FAQ’s About Workers’ Compensation

At The Law Office of Dennis Dean Smejkal, P.A., we understand the frustration you are facing if you are encountering a difficult issue regarding workers’ compensation. It can be a very stressful circumstance to deal with when you are injured or ill, and you will need to have all of your questions answered.

Below, we provide answers to frequently asked questions that can serve as a starting point for your understanding of workers’ compensation in Florida.  If you have a question that’s not listed here feel free to contact us. We’re glad to talk, even if only to answer your questions.

General Questions

Do I have a case if I do not feel hurt?

You may still have a case even if you do not feel hurt at the scene. The biological response to a traumatic situation like an accident sends a rush of adrenaline through the body, which can temporarily reduce sensations of pain. You may start feeling significant pain or developing other symptoms later.   Contact us and we will walk you through your next steps.

What do I do if an insurance adjuster calls me?

You should not speak with an insurance adjuster for someone else involved in the litigation. They may seem friendly and sympathetic, but they are almost certainly trying to coax statements from you that would reduce the liability of their insured.

Please talk to us first.

How long will it take to settle my claim?

Very few personal injury cases actually go to trial. The overwhelming majority end in a settlement with the defendant or an insurance company.

What to do after a work related accident?

  • Take photos of your injuries
  • Report the incident to your employer immediately.
  • Visit a doctor if you haven’t already
  • If you have visited a doctor, follow their care plan and attend all follow-up appointments
  • Write down a narrative of what happened while it’s still fresh in your head
  • Make a list of witnesses and their contact information if you know it
  • Follow any additional instructions from after you contact us.

How Can We Help You?

Every case depends on the unique set of facts present in the case.  We can give you more specific answers to these questions based on the actual circumstances of your case once we speak with you.

We can then guide you through the process to get the maximum compensation possible.

After Your Injury

Should I hire an attorney?

Answer: Yes. You should hire a workers’ compensation attorney.

In spite of what you may hear or read or assume about your workers’ compensation case, you are at an extreme disadvantage if you do not have an attorney on your side. Regardless of how small your case is, you deserve to be on a level playing field with the employer and the insurance company, and here are the reasons:

Your Health – the insurance company has no incentive to make sure that your doctor is working for your best interest. In fact, medical costs are the insurance company’s biggest expense and the carrier will try to do everything they can to limit your medical care. This includes using the rules, laws, and procedures to their advantage to make sure that you get back to work earlier than you should, even if you are not healthy.

Your Income Benefits – the insurance company will do everything they can to make sure that your income benefits are stopped as soon as possible. In fact, an insurance adjuster’s career rises and falls based on whether they are skilled at limiting the income benefits of the claimant’s they are meant to serve.

Fairness in Representation – Do you realize that every single workers’ compensation claim is reviewed and analyzed by a team of seasoned workers’ comp defense attorneys that work for the insurance carrier? Every claim. Ask yourself why the insurance company needs lawyers, but you don’t. The short answer is: you need an attorney. Don’t believe the adjuster when they tell you that you don’t need to get a lawyer. They do not have your best interest at heart.

Questions About Employment

Can my employer fire me after a workers comp injury?

Answer:  It depends.

It is not uncommon for the relationship between an employer and an injured employee to turn sour following a workplace injury or illness.  Surprisingly, there are only a handful of reasons why an employer is not allowed to terminate an employee following a work-related injury or illness.

Most of these have to do with federal protections under Title 7 of the Civil Rights Act such as: race, color, religion, sex, or national origin. Some large companies are required to keep your job on hold following an injury or illness for a certain amount of time by the Americans with Disabilities Act of 1990.

Floria law prohibits an employer from retaliating in any way against an employee for pursuing his or her rights (such as seeking legal counsel or filing a workers’ compensation claim).

When an employer shouldn’t fire you

Employers are generally prohibited from discriminating (or retaliating) against an employee who has:

  • made a claim for worker compensation in good faith
  • consulted with or hired a lawyer to represent the employee in a claim
  • filed a workers’ compensation claim against the employer’s insurance company, or
  • has testified (or is planning to testify) in an administrative proceeding regarding a claim for workers’ compensation.

Workers’ Comp Dispute Questions

What if Worker Comp disputes my claim?

