Workers’ compensation is an important protection for employees throughout Florida. This protection is provided by specially-purchased insurance. When a person is injured while working, he or she is entitled to payments in order to cover medical care and lost wages. Although these payments do not replace all of the income that the person was receiving prior to the injury, the compensation often is critical to get through a period of time when the person cannot work at all, or in part. If you have been injured in a workplace accident, the skilled South Florida workers’ compensation attorneys at Greenberg, Stone & Urbano will fight to get you the compensation that you deserve.
One of the most important elements of workers’ compensation is that the employee does not have to prove fault or negligence. There is an exception to claims automatically being paid if the employee was injured due to intoxication or intentional actions on the part of the injured worker.
Injuries at the workplace can happen because there are inherent dangers in the environment, the equipment is faulty, the employees are not properly trained, or there simply was an accident. There are many different types of injuries that can happen in a work environment, resulting from tripping on a piece of carpeting that was not properly nailed down to getting caught in a machine at a factory. Some of the common types of injuries that occur on a worksite include:
- Tendonitis, carpal tunnel, or other injuries that are caused by repetitive motions in the workplace;
- Injuries that are sustained as a result of lifting, pulling, or pushing – these injuries may include hernias, strained or torn ligaments or tendons, muscular damage, fractured or broken bones, or other harm;
- Injuries sustained in falls or other impact trauma involving the head, such as traumatic brain injuries and other head injuries;
- Crush injuries from heavy equipment;
- Temporary or permanent hearing loss from load machinery or other noises;
- Temporary or permanent blindness;
- Mental illnesses;
- Illnesses from environmental toxins, including asbestosis or mesothelioma; or
- Injuries from jobs where there is inherent dangers, such as construction, emergency response, and other professions.
A person who is injured in the workplace is entitled to the following benefits:
- Coverage for medical treatment necessitated by the workplace injury;
- Coverage for prescription drugs;
- Compensation for lost work time – a person is entitled to two-thirds of the wages that he lost as a result of the injuries;
- Permanent disability payments if the person is unable to return to work; and
- Death benefits for an employee’s family if the worker was killed in the accident.
Although these benefits are supposed to be paid to the employee regardless of fault, there are many times when an employer or the insurance provider attempts to prevent the payment on a workers’ compensation claim in order to save money. When this happens, it is important to get the right legal help fighting to prevent the employee’s interests.The Filing of a Workers’ Compensation Claim
In the State of Florida, most employers with at least four employees are required to provide insurance coverage to their employees who are injured in the workplace. In addition, a construction company with at least one employee must have workers’ compensation insurance.
When an employee is injured, it is important to submit a notification about the incident that led to the injury in a timely manner in order to ensure payment. Under Florida law, a person has 30 days from the time of the injury to file a report providing the details of the accident. The report should contain the following information:
- The events that led to the injury, providing specific details about the accident or the series of motions that resulted in the harm;
- Any witnesses to the accident;
- The date, time, and location of the accident; and
- Any other details that are relevant to the injury.
Once the injury report has been submitted, the employee has up to two years to submit the actual claim against the workers’ compensation insurance. This means that the employee has time to get the appropriate diagnosis and medical treatment rather than having to rush through the process. It is important to obtain a medical evaluation as soon as possible. This serves several purposes. First, prompt medical attention is important to prevent exacerbation of the injury. Second, long-term recovery often depends on a careful course of treatment. Finally, if the employer or insurance provider does dispute the merit or extent of the claim, it is important to have a comprehensive medical record, as well as a physician who is familiar with all the elements of the claim, who can provide testimony about the extent of the harm and how it impacts the person’s life.The Independent Medical Examination
An employee who was injured in a workplace event should find a doctor as soon as possible. It is important to get evaluated by a physician who is not affiliated with the employer or the insurance provider. The examination is important to determine the plan for treatment and rehabilitation. In addition, it also is crucial to document the nature of the injury and the cause of the harm. This is an important piece of evidence in any case where there has been a challenge to a workers’ compensation claim. It is possible for a medical report to support the fact that a particular injury was the result of a specific type of workplace injury.Employer Tactics to Deny Claims
When an employee is injured, the employer may try to disprove the extent of the injury. By disputing the seriousness of the harm, the employer may try to minimize the payment that is made to the employee. It is important for an employee to exercise the right to get examined by the physician of his or her choice, rather than relying on a diagnosis by an employer-suggested doctor. In addition, an employer or insurance provider may make the argument that the employee was suffering from a pre-existing condition or that the person was injured outside of work. The basic argument is that the injury was not the result of workplace conditions.What Happens after a Claim Denial?
In a situation where an employer or insurance provider denies payment on an injury claim, it is critical for a person to have the right attorney to fight for an appeal and a reversal of the decision. The appeal is to be filed with the Division of Administrative Hearings (DOAH). When the appeal has been filed, it is assigned to an administrative law judge who must schedule a hearing within 40 days.
The hearing is an opportunity for the employee to present evidence of his injury and why he is entitled to the workers’ compensation payments. It is important to build a strong case in order to have a successful appeal. As with the submission of a claim, the medical records prepared by the employee’s physician, as well as the opinion of the doctor about the extent of the injury and the cause of the harm, is going to be critical for the right results. Many times, the doctor also can provide testimony about the employee’s ability to resume work. Representatives for the employer and/or insurance provider may submit evidence in support of the claim denial. Once the parties have concluded their arguments, the judge will render a decision within 30 days in most cases. If there is an adverse result for the employee after the appeal, it is possible to appeal that decision to the Court of Appeals.Greenberg, Stone & Urbano Offer a Free Initial Consultation
Our attorneys have more than 130 years of collective experience in getting our clients the results that they deserve. We have received an AV rating from Martindale Hubbell in recognition of the work that we do. Our attorney also have been voted as South Florida’s Top Rated Lawyers by the Miami Herald. To schedule an initial consultation, please call (888) 499-9700 or (305) 595-2400 or visit our website.