What Does Florida Workers’ Compensation Insurance Cover?
Most Florida workers are covered by workers’ compensation insurance if they are injured in the scope of their employment. However, workers’ comp does not cover all losses and damages caused by a workplace injury. Understanding workers’ compensation claims can help you know what to expect after an accident.
Below, our Gainesville workers’ compensation lawyers discuss Florida workers’ compensation and the benefits you can expect to receive if you are injured on the job.
What Is Workers’ Compensation Insurance Coverage?
Workers’ compensation is no-fault insurance coverage for injured employees. Employers who conduct business in Florida must purchase workers’ compensation insurance for their employees. The workers’ comp requirements depend on several factors, including the type of industry, the number of employees, and the business entity.
A company must purchase workers’ comp coverage if it has at least:
- Six regular workers or 12 seasonal workers in agriculture
- Four workers (including owners) in a non-construction industry
- One worker (including owners) in the construction industry
The construction industry is a high-risk industry for injuries and accidents. Therefore, all construction companies must have workers’ compensation insurance. Most other companies also fall under the requirements for workers’ comp coverage.
However, some companies or individuals do not need workers’ comp. For example, companies are not required to provide workers’ comp for independent contractors. In addition, charities are not required to cover volunteers, and homeowners are not required to cover domestic servants.
Employers have a duty to determine if they are required to have workers’ comp coverage.
They can obtain workers’ compensation insurance by:
- Purchasing a workers’ comp insurance policy through a private insurance company
- The Florida Workers’ Compensation Joint Underwriting Association (FWCJUA), a non-profit corporation created by the Florida legislature
- Self-insuring – some large companies qualify as self-insurers and maintain a self-insurance fund for workers’ comp claims
If an employer does not have the required workers’ compensation coverage, a worker might be able to sue the employer for damages caused by a work-related injury.
How Does Workers’ Compensation Insurance Work?
Workers’ compensation insurance covers most on-the-job injuries. The employee does not need to prove negligence to receive workers’ comp benefits. If the employee proves they were injured in the ordinary course of employment, they are likely eligible for benefits.
An employee might not be eligible for workers’ comp benefits if they:
- Intentionally caused their injury
- Intentionally injured themselves
- Are injured because they were using drugs or alcohol
- Refused to follow safety standards and rules or use available safety equipment
Florida’s Workers’ Compensation Law outlines the process for filing a workers’ comp claim. Employers who comply with workers’ comp laws typically cannot be sued by injured employees. The law limits an injured worker’s remedy to filing a worker’s comp claim.
There are instances where a third party could be liable for a claim. For example, a manufacturer could be liable for damages caused by a defective tool, or a driver could be liable for a car accident. A third-party lawsuit is a personal injury claim separate from a workers’ comp claim.
What Does Workers’ Compensation Cover in Florida?
Workers’ comp insurance covers job-related injuries and illnesses. The injury must have occurred in the ordinary scope and course of employment.
Additionally, the person’s job, an accident at work, or the workplace environment must be a contributing factor. The person’s workplace must be at least 50% to blame for the worker’s injuries or illness.
Unfortunately, insurance companies and employers use a variety of reasons for denying workers’ comp claims.
For example, the insurance company might point to a pre-existing condition as the cause of the current condition. They’ll claim that the person’s job was not a 50% contributing factor. Instead, the pre-existing condition was to blame.
An insurance company might deny a workers’ comp claim because the worker cannot link the cause to the injury. For instance, linking exposure to hazardous substances to an illness or injury can be difficult. Likewise, it can be challenging to prove that repetitive motions cause an injury.
An experienced workers’ compensation lawyer will know how to fight these excuses for denying valid workers’ comp claims.
What Workers’ Comp Benefits Will I Receive?
You can receive several benefits if you are injured at work, including:
Workers’ compensation pays for the necessary and reasonable medical bills related to your work injury. However, you must seek medical treatment from a doctor approved by your employer or the workers’ compensation provider.
If so, the workers’ comp benefits should cover all medical expenses, including:
- Emergency room visits
- Doctor’s bills
- Physical therapy
- Prescription and over-the-counter medications
- Medical equipment
- Occupational therapy
- Nursing care
- Lab and diagnostic tests
An insurance company might argue that you do not need a specific treatment or surgery. If so, contact a lawyer immediately for help.
Workers’ compensation benefits do not reimburse you for all loss of income after a work accident.
If you cannot work because of your injury, you can receive total temporary disability (TTD) benefits. TTD benefits equal approximately two-thirds of your average weekly wages. Workers with severe injuries could receive up to 80% of their average weekly wages.
However, TTD benefits are subject to maximum amounts. Therefore, you might not receive the full TTD benefits, depending on how much you earn.
Sometimes, a worker is released to work on light or restricted duty. If they cannot earn at least 80% of their regular wages, they might be eligible for partial temporary disability (PTD) benefits.
Permanent Disability Benefits
Sometimes, a worker sustains a permanent impairment or disability. If so, they could be entitled to income impairment benefits or permanent total disability benefits. However, a doctor must state that you are disabled or impaired after reaching maximum medical improvement.
A worker may die due to workplace accidents and injuries. Their family can receive benefits for a work-related death.
Death benefits include:
- Compensation for dependents
- Up to $7,500 for burial and funeral costs
- Educational expenses for a surviving spouse
Death benefits are capped at $150,000 for Florida workers’ compensation claims.
Workers’ Compensation Does Not Pay You for All Losses
Unfortunately, workers’ compensation does not pay an injured employee for all losses. Workers’ comp does not cover all economic damages. In addition, it pays nothing for non-economic damages, including pain and suffering.
Sadly, injured workers and their families might experience a financial crisis because of a work-related injury. However, a third-party claim could help. A personal injury claim could compensate the injured worker for all damages.
The best way to know if your workplace accident supports a third-party claim is to discuss your case with an experienced workers’ compensation lawyer.
Call Now for a Free Consultation With a Gainesville Workers’ Compensation Lawyer
Our legal team at Allen Law Firm, P.A. will work hard to get you all the workers’ comp benefits you deserve. Contact our law firm to schedule a free case review with an experienced Gainesville workers’ comp attorney at (877) 255-3652.