury, you should contact the Employee Assistance Office immediately at 800-342-1741 and report the injury and request medical care.
Q: I have not seen an authorized workers’ compensation physician for over a year for my work injury. Now the carrier says I am no longer entitled to benefits. What can I do?
A: If your accident occurred prior to January 1, 1994, you have up to two years from the date you last treated with your authorized doctor to seek medical care. If the carrier refuses to provide any additional care, you should immediately file a Request for Assistance asking for your medical care. If your accident occurred after January 1, 1994 and it has been more than a year since you received authorized treatment, you may not be eligible for any additional benefits. However, if it has been less than 2 years since the accident, you may be able to file a claim for additional benefits. There may be some exceptions to this.
Q: My doctor has released me, but I cannot do the job I used to do. What can I do?
A: If your accident occurred after January 1, 1994, you may not be eligible for any additional lost earning benefits unless you qualify for retraining through the State of Florida OR you are permanently and totally disabled.
Q: I am not happy with my medical care, but the adjuster says I have to stay with my authorized doctor. Is this true?
A: No, if you are part of a managed care arrangement, you are entitled to a one time change in medical providers. You should request a copy of the grievance procedures and the list of doctors in your area.
Q: My doctor took me out of work for 5 days, but I didn’t receive any benefits from the workers’ compensation carrier. Don’t they have to pay me while I am off work?
A: Yes, but there is a waiting period of 7 days before you become eligible for benefits. The 7 days does not have to be in a row, it can be a total of 7 days over a period of time.
Q: I want to see my own doctor and the adjuster says I cannot, is that true?
A: Under certain circumstances, you are entitled to see a doctor of your choice for a one time visit. There are several restrictions however, and you may have to choose a doctor off of your managed care list. If you choose a doctor as your Independent Medical Examiner, you will be bound by what that doctor says.
Q: What benefits am I entitled to under workers’ compensation?
A: If your doctor has you off of work because of your accident, you are entitled to approximately two-thirds of your average weekly wage. You are entitled to your medical care and you are entitled to payment for your mileage to medical appointments.
Q: How does the insurance company decide how much to pay me?
A: If you worked for the employer where you were hurt for 13 weeks, the insurance carrier is supposed to average your earnings for the 13 weeks immediately prior to your accident. If you have not worked for your employer for 13 weeks or more, the insurance carrier may use your contract rate of hire or they may use an employee who was performing a similar job for similar pay at the same company.
Q: What are impairment benefits?
A: Impairment benefits are based on the impairment rating which your doctor assigns to you once you have reached maximum medical improvement. Impairment benefits are paid out at one third of your average weekly wage and you receive three weeks of benefits for each percentage of impairment assigned.
Q: My doctor gave me a 3% impairment rating, but I hurt much more than that and I know my impairment is higher. How can I get a higher rating?
A: The physicians use a book called the Florida Impairment Guide to assign impairment ratings. The ratings are based mainly on objective findings such as a positive MRI or nerve studies. Unfortunately, ratings are not given for pain and generally do not reflect your inability to do the things that you could do prior to your injury.
Q: When do I need to get an attorney?
A: Generally, as long as the insurance carrier is providing you the appropriate benefits, you do not need an attorney. If the carrier refuses to authorize medical care or does not provide benefits to which you feel you are entitled, you should seek the advice of an attorney to make sure you are receiving the benefits to which you are entitled. Our firm does not charge for the initial half-hour consultation fee.
Please note that the above are general answers to often asked questions. The law in Florida has undergone many changes since it was first implemented and therefore the above answers may vary depending upon your date of accident.
Q: Can I get paid mileage for going to my doctor appointments?
A: The Carrier is responsible for reimbursing you for your travel time to and from your medical providers including doctor appointments, physical therapy and diagnositic testing. You will need to submit your mileage in writing directly to the Carrier, preferably by Certified Mail with Return Receipt Requested. The Carrier will have 45 days from the date they receive the request. This rate is subject to change.
Q: Can my family be paid to care for me?