If your employer has opted into workers’ compensation in Florida, you should receive benefits if your job makes you sick or if you are injured while doing work tasks. Workers’ compensation provides broad coverage and you are eligible to make a claim any time you can prove your injuries were job-related, regardless of whether your employer was negligent or not.

Unfortunately, in some cases, an insurance company will deny coverage after you have reported a work injury. When an insurer contests a workers’ compensation claim, there are multiple stages of appeal to try to get the decision reversed.

What to Do When an Insurer Contests a Workers’ Comp Claim

When you get hurt at work, you need to report your injury or illness to your employer within 30 days. The insurance carrier should be notified and you should begin to receive benefits including income for lost wages as well as coverage for medical bills.

If an insurer decides that your injury is not really work-related, you may receive a letter denying your claim. When an insurer contests a workers’ compensation claim, you will need to enter the dispute resolution process. Dispute resolution refers to a series of different proceedings that are brought before the Florida Department of Insurance- Division of Workers’ Compensation.

The different stages of dispute resolution include:

  • A benefits review conference: An informal meeting held at an office of the Division of Workers’ Comp. A representative from the insurance company will attend and you will have the chance to resolve your disagreements. If a compromise or solution is reached, you and the insurer can sign a binding agreement.
  • Arbitration: If you do not agree at a benefits review conference, you can choose to have an independent arbitrator hear evidence and decide on the disputed issues.
  • A contested case hearing: If arbitration is not chosen to resolve the dispute, a hearing will be scheduled and both the insurer and the injured worker will have the chance to present arguments to a hearing officer. The hearing officer will notify you of his legally binding decision in writing.
  • An appeal before the Division of Workers’ Compensation appeals panel: The appeals panel reviews written arguments about why the decision made by the hearing officer was not appropriate.
  • Judicial review of the decisions that were made by the Division of Workers’ compensation. A judge will review the actions taken during the appeals process with the Division of Workers’ Compensation.

You need to understand your legal rights and make compelling arguments at every different stage of the appeals process. If you fail to respond in a timely manner when an insurer contests a workers’ compensation claim, you may be unable to secure benefits.

Workers’ compensation laws indicate that you cannot sue your employer if the company buys workers’ compensation insurance, so you may lose out on your only option for getting benefits after a work injury.

Income Benefits Questions

How much money will I get per week?

Answer: If you lose wages because of your work-related injury or illness, you should receive Temporary Income Benefits (TIBs), which amount to 70% of your Average Weekly Wage until you reach Maximum Medical Improvement (MMI).

After you reach MMI, you will receive an Impairment Rating and be paid for your physical impairment. At that time you will receive Impairment Income Benefits (IIBs), which also pay 70% of your Average Weekly Wage.

If, after reaching MMI, your Impairment Rating is 15% or higher, you may be eligible for Supplemental Income Benefits (SIBs), which are based on 80% of your Average Weekly Wage.

How long until I receive my benefits check?

There is a seven-day waiting period before you can receive your benefits. You have to be unable to work for 7 days before you can receive any benefits. The first seven-day waiting period is due after you have reached the 21-day minimum day requirement.

Medical Benefits Questions

How will my ER or doctor bill get paid?

Answer: Often, after a work-related injury or illness, injured employees go to the emergency room for evaluation and treatment. Other times, an injured employee may go to their own doctor before any workers’ compensation claim gets filed or accepted by the insurance carrier.

Once the workers’ compensation insurance carrier has accepted your injury or illness, simply send the bill to the insurance adjuster for reimbursement. The carrier should reimburse you quickly and without issue. Additionally, be sure to call the emergency room (or your own doctor) and

  • make sure the billing department knows that your treatment was for a workers’ compensation claim and
  • make sure the billing department has the workers’ comp carrier phone number, adjuster name, and claim number.

How long will I receive benefits?

You may receive Temporary Total payments, Temporary Partial Disability payments or a combination of these payments up to a maximum of 104 weeks, or until you reach maximum medical improvement or are returned to full duty work.

Do you have more questions? Injured in a work accident? Call now.

You have rights after being injured at work. Visit my Frequently Asked Questions area, our Resources area, or contact me. I will evaluate your case and help you every step of the way.