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ATTORNEY QUESTIONS

How do I know if I have a viable Workers' Compensation claim?

Most of the time when you get injured at work, you have a viable Workers' Compensation claim. In Florida you do not have to prove liability, so it does not matter who's at fault. It's simply... Were you at work? Did you get hurt? There are very stringent requirements for filing, so it's very important that you notify the employer immediately. If a case has not begun, you need to contact the state ombudsman's office or an attorney for assistant.

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When should I retain counsel to represent me regarding my Workers' Compensation claim?

As soon as you believe you've suffered a Worker's Compensation injury, it is advisable to hire an attorney. There are many benefits that are available to you that the insurance company won't advise you and won't provide to you without an attorney making that specific request. So, to ensure that you have received everything that you're entitled to it's advisable that you contact an attorney as soon as possible.

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How do I pay for an attorney to represent me regarding my Workers' Compensation claim?

When you sign up with an attorney, the attorney's usually will be paid based on the benefits that they attain for you. If the attorney has to file a petition for benefits for you, and the insurance company provides them within 30 days, the fee is based on the value of the benefits at the statutory percentage or a percentage that you agree with, with your attorney. If the insurance company fights you on the benefits, and then your attorney is successful, the attorney gets paid by going after the insurance company directly.

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For Workers' Compensation in Florida, can I recover for my pain and suffering, loss of consortium, and emotional distress?

Unfortunately in Florida, you cannot recover for those items. It's a trade-off for other benefits, not having to prove liability, for example, in the case. So unfortunately, it's limited to indemnity or lost wages and medical care.

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What redress does an injured worker have in Florida if they are not receiving their proper Workers' Compensation benefits?

Well if you're injured on the job and you don't think you're getting the proper benefits or you're getting enough benefits, then what we do is we file what's called a Petition for Benefits and we take the case to court before a Judge of Compensation Claims. So if you think that you're not getting enough money or you're not getting adequate medical care, then procedure is for us to file what's called a Petition for Benefits and we go initiate the litigation process to obtain those benefits.

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If I don't think the law is fair in my case, do I have other options?

Well, there are restrictions on Workers' Compensation cases that prevent you from suing other parties, your employer, directly, most of the time. However, there are ways of looking at alternative theories and methods of recovery including constitutional attacks. It's very important you contact an attorney to explain what your specific fact situation is. Sometimes there is a creative solution that we can approach outside of the normal box and benefits that the insurance company is trying to offer you.

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What time limits apply in Workers' Compensation cases in Florida?

Well, timing in Workers' Compensation cases is very important, especially at the beginning. An employee has thirty days from when they know or should have known that their injury either is or could be work-related to report that injury, so timing is very important.

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What can I do if my Florida employer and I disagree on my Workers' Compensation benefits?

This is a common dispute between an employee and employer and their insurance company. Your best bet is to contact an attorney. There are many benefits that are available to you that you may not be aware of. You may dispute what monies you're receiving. You may dispute what medical benefits you're receiving. An attorney can help guide you through this process and explain what benefits you truly are entitled to and how to maximize receipt of those benefits.

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What is major contributing cause?

Major contributing cause is a standard placed into our Worker's Compensation statute that has to be met in order for your case to be compensable. It's basically an identification that the accident and injury is more than 50% the cost of your ongoing need for care and injuries. It's a legal standard that's thrown around in numerous facets of our law, and when the adjusters start mentioning those words to make sure you speak to someone about what's going on with your case.

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How has the Westphal decision changed the law and does it impact my case?

The Westfall decision changed the law and took temporary benefits from being only 104 weeks or two years total to being five years for temporary total disability and we believe also five years for temporary partial disability. So essentially, it extended what would have been two years to possible ten years worth of temporary benefits for you. It affects every case because any time that you're placed at a light duty status or no work status, it extends that benefit period. It also affects every case and your case because it increases the value of all claims and the potential that the insurance company will have to pay for all claims, so it was a landmark decision which increased benefits for all injured workers.

