Our Attorneys Break Down Workers Compensation Benefits and Eligibility
In Florida, the workers’ compensation system is designed to ensure that injured workers and families who lose loved ones in job-related accidents have access to the money they need during their recovery. Unfortunately, recovering workers’ compensation benefits is rarely as easy as it should be. Employers and workers’ compensation insurance companies routinely deny claims for medical, disability and death benefits, and many individuals and families struggle needlessly as a result.
At Maus Law Firm, we help employees who have been injured on the job secure the benefits to which they are entitled under Florida law. We also help families recover death benefits after fatal job-related accidents. Regardless of your situation, we can use our experience to seek maximum workers’ compensation benefits on your behalf, and we can make sure you are not wrongfully denied the benefits you deserve.
When is a Worker (or a Worker’s Family) Eligible to Receive Workers’ Compensation in Florida?
In order to be eligible for workers’ compensation in Florida, a worker must generally be classified as an “employee,” as opposed to an “independent contractor.” If you receive a regular paycheck with deductions for taxes and Social Security and your employer sends you a W-2 at the end of the year, then you are an employee. If you do not (i.e. if you receive a 1099 at the end of the year), then you may be classified as an independent contractor; however, how you get paid is not the sole factor for determining your employment status.
Most people are employees; and, if a company has classified you as an independent contractor, this classification could be wrong. As a result, we recommend that anyone who has been injured on the job (or who has lost a loved one in a fatal on-the-job accident) contact a Fort Lauderdale workers’ compensation lawyer to discuss their legal rights.
What Workers’ Compensation Benefits are Available in Florida?
In Florida, eligible employees can recover two primary types of benefits. These are: (i) medical benefits, and (ii) wage replacement benefits (which are also known as disability benefits).
Medical Benefits in Florida Workers’ Compensation Claims
Medical benefits provide coverage for the costs of treatment related to your on-the-job injury. This includes:
- Hospitalization (if necessary)
- Doctor’s visits
- Diagnostic testing
- Surgical procedures
- Medical supplies
- Prescription medications
- Physical therapy
- Travel costs for doctor’s visits and trips to the pharmacy
Importantly, in order to receive medical benefits (and to preserve your workers’ compensation rights in general), in Florida you are required to see a doctor who has been pre-approved by your employer. If you are not satisfied with the doctor to whom you are sent, you are entitled to request a one-time change. Your entitlement to medical benefits will continue until you reach maximum medical improvement (MMI), as determined by your workers’ compensation doctor. From this point forward, you can still obtain necessary treatment (i.e. pain medications) with partial workers’ compensation coverage, but you will need to pay a co-pay.
Wage Replacement (Disability) Benefits in Florida Workers’ Compensation Claims
If you are unable to work as a result of your job-related injury for seven days or longer, then you are entitled to wage replacement benefits in addition to your medical benefits. Your wage replacement benefits will begin on the eighth day of your disability, unless you are unable to work for 21 days or longer, in which case you are entitled to wage replacement benefits from the day you got injured.
Wage replacement benefits can be either full or partial, and they can be either temporary or permanent. Full wage replacement benefits are generally calculated as two thirds of the injured employee’s weekly wage, although there is a cap for high-earning employees. Partial wage replacement benefits are paid when an employee is able to work in some capacity, but is required to take a lower-paying job as a result of his or her injury. Temporary benefits are paid until you reach MMI, while permanent benefits are paid until age 75 (or for five years if the injury occurs after age 70).
There are four types of wage benefits you can receive under Florida’s workers compensation laws. The four types are: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), Permanent Total Disability (PTD), and Impairment Benefits (IB’s). The easiest way to determine what type of benefit you are receiving is to look on the check stub that comes from the insurance company. You will usually see a notation on the check that indicates which one of these classifications of wage benefits is being paid, and the time period for which it is being paid. However, it can be very confusing understanding when and why you are entitled (or not entitled) to workers compensation wage benefits.
Here is a brief explanation of the four types of wage benefits:
Temporary Total Disability Benefits (TTD)
A Florida workers compensation insurance company is obligated to pay TTD wage benefits when the authorized treating physician provides the opinion that a person is completely unable to perform their job. It is called Temporary because most people will return to some level of performing work after they receive medical care. The full criteria for awarding TTD can be found at Fla. Stat. 440.15(2).
To calculate TTD, you need to first determine what your average weekly wage (AWW) is. Your average weekly wage is defined in Fla. Statute 440.14 as the average weekly wages earned during the 13 weeks immediately before your accident occurred. To calculate TTD, you take your AWW and multiply it by 66 2/3 %, i.e. you earn $500/week, your AWW would be $500 and your TTD, or Compensation Rate, would be $333.00.
