Florida Workers Compensation Claims: Eligibility, Filing and Appeals

According to workers compensation Florida law employers in the construction industry with even one part time employee must provide workers’ compensation for that employee. Sole proprietors, partners and corporate officers are considered employees but can opt out of coverage. Employers outside of the construction industry with four or more full time employees are required to provide worker’s compensation coverage to non-exempt employees. Again, corporate employees have the option of workmans comp exemption. All other employees must be covered, with the exception of part time domestic workers and agricultural workers who work for employers with less then 5 employees or who work for less then 30 days per year for an employer.

Common Covered Work Related Injuries

Employers can recover for “injury or death arising out of and in the course of employment and such diseases or infection as naturally or unavoidably result from such injury.”  The damage must occur as a result of an accident that occurs during the normal course of employment.

Injury includes all personal injury, including damage to glasses, dentures, prosthetic limbs and other devices. Illness is included under the definition of injury if the illness was caused by work related exposure or activities.

Accident is defined as a sudden or unusual event. Injury that results from exposure to a toxic substance is only considered to be an injury arising out of work if there is clear evidence that the exposure occurred as a result of the job, that there was exposure, and that the level of exposure can cause the illness or injury.

Filing a Florida Workers Compensation Claim

According to worker comp law you must give your employer written notice of your injury as soon as possible, but no later then 30 days after sustaining the injury or your claim may be denied. You can report the injury to your employer or directly to your employer’s workers compensation insurer.

You must include medical documentation of your injury, as well as information about witnesses to the injury and other pertinent information.

Required forms when filing a claim include DFS-F2-DWC-1 (First Report of Injury or Illness). If you are claiming temporary or partial disability, you are also required to submit form DFS-F2_DWC-1a (Wage Statement) and DFS-F2-DWC-3 (request for wage loss). Additional forms may be required to claim permanent disability, including the permanent total offset worksheet and permanent total supplemental worksheet.

Your employer should provide you with required forms to file an official claim, but if your employer is unable or unwilling to provide you with forms you can obtain the forms from the Employee Assistance Office of the Florida Department of Worker’s Compensation.

Workers Compensation Claim Denials

Common reasons for denial include failure to file claims within the requisite period of time, improper completion of paperwork, and lack of substantiating medical data to confirm the extent of the disability.

Appealing a Florida Workers Compensation Denial

When a claim for benefits is disputed, you must file a petition for benefits with the Division of Administration hearings. The Judge of Compensation Claims, an administrative judge, then schedules a mediation conference within 40 days of the filing and notifies all parties of the date of the conference. The conference must be held within 130 days of the filing of the petition. During this waiting period, you may be asked to submit additional evidence or undergo a medical exam.

A pretrial hearing is scheduled prior to the Final Hearing, and during this pretrial hearing, mediation is encouraged. If a settlement is not reached, the final hearing must be held within 90 days of the mediation conference. Evidence and expert testimony can be presented. The judge will then issue a final decision within 30 days of the hearing. If you wish to appeal the judge’s decision, you then must file an appeal with the First District Court of Appeals.

Collecting Florida Workers Compensation Benefits

Workers compensation rate benefits in Florida include death benefits, medical care reimbursement and disability. In the event of an injury that causes death, a worker compensation settlement pays up to $7,500 in funeral expenses. Up to $150,000 in death benefits may also be paid to dependent spouses and children, with proof of dependence, based upon the deceased workers wages.

Employers must pay medical bills within 45 days of incurring the cost. Medical coverage includes treatment, prescriptions and other medical necessities. An approved physician must provide treatment in order to ensure coverage.

If employees are unable to work for more then seven days as a result of the injury, temporary or permanent disability may be paid. Temporary disability is equal to 80% of the workers average weekly wages, up to a $700 a week maximum, if the worker lost a limb or eyesight. These benefits can continue for up to six months. Temporary disability benefits at 66 2/3 percent are available if an employee did not sustain the loss of a limb.

Permanent total disability loss is payable at 55 2/3 percent until age 75. If the permanent disability is a partial disability and the employer is able to return to work, the employer will pay benefits of up to 80% of the difference between the average weekly wages before and after the injury for up to 104 weeks. After 104 weeks, the permanent impairment rating is evaluated to determine the extent of the permanent impairment, and the carrier then pays impairment workmans comp rate benefits using a formula which factors in the permanent impairment, the temporary total disability benefits and the return to work wages.

Hiring a Florida Workers Compensation Lawyer

Hiring a Florida Worker Compensation lawyers is optional. You may wish to hire an attorney to help ensure the forms are properly filled out and that you are complying with all rules regarding obtaining medical exams and treatments. Attorneys can also assist in filing appeals with the worker’s compensation board.

Florida Workers Compensation Office Locations

Division of Workers' Compensation
200 East Gaines Street
Tallahassee, FL 32399-4220
(850) 413-1600 Helpline 1-800-742-2214
Fax (850) 488-2305
Division of Workers' Compensation