Florida workers' Compensation by vwt15444


									Florida workers’ Compensation                                                      pre-injury wage. The employee must still, however, have not reached his
                                                                                   MMI. The wage benefit will be calculated based on the following formula.
                                                                                   [(Pre-injury wage) – (Post-injury wage)] x 80% = Total Benefit
Learning Objective:                                                                The total benefit equals 80% of the difference between the post-injury
                                                                                   wage and the pre-injury wage.
           Identify the purpose of workers’ compensation                           Permanent Impairment Benefits
           Understand the procedures to obtain workers’ Compensation               If an employee’s impairment due to an on the job injury extends past the
           benefits as required by Florida law                                     MMI, he is eligible for permanent impairment benefits once he reaches MMI.
           Know the various benefits offered by workers’ compensation              At this point an authorized doctor will assign the employee an impairment
                                                                                   rating based on the percentage of impairment relative to the entire body and
Introduction                                                                       its functions. The workers’ compensation carrier has a schedule of ratings
             Workers’ compensation was developed in the early 20th century         created using information provided by agencies like the American Medical
during the industrial revolution. Prior to workers’ compensation employees         Association and the Department of Labor. This schedule is used to determine
injured on the job would have to sue to get any compensation. This usually         how much compensation an employee will receive based on his impairment
required an attorney, and compensation was not guaranteed.                         rating.
Workers’ compensation came as a benefit to both employers and employees.           Permanent Total Benefits
Employees are guaranteed payment for medically necessary care and                              These benefits apply to an employee who becomes permanently
treatment that is related to the injury, while relinquishing their right to sue    and totally disabled as defined by the law.
their company under most circumstances. It protects both workers and               Death Benefits
employers, and helps employees get the attention necessary to return to work                   If an employee dies a work-related death, or as the result of a
if possible.                                                                       work-related injury, dependents or a spouse are entitled to up to $150,000,
                                                                                   depending upon the relationship and the employees former salary.
Procedures and Requirements                                                                    The Florida Department of Financial Services has also developed a
            When an injury occurs on the job, the injured worker needs to          flow chart diagramming the benefit delivery process, as seen below.
report his injury to the employer as soon as possible. If the employee fails to
inform his employer within 30 days of the injury, that fact can be used as
defense against his claim. Once the employer becomes aware of the injury,
she has seven days to report the injury to the workers’ compensation carrier.
Failure to do so may result in a fine of up to $2,000.
            The employer can often report the injury over a toll-free service or
she can send the First Report of Injury or Illness form, shown on a following
page, to the carrier. Once the carrier is aware of the injury they can begin
coverage. They assess the information and based on that information they
will determine if and how much the employee will be compensated for his
            The carrier will also provide the name of an authorized doctor that
will treat the injury. Visits to unauthorized doctors will not be covered,
except in the case of emergency. In addition, the authorized doctor cannot
make a referral without first getting prior authorization from the carrier. The
referral must be made to another authorized health-care provider.
            During the course of treatment the doctor will at some junction
determine the point of Maximum Medical Improvement (MMI). This is the
point in time at which the doctor does not feel further healing is likely. The
MMI has significant effects on the employees benefits, as will be discussed
Medical Benefits
            When an employee is injured on the job, workers’ compensation
will pay for any medically necessary care including the following:

           Doctor’s Visits
           Physical Therapy
           Prescription Drugs
           Medical Tests
           Travel Expenses to and from Authorized Doctor

The injured employee should not have to pay for any of these various
treatments while covered under workers’ compensation, until the maximum
medical improvement (MMI) is reached as determined by an authorized
Wage Replacement Benefits
            For workers that are unable to return to work quickly, there are
various wage replacement benefits in place. Wage replacement can begin on
the eighth day following injury, and unless the employee is unable to return to
work for more than 21 days, he will not be paid for the first 7 days after he is
injured. How much they receive depends on the extent of impairment and the
length of time the impairment lasts. Unless otherwise stated the amount of
benefit usually equals 2/3 the average pre-injury weekly salary, not to exceed
Florida’s average weekly wage (as of January 2007, $724.00/week).
Temporary Total Benefits
This type of wage replacement applies if the injured worker temporarily
cannot return to work, and has not yet reached the MMI.
Temporary Partial Benefits
If the employee’s authorized doctor allows the employee to return to work, he
may still be eligible for wage replacement if he is making less than 80% of his
References                                                                   1.    Failure of an employer to report an injury to the carrier within 7 days of
“Important Workers’ Compensation Information for Florida’s Workers,”               becoming aware of the injury may result in
Florida Department of Financial Services, October 2003.                            a) A $2,000.00 fine
      “Important Workers’ October 2003.                                            b) Denial of payment
      “Benefit Delivery Process,” Department of Workers’ Compensation,            c) Verbal warning
      2006. http://www.fldfs.com/WC/pdf/fflowchar.pdf                        2.    At the point where no further recovery is expected for the injured
       Compensation Information for Florida’s Workers,” Florida Department        worker, the doctor will issue which of the following?
      of Financial Services,                                                       a) A referral
Review Questions                                                                   b) The MMI
Answers to review questions can be found on page 70.                               c) A prescription
True or False?                                                               3.    Wage replacement benefits can begin
Decide whether the following statements are true or false.                         a) Immediately after injury
                                                                                   b) One month after injury
1.  An injured worker should try to wait one week before reporting the             c) Eight days after injury
    injury.                                                                  4.    The formula duration)
2. The injured worker can only see a doctor approved by their workers’              [(Pre-injury wage) – (Post-injury wage)] x 80% = Total Benefit
    compensation carrier.                                                            is used under which of the following?
3. It is up to the employee to inform the carrier when an injury occurs.          a) Temporary Partial Benefits
4. If an injured worker reaches his MMI, it shouldn’t affect his workers’          b) Permanent Impairment Benefits
    compensation benefits.                                                         c) Temporary Total Benefits
5. Wage replacement benefits are not to exceed Florida’s average weekly      5.    An injured worker who is permanently and totally disabled will
    salary.                                                                        receive...
Multiple Choice                                                                    a) Permanent Total Benefits
Choose from the best answer listed for each question.                              b) Permanent Impairment Benefits
                                                                                   c) Temporary Total Benefits

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