Florida Workers Compensation Basics 101

Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com an excellent service.

In Florida, every employer who has four or more employees, whether full time or part time is required to carry workers compensation insurance. [Corporate officers who have elected to exempt themselves from work comp coverage do not count as an employee]. There are a couple of exceptions to this rule. If you are in the construction industry and have one or more employees, you are required to have work comp coverage. Florida farmers who have more than five regular employees, or twelve or more seasonal workers who are employed for 30 days or more, are required to have work comp coverage.
 
Obtaining Coverage:
To obtain workers compensation coverage in Florida, the employer has several options including:
1.      purchasing a workers compensation insurance policy from a state approved insurance company
2.      qualifying as an approved self-insured employer
3.      contracting with a professional employer organization [employee leasing] that has a group workers compensation policy
4.      purchasing a workers compensation insurance policy from the Joint Underwriting Association, a Florida state agency that sales workers compensation insurance  coverage to employers who are unable to obtain coverage in the open market (WCxKit)
 
Claim Reporting:
The employee must report the injury to the employer within 30 days of the occurrence. If the injury is not reported timely, the insurance carrier has the option to deny the claim. The employer is under a strict time limit of 7 days to report the claim to the insurance carrier. The insurance company then has 3 days to send to the employee an informational brochure which outlines the employees rights and responsibilities under the workers compensation statutes.
 
Medical Benefits:
The employer selects and authorizes the initial medical provider. All subsequent medical treatment must be at a medical provider approved and authorized by the workers compensation insurance carrier. All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation.
 
Temporary Total Disability Benefits:
The temporary total disability (TTD) benefits are calculated as two-thirds of the employees average weekly wage over the 13 weeks prior to the injury, not counting the week the injury occurred. The maximum amount of TTD benefits that can be paid weekly changes every January 1st. The maximum TTD benefits per week for accidents occurring on or after January 1, 2010 is $772.00 per week. The state minimum weekly benefit is $20, which has not changed since 1972.
 
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 104 weeks. There is no provision in the Florida law that requires the employer to hold open a job for an employee who is unable to work due to the employee being unable to work. (Holding the position for the employee is the smart thing for the employer to do in most cases).
 
Temporary Partial Disability Benefits:
Florida work comp also provided for temporary partial disability (TPD). An employee will receive TPD if the medical provider releases the employee to work with restrictions on the number of hours the employee can work. If the employee is unable to earn 80% of his wages prior to the injury, the insurance carrier will pay TPD benefits on the hours the employee is unable to work per week.
 
Impairment Benefits:
When an employee reaches maximum medical improvement, the medical provider will determine whether or not the employee has any permanent partial disability. If the employee receives a disability rating, the employee is entitled to Impairment Benefits (IB).   The amount of IB is one-fourth of the TTD rate plus 1 cent. For example if the weekly TTD rate is $600.00, the IB rate would be $150.01. The number of weeks of IB is determined by a disability scale. A 10% rating on the scale is worth 20 weeks of IB; a 25% rating is worth 85 weeks of IB, while a 50% rating is worth 235 weeks of IB.
 
Permanent Total Disability Benefits:
Florida has a unique way of determining if an employee who has reached maximum medical improvement has a permanent total disability (PTD). If the employee can be placed in a sedentary job within 50 miles of his residence, the employee is not PTD, unless he has a severe injury as defined by the Florida work comp statutes. Some of the severe injuries include spinal cord injuries that involve paralysis of an arm, leg or the trunk; amputation of a hand, arm, foot or leg; severe brain injury; and, second or third degree burns over 25% of more of the body. If the employee is classified by the Division of Workers Compensation as PTD, the employee will receive PTD benefits which are the same as TTD benefits until the age of 75. If an employee is drawing social security benefits, the PTD benefits are reduced to the point where the social security benefit plus the PTD benefit equals 80% of the average weekly wage earned prior to the injury.
 
Death Benefits:
If an employee dies as a result of an on-the-job accident within one year of the date of the accident, or if the employee dies as a result of an on-the-job accident within five years with continuous disability, funeral expenses up to $7,500 is covered by workers compensation. The spouse is entitled to 50% of the average weekly wage, not to exceed $772.00 (for calendar year 2010). The spouse plus one child is entitled to two-thirds of the average weekly wage, not to exceed $772 (year 2010).   If the employee leaves behind one child as the only beneficiary of death benefits, the child receives one-third of the average weekly wage, not to exceed $772 (year 2010). There is no time limit on how long benefits can be paid, but the maximum amount of death benefits is $150,000 (not including funeral expenses). If the spouse remarries, the spouse receives a lump sum payment of 26 weeks (as long as the $150,000 cap is not exceeded. The spouse is also eligible for tuition benefits at a vocational technical center or community college. (WCxKit)
 
 Vocational Benefits:
If due to the employees on-the-job injury the employee is unable to return to work because of permanent work restrictions, the employee is entitled to assistance from the Workers Compensation Vocational Rehabilitation Section of the Florida Department of Education. At no cost to the employee, the employee can receive vocational counseling, transferable skill analysis, training on job-seeking skills, job placement, on-the-job training and formal retraining. 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: 
RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Discussion

  1. Marylou Kaplan says

    Questions: are all medical bills paid in accordance with the Florida Fee schedule?

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