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, however. 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.
4 Ways to Obtain Coverage:
To obtain workers compensation coverage in Florida, the employer has several options including:
- Purchasing a workers compensation insurance policy from a state-approved insurance company.
- Qualifying as an approved self-insured employer.
- Contracting with a professional employer organization (employee leasing) that has a group workers compensation policy.
- 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.
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Claim Reporting:
The employee must report the injury to the employer within 30 days of the occurrence. If the injury is not reported in a timely manner, the insurance carrier has the option to deny the claim. The employer is under a strict time limit of seven days to report the claim to the insurance carrier. The insurance company then has three days to send an informational brochure to the employee outlining the employee’s 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 employee’s 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 Jan. 1. The maximum TTD benefits per week for accidents occurring in 2010, was $772. The maximum TTD benefits per week for 2011 is $782. 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 Florida law that requires the employer to hold open a job for an employee who is 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 percent 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.
This is when the employee has been released by the authorized treating physician to return to work in any capacity. The payment is then 80 percent of the difference between 80 percent of the employee’s AWW and earnings. This is referred to as the 80/80 formula. If work is available within the employee’s restrictions and the employee does not return to work then no benefits are payable.
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 permanent impairment rating, a scale is used to establish the number of weeks of compensation the employee is entitled to.
The employee will receive:
- Two weeks for each percentage point of impairment from 1 percent through 10 percent
- Three weeks for each percentage point of impairment from 11 percent through 15 percent
- Four weeks for each percentage point of impairment from 16 percent through 20 percent
- Six weeks for each percentage point of impairment from 21 percent and up.
If the employee is earning the pre-injury wage or higher, the benefits are reduced by 50 percent.
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 percent 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 percent of the average weekly wage earned prior to the injury.
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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 percent of the average weekly wage, not to exceed $782.00 (for calendar year 2011).
The spouse plus one child is entitled to two-thirds of the average weekly wage, not to exceed $782 (year 2011). 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 $782 (year 2011). 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.
Vocational Benefits:
If, due to the employee’s 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. See www.LowerWC.com for more information. Contact: [email protected].
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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.
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