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If someone is killed on-the-job in Florida, is the claim for Workers' Compensation or wrongful death?

Well, the answer could be both. If somebody dies as a result of the on-the-job injury, then there is definitely a claim for Workers' Compensation benefits, and there are death benefits that are payable. Those benefits are capped at $150,000 for Workers' Compensation, and $7,500 for funeral expenses. There could also be a wrongful death claim, depending upon the mechanism of how that person died on the job.

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What is mediation?

Mediation is an informal process that we use in our court system, which allows us to bring the parties together to discuss the resolution of a case, the resolution of issues in a case. We do this prior to trial, in the process of litigation, to see if there's a reasonable settlement or a resolution that can be reached. In Workers' Compensation, you're required to go through the mediation process before getting to the Judge to make the final decision.

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Can I get a settlement from my Florida Workers' Compensation claim?

Absolutely. We can negotiate settlements. Unfortunately, we can't force the other side, the Employer or Carrier, to settle your claim, your case. However, most of the time, we can negotiate a settlement. It's something that has to be entered voluntarily from both sides, and it's based on the value of the medical care and lost wages.

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INJURY QUESTIONS

What should a worker in Florida do if he or she suspects that an illness or injury is work-related?

First and foremost, you should notify your employer. It is very important that you notify them as soon as you believe that you have any sort of illness or injury. There are very stringent time constraints on the filing of a claim and being able to initiate a claim and if you miss that window, you may not ever be able to file your claim. When you file and notify them, if they do not immediately send you or offer you medical care which you need to request or accept if that is not offered to you, you should contact an attorney or the state ombudsman's office for further assistance.

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Am I entitled to get Workers' Compensation if I have a pre-existing condition?

Absolutely. The Florida Workers' Compensation statute provides that people with pre-existing conditions who injure that condition in a workplace accident are entitled to coverage. If you aggravate or accelerate that injury, it is covered through the Workers' Compensation system.

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Are on-the-job injuries covered by Workers' Compensation in Florida even if I was at-fault?

Yes. Even if you're at fault for your own accident, you are still entitled to medical care. There are some situations where an insurance company or your employer can reduce the amount of wage loss benefits, but, even if it's your own fault and you get hurt on the job, you're still entitled to medical care.

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EMPLOYER QUESTIONS

Can I ever sue my Florida employer in court over a work-related injury?

If you have a work related injury that occurs at work or during the course and scope of your duties for work, you can sue your employer. That is initially done through the Worker's Compensation courts, which is a Division of Administrative Hearings. However, there are certain circumstances where you can go in to Circuit Court in order to obtain judgments as well.

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How long after my injury should I report it to my employer?

It is very important to notify your employer of injuries as soon as you are injured or suspect that you had an injury or exposure. There are statutory limitations upon getting benefits based upon your notifying the employer. It's usually within 30 days, but the safest bet is to notify them as soon as possible.

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Must an injured Florida worker notify their employer of a work-related injury?

Yes. In Florida, an injured worker has thirty days to notify his employer of an on the job injury. If he doesn't report his injury within thirty days, he could potentially jeopardize his claim and waive any rights to any medical care or lost wages. It's very important, if you're hurt on the job, to report your injury within thirty days.

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What are my rights if the Workers' Compensation doctor has released me for light duty work, but my Florida employer advises that there is no such work available?

Well, if your doctor releases you to work on what we call "light duty" and your employer doesn't have any work for you within those particular restrictions, then you're entitled to receive what we call "workers' compensation benefits," monetary benefits, until you are able to return to either full duty or your employer finds a job for you to do within your specific work restrictions.

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If I return to light duty, can my employer reduce my rate of pay?

That's an interesting question and the answer is it depends. If you go back to light duty in the same job you were doing before, then you'll receive your pre-injury wages. If your employer provides you light duty in some other job that you weren't doing before, then you'll only entitled to get paid the same amount that anybody else doing that job would get paid. It depends upon what kind of work you're doing in your light duty capacity.