A: If your doctor determines that you are unable to care for yourself, he may request attendant care to be provided to you to assist in activities of daily living, including assistance in bathing, dressing, cooking and cleaning. This attendant care may be provided by a home health care agency or a family member. Your physician would need to state how many hours per day and how many days per week this care would be required.
Q: Can I choose my own doctor?
A: You are entitled to one Independent Medical Evaluation (IME). If the physician is unable to give opinions on all of your injuries, you may be entitled to additional IME’s.
Q: Can I be fired?
A: Florida is an “at will” employment state. As a result, an employer may generally terminate an employee for any reason, or without any reason whatsoever. There are some rare exceptions to this “at will” employment rule. The most common of these rare exceptions includes discrimination on the basis of an employee’s disability as defined by the Americans with Disabilities Act and harassment by an employer in retaliation for an employee applying for or receiving Workers’ Compensation benefits. Furthermore, if you are fired for filing a Workers’ Compensation claim, your employer may be liable for damages.
If you feel that you have been terminated from your employment because of your injury, speak with your attorney immediately.
Q: When does the insurance company have to pay me?
A: You may be eligible for payment of your lost wages if your physician states that you are unable to work or that you may be able to work but at a limited duty status. You may be eligible for these benefits if you have been out of work for more than seven (7) calendar days on the advice of your approved doctor and one of the following is true:
- You are unable to return to work as a result of the accident.
- You are able to work but because of your injury you earn wages less than 80% of what you earned before your injury.
- Your doctor says you will have a permanent loss of a bodily function as a result of your injury.
These cash benefits begin on the eighth day of partial or total disability. You will be paid for the first seven (7) days only if you are disabled for more than twenty-one (21) days.
Your average weekly wage (AWW) is based on a percentage of the wages you earned in the thirteen (13) weeks prior to your accident. If you have a second job, those wages may be considered also.
In Workers’ Compensation, the law changed effective January 1, 1994. It states that under certain circumstances, if you go one year without receiving benefits or medical care, your statute of limitations may expire. The statute of limitations is a period of time that the State of Florida indicates that an individual has in which to bring suit or file a claim or Request for Assistance. If benefits are not requested or provided by the insurance company within that time period, you may be forever barred.
Therefore, we are suggesting that all individuals receiving benefits under workers’ compensation make sure that they receive medical care, authorized by the workers’ compensation carrier, a minimum of once per year. Should you receive care less than that, you may subject yourself to the statute of limitations running.
Your case is started by the filing of a request for benefits. This Request is filed with the Employee Assistance Office in Tallahassee and sets out those benefits we are requesting. The Carrier has a period of time to respond to the request. Usually this is done by a Notice of Denial or letter.
After the time period is up, if the Carrier has failed to provide us with the requested benefits or has denied those benefits, a Petition for Benefits is filed. From there, the Petition will be reviewed by a Docketing Judge to make sure that it contains all items as required by Florida Statutes. Once the Petition is approved as being consistent, then it will be forwarded to the Judge of Compensation Claims in the District in which you were injured. The Judge will schedule your claim for a Mediation Conference at that time.
Mediation is where you and the Employer/Carrier can discuss and attempt to settle outstanding issues regarding your workers’ compensation case. Anything said by either party is completely confidential and cannot be used against you at a hearing before a Judge of Compensation Claims.
During your case, the Attorney for the Employer/Carrier will usually take your deposition. A deposition is a tool of discovery utilized by the insurance company to find out such things as how the injury occurred, whether there were any witnesses, what physical problems you have had as a result of the injury, and what physical problems you may have had before the accident. Your testimony will be taken under oath by a Court Reporter and your attorney will be present at that time.
If no agreement is reached at mediation regarding the outstanding issues, a Final Hearing and Pre-trial Conference will be scheduled. At the Final Hearing, the Judge will review all evidence and make a determination as to the entitlement of benefits sought.
At any time during your case, a settlement agreement can be reached settling either the indemnity portion or both the indemnity and medical portion of your claim. The decision to settle is entirely up to you.
Please note that the above are procedures. The law in Florida has undergone many changes since it was first implemented and therefore the above procedures may vary depending upon your date of accident.