There are many variations to how your AWW is calculated, so it is best to review your earnings with an experienced Florida workers compensation attorney.
Temporary Partial Disability (TPD)
TPD is paid, prior to reaching maximum medical improvement (MMI), when your doctor says that you can return to work on a light duty basis, and your employer has light duty work within your restrictions for you. TPD is also paid based on the amount of your AWW, in conjunction with the amount of money you earn on a weekly basis after you return light duty.
The full explanation of when TPD should be paid can be found at Fla. Stat. 440.15(4). In general, if after returning to light duty work, you are not earning at least 80% of your pre-injury AWW, the insurance company has to pay you 80% of the difference between 80% of AWW and what you are earning in a light duty capacity. For example, your AWW is $500. You return to work light duty and are only making $300 per week. The insurance company would have to pay you 80% of the difference between $300 and $400 (80% of your AWW), or an additional $80.00.
Permanent Total Disability (PTD)
The definition for PTD can be found at Fla. Stat. 440.15(1). PTD benefits are to be paid when the injured worker cannot return to any employment after they have been injured at work. If you qualify for PTD, payments will continue until the injured worker reaches the age of 65 years old. PTD is to be paid at the same rate as TTD, or 66 2/3% of your AWW. Again, there are many variations of why and when PTD benefits should be paid, so it is best to speak with an experienced Florida workers compensation lawyer to see whether you are eligible for PTD benefits.
Impairment Benefits (IB’s)
IB’s are to be paid after the authorized treating physician has placed you at maximum medical improvement (MMI). IB’s will be paid as long as the doctor gives you an impairment rating based upon the injury you suffered at work. The rate at which IB’s are to be paid can be found at Fla. Stat. 440.15(3). IB’s are to be paid at the rate of 75% of your TTD rate, and will be paid as follows:
- 2 weeks of IB’s for each percentage point of impairment from 1-10 — i.e. – a 7% impairment rating entitles you to 14 weeks of IB’s.
- 3 weeks of IB’s for each percentage point of impairment from 11-15% — i.e. – a 12 % impairment rating entitles you to 26 weeks of IB’s.
- 4 weeks of IB’s for each percentage point of impairment from 16-20% — i.e. – a 17% impairment rating entitles you to 43 weeks of IB’s.
- 6 weeks of IB’s for each percentage point of impairment from 21% & up — i.e. – a 21% impairment rating entitles you to 61 weeks of IB’s.
This is an extremely simplified explanation of wage benefits paid through Florida’s workers compensation laws. In order to determine whether you should be receiving workers compensation wage benefits, it is best to consult with an experienced Florida workers compensation lawyer.
Can Independent Contractors Receive Workers Compensation Benefits?
Many employers will attempt to classify its workers as independent contractors rather than employees to avoid having to pay for workers’ compensation coverage and payroll taxes. However, Florida Statutes Sec. 440.02 establishes several factors that courts use to determine whether a person is working as an employee or as an independent contractor. Those factors include:
- The independent contractor performs or agrees to perform specific services or work for a specific amount of money and controls the means of performing the services or work
- The independent contractor incurs the principal expenses related to the service or work that he or she performs or agrees to perform
- The independent contractor is responsible for the satisfactory completion of the work or services that he or she performs or agrees to perform
- The independent contractor receives compensation for work or services performed for a commission or on a per-job basis and not on any other basis
- The independent contractor may realize a profit or suffer a loss in connection with performing work or services
- The independent contractor has continuing or recurring business liabilities or obligations
- The success or failure of the independent contractor’s business depends on the relationship of business receipts to expenditure
If you’re an independent contractor, don’t assume you’re ineligible for workers compensation benefits. Contact our firm and let our attorneys evaluate your options.
What Should I Do if I Believe I Am Entitled to Workers’ Compensation Benefits?
If you believe that you may be entitled to workers’ compensation benefits as the result of a job-related injury or death in Fort Lauderdale, what should you do?
If you have not done so already, you should report the accident to your employer (or your loved one’s employer) promptly. Under Florida law, you only have 30 days to file an accident report, and you do not want to wait any longer than necessary. It is also important that you speak with a workers’ compensation lawyer as soon as possible, as an experienced lawyer will be able to help you avoid potentially-costly mistakes while dealing with your claim on your behalf.
Contact Fort Lauderdale Workers’ Compensation Lawyer Joseph Maus
To learn more about the steps involved in filing a workers’ compensation claim in Florida, schedule a free, no-obligation consultation with Fort Lauderdale workers’ compensation lawyer Joseph Maus. Call 855-999-5297 to request an appointment, or tell us how you would like to be contacted and we will be in touch with you shortly.