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CLAIM STATUS QUESTIONS

What is the process for filing a Workers' Compensation claim in Florida?

Filing a Workers' Compensation claim is a very easy thing to do. As soon as you know that you're injured on the job, the first thing that you have to do is report that injury to your Employer. They will in turn report to Risk Management and a claim will get opened for you. But it's very important at the beginning of your claim to report any injury, even if you don't think it's very bad or you're not very hurt, because you never know what can happen in the future. Just report it to your Employer, your immediate supervisor or your boss at the time of the injury.

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Do I have to file a Workers' Compensation claim within a specific period of time in Florida?

Yes. Workers' Compensation claims have to be filed within thirty days of the day that you're either hurt or the day that you think that your injury was caused by the job, so yes, the answer is thirty days from the date of your accident, you have to report your claim.

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What if my Florida employer tells me not to file a Workers' Compensation claim or threatens to fire me if I do?

All right, well, fortunately, in Florida there is a law that strictly prohibits Employers from either threatening, harassing or coercing an injured worker from either filing or trying to file a Workers' Compensation claim, so you are always able to file a Workers' Compensation claim and your employer is strictly prohibited from preventing you from doing that.

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How long is my Workers' Compensation claim open in Florida?

Workers' Compensation claims are subject to a statute of limitation, and the Statute of limitations is either two years from the date of your original injury or one year from the date of your last authorized medical care. As long as you report your claim, and as long as you see your authorized doctor every year, your claim can last your entire life.

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Should I consult with an attorney if I receive notice that my Florida Workers' Compensation claim has been denied?

Absolutely. That is the most important time to contact an attorney. Most denials are improper or incorrect. There are often benefits that are available. Usually, an attorney can look into the case and find whether other benefits or any benefits are available for you and medical or lost wage and begin the case. Simply because the Carrier or the Employer is denying does not mean you don't have a case. Usually it's the exact opposite.

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DOCTORS/TREATMENT QUESTIONS

Can I select my own doctor or hospital?

Under Florida worker's compensation the Employer/Carrier does have the ability to choose their treating doctors. However, you do have the ability to select your own independent medical examiner and you do have the opportunity to request your one time change doctor if the insurance company or employer does not respond to your request within five days.

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My doctor says my condition is not related to work, what should I do?

Obviously you want to get that evaluation taken care of to make sure that we get from the doctor the information if it is related or not. Further, there are all kinds of avenues you can take with independent medical evaluations, transfer of doctors, and actually questioning the treating physician to make a determination if his statement to that regard is accurate. A lot of times physicians are confused as to the current standard of what they are to provide in medical care and what injuries they are to cover. Contacting an attorney to help you with that is important.

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What can I do in Florida if I do not agree with what the doctor for the Workers' Compensation insurance company says?

This is a common problem. Often times you will not agree with what the workers' comp doctor says. You have the opportunity for a one time change in your case, where we can request a change in doctor and have a new doctor assigned. You also have the opportunity to utilize what's called an independent medical exam, where we can select a doctor to evaluate you, one time, for an evaluation that can be reviewed by the judge to get an outside, independent opinion, a real opinion, by a real doctor to go ahead and assess what we can potentially do for you. What benefits are available.

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What is Maximum Medical Improvement (MMI)?

Maximum medical improvement is a term we use in the workers' compensation system that identifies, basically, that your medical condition has gotten as good as it's going to get. The doctors use this to identify a point in your treatment, a point in your care, where you have reached this plateau that they're no longer to get you better from. It's important to know your rights and obligations when you get to maximum medical improvement because additional benefits could be due at that point.

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My doctors says I am at MMI and released me. Can I still get care?

Absolutely. There's two types of medical care that are provided through Workers' Compensation. We have palliative medical care and remedial medical care. Remedial means that they're making you better. Once you reach a point of maximum medical improvement, the doctor has identified you're not going to get better, we're at a plateau. After that point, you are entitled to palliative care. You may still have pain and symptoms, and you're entitled to continue to get care, even though you've reached maximum medical improvement.

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What is the difference between restrictions and impairment rating?

When a doctor assigns you restrictions, that is something to safeguard your physical ability, and limits what you can do at work and what you should do at home. An impairment rating does not limit your physical ability. It's based upon your physical ability, but you can be a full duty, full work and receive an impairment rating, and receive checks for impairment rating from the Carrier, so they're very different categories. Restrictions restrict what you're capable of doing, but again, the impairment rating does not restrict your functionality. It only pays you for what your impairment is.

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For Workers' Compensation in Florida, what is an Independent Medical Examination?

Well, an independent medical examination is something that the employee has the right to do if they are not happy with the medical care that they're getting. They are entitled to go and get their own independent doctor to give them an evaluation and provide them an opinion as to any future medical care or some specific procedure that they think that they may need. It's important that injured workers take advantage of that right, to get their own doctor to perform an independent medical exam to address any concerns that they may have.

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The assigned Workers' Compensation doctor refuses to treat one of my injuries. What do I do now?

We see that a lot in Workers' Compensation cases. You may have a situation in which you have a shoulder injury that the doctor has been treating but is refusing to treat your wrist injury that occurred in the same accident. Make sure that you identify to the doctor that you have a wrist injury, that you wish it to be addressed, and let the doctor write in his reports whether or not he is addressing that for you. If he's not, you need to contact an attorney and/or get with the adjuster to make sure that this wrist injury is taken care of and recorded.

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What if I cannot do my job because of restrictions a doctor put on me after I was hurt on-the-job in Florida?

Well, when you leave the doctor's office, you should always get whatever they recommend or whatever restrictions they place upon you in writing. You should provide that to your employer. If your employer is able to accommodate you, you need to go and work within those accommodations or restrictions if you're capable. If you're not capable, or your employer cannot accommodate the restrictions, you're entitled to stay home and collect what's called temporary partial disability benefits, which would be paid by Workers' Comp.

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BENEFITS QUESTIONS

Who decides my entitlement to receive Workers' Compensation benefits in Florida?

In Florida, we have what are called judges of compensation claims which are the judges who decide what benefits injured workers are entitled to, so when we go to a trial, we got a trial in front of what's called the judge of compensation claims and that judge will make any determination to medical benefits or indemnity benefits.

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How much will my lost wage payments be?

Loss wage payments and workers compensation are categorized into numerous areas. There is temporary total disability benefits, which are paid out at sixty six and two thirds of your average weekly wage. There is temporary partial disability benefits where you may have been returned to work that's done on an 80% formula, minus any earnings that you earn, again taken at 80%. There is also other types of benefits such as permanent total disability, impairment benefits and other loss wage benefits that are calculated all using your average weekly wage.

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Am I required to pay taxes on my Workers' Compensation benefits?

Workers' compensation benefits both temporary and total, and any settlement that you receive from worker's com are not taxable. They are already reduced by the insurance company, paid at a reduced rate, and we do not need to declare them as taxable income at the end of the year.

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How long must I be out of work before I am eligible to receive Workers' Compensation benefits in Florida?

Well, here in Florida you have to miss seven days or more before you're able to receive lost wage benefits. If you have an injury and you miss one or two days, you're not eligible to receive worker's compensation payments. You will still receive medical care, but in order to get lost wage benefits you have to be out of work seven days or more.

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How long can I receive Workers' Compensation benefits in Florida if I am totally disabled?

There are two different classifications for totally disabled. There's temporarily totally disabled and permanent totally disabled. The temporary disabled used to be two years per the statute. I recently had a Supreme Court case where I've had the Supreme Court determine the statute was unconstitutional and they extended it to five years. The permanent disability is something that you get a minimum of five years or up until you're age 75.

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Am I entitled to Workers' Compensation benefits if I am involved in a car accident on the job?

Absolutely. It's a great question. The fact of the matter is you're entitled to two separate benefits with regards to a motor vehicle accident on the job, one against the tortfeasor who may have hit you and caused the negligence that caused the accident, and second from Workers' Compensation because you're in the course and scope of employment. You're entitled to your medical benefits. You're entitled to your lost wage benefits as a result of that on-the-job injury, in addition to the tortfeasor liability.

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What benefits are payable to survivors of a Florida worker whose death was caused by a work-related accident?

Death benefits are payable in Florida workers compensation law, and they're capped. The cap for death benefits in Florida is $150,000 for the workers compensation claim, and $7,500 for funeral-related expenses.

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What if I am fired while receiving Workers' Compensation benefits in Florida?

Your medical benefits will continue unaffected. However, whether you were fired for cause or not may affect your indemnity benefits from the employer or from the insurance company. You may also have the right to file a claim against the employer for an improper termination or retaliatory type firing, and that's specifically prohibited under the Florida Statutes. It's something that we would need to evaluate, you would need to evaluate with an attorney as soon as possible.

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What if I quit my job while receiving Workers' Compensation benefits in Florida?

If you quit your job while receiving benefits, your medical benefits will continue. However, it may affect your right to claim temporary partial disability benefits in the future. It won't affect your temporary total disability. If a doctor has you out of work completely, you'll still receive the benefits from the insurance company. However, if you're on a light duty status and your employer tells you that they have a position available for you and you've already quit, then you may not get paid for that period of time.

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What is partial disability?

Partial disability is when your doctor says you are able to do some kind of work, but you may not be able to do your full duties or your full job. So your doctor says that you're partially disabled, meaning that you can do some light duty for some period of time, but you're not yet ready to go back to full duty.

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What is temporary disability?

Temporary disability is when a doctor says you are unable to work, but for a short period of time, such as after a surgery, or initially after an accident when you're not able to return to work, but you are expected to be able to return to work at some point in the future.

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What is total disability?

Permanent total disability means that you can no longer find any gainful employment and your doctor says you are unable to do any kind of work. If that's the case, then your permanent total disability benefits are wage loss benefits that you are entitled to receive until you turn 75 years old.

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What is permanent disability?

Permanent total disability benefits in workers' compensation are when your doctor says that you can no longer do any work as a result of an on-the-job injury. If that is the case, and because of your injury, you are not able to return to any job, then you are what's considered permanently and totally disabled, which entitles you to medical care and wage loss benefits until you're age 75.

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When do wage loss payments stop under Workers' Compensation in Florida?

Wage loss is essentially a temporary indemnity, and you can receive up to five years of temporary partial benefits and five years of temporary total benefits, or up until the doctor places you at maximum medical improvement. Following being placed at maximum medical improvement, the doctor will either tell you you're unable to return to work, or assign an impairment rating. Those are different classifications for benefits which you can also be paid for.

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SETTLEMENT QUESTIONS

Can I settle my Workers' Compensation claim?

In short, yes. If you and the insurance company in your case decide that you want to settle your claim and you can agree on numbers and values of your claim, then yes you are able to settle your Workers' Compensation claim. It's important to note that if you do settle your Workers' Compensation claim, you are giving up your right for Workers' Comp to pay for any of your future medical care or any of your future lost wages.

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When is a Workers' Compensation claim considered settled and permanently closed in Florida?

Settlement of a Worker's Compensation claim has to be approved by a Judge. If somebody settles their claim, it becomes effective on the day that the Judge approves the settlement and signs what we call the Order settling the case.

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Can I settle my Workers' Compensation case for cash?

You can settle your case for cash. In order to reach a settlement, we have to base the value on the future medical care and the future loss wages. It's not something we can force the insurance company to do. They also cannot force you to. It has to be a mutual agreement. You are giving up your right to future medical care and future loss wages. Most cases do end with a cash settlement.

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