A workers' compensation claim is basically defined as an injury that happens on company time while performing tasks requested by your employer. If you have been injured on the job, you may be eligible to have your medical bills paid and have part of your wages paid as well.
The workers' compensation insurance company may also provide additional benefits to you such as, mileage reimbursement, prescriptions, and more.
Benefit #1: Medical Care and Treatment
After a work-related accident, an employer will typically direct an injured worker to their workers’ compensation insurance company. The insurance adjusters from the workers’ compensation insurance company will make most of your medical care decisions.
They are allowed to decide the following:
- The doctor you will see and when you will see him or her;
- The kind of care you will receive;
- The medical tests you will undergo;
- The procedures the doctor will provide;
- The prescription(s) you will receive (once, I even had an adjuster tell me she could dictate whether an injured worker could get aspirin paid for by workers’ comp);
- Where you’ll go for therapy (if needed); and
- Whether the doctor will continue to treat you, regardless of whether you continue to suffer from your injuries
As you can see, the insurance adjusters can micromanage almost every aspect of your medical care.
Keep in mind, you should never consider the workers’ comp insurance company as an entity that is representing your interests and giving you a full range of options and benefits. Workers’ comp law is NOT designed to get you the best care with the best doctors. Instead, the workers' comp insurance company’s main responsibility is to provide the minimum care the law requires it to pay.
Benefit #2: Wage Loss Benefits
If the authorized doctor says that an injured worker cannot work, then wage loss benefits will typically be paid to the injured worker. There are two types of wage loss benefits: Temporary Total Disability Benefits and Permanent Total Disability Benefits.
Temporary Total Disability Benefits (TTD)Temporary Total Disability Benefits pay 66 ⅔ percent of your average weekly wage. The exact dollar amount you will receive in will depend on the wages you received in the 13 weeks before you were injured. You will need to fill out a Wage Statement form in order to report your wages for the 13 weeks prior to your injury.
It does not matter if you went on an unpaid vacation or took sick time off sometime during those 13 weeks before you were injured.
Your paychecks should be the only paperwork you need to determine your weekly wage. However, if you do not declare all of your income, such as tips, it will affect the amount the workers’ comp insurance company pays you.
Permanent Total Disability Benefits (PTD)
If you are seriously injured to the point where you will never work again, then you are eligible for Permanent Total Disability benefits. These benefits are paid to you until you reach the age of seventy-five.
Whether you receive Permanent Total Disability benefits is dependent on the opinion of the authorized doctor and factors such as the severity of your injury, your age, educational background, and employment history.
Other Wage Loss Benefits You Could Be Entitled ToIf you were injured on the job and you have a second job, then your wage loss benefits could be calculated upon both jobs. This is called “concurrent employment.”
As with all benefits, there are some rules. First, if you do not pay taxes on your second job, aside from having possible issues with the IRS, you might not get the benefit of that second job on your workers’ comp check. Second, workers’ compensation insurance must be maintained at both jobs.
If both of these requirements are met, then you may be able to add the wages from both jobs together to calculate the total amount you should be paid. The total amount is called a “compensation rate” and is determined by your average weekly wage from all employment, including your second job, reported tips, etc.
Your average weekly wage is multiplied by 66 ⅔ to arrive at the correct compensation rate.
Benefit #3: Mileage Reimbursement
You can receive reimbursement for the expense of driving to doctor appointments if the appointment is related to your on-the-job injury.
The first step to receiving mileage reimbursement is to log your miles on a mileage claim form. Click here to download my sample mileage claim form.
3 tips for filling out a mileage claim form:
- Make sure to write down the date of the doctor’s appointment in the first column.
- Make sure to write the actual address of the doctor’s office. For example, write “1285 N Orange Ave Winter Park, FL 32789” not “Jewett Orthopaedic Clinic.”
- The miles logged must begin from where you left from and back. If you ran an errand on your way to the doctor appointment, you cannot calculate that mileage in.
If you do not have a car or means of transportation, the workers’ comp insurance company may be required to provide transportation to and from these appointments for you.
Benefit #4: Prescription Drugs
Florida workers’ comp insurance companies must allow you to purchase your prescription drugs anywhere, including from mail delivery sources. There are some pharmaceutical mail-order companies that will provide you with your prescriptions even if the workers’ comp insurance company has temporarily suspended paying for medical benefits.
Typically, these companies work exclusively with injured workers and understand that oftentimes there is a delay between the time the benefits are authorized and the time benefits are provided to an injured worker. Knowing the importance of receiving prescription medications, these companies will continue to provide them even if the insurance company’s authorization is late.
Benefit #5: House Modification
If you are so catastrophically injured that your house requires modification or you need specialized transportation, the worker’s comp insurance company may be responsible to pay for different types of assistive devices for your home. This depends upon the unique circumstances of your case and requires an authorized doctor to state that your limitations require home modifications.
Examples of house modifications:
- Wheelchair lifts
- Shower modifications
- Enlargement of doorways to accommodate a walker or a wheelchair
- Handicap-accessible walkways
Benefit #6: Home Health Care
If you are unable to perform the regular activities of daily living and require some type of assistance, there are some home health care options that may be available to you. You may be able to ask the workers’ compensation insurance company to send someone to your home to assist you with needed tasks around the house, as necessary.
Services available include the following:
- Home repairs
- Home health care
- Daily living, such as dressing, bathing, and cooking
If a friend or family member is going to help you, then he or she could be entitled to payment as well. In order to receive this benefit, your authorized doctor must write an order or prescription for the attendant care prior to the time it is needed; otherwise, even though a friend or family member may be providing attendant care to an injured worker, that friend or family member is not allowed to receive payment for their services after the fact.
So, as a practical matter, if you have experienced a serious injury at work make sure to have a conversation with your authorized doctor about your at-home needs before you are discharged from a hospital or surgical center.
Benefit #7: Reeducation and Retraining
What if a work injury prevents you from doing a job you have been doing your whole life? You can explore your options with the Florida Division of Vocational Rehabilitation office.
Visit www.rehabworks.org to find the nearest vocational rehabilitation office near you, or call 800-451-4327. Here, you can find vocational counseling, job-seeking skills, on-the-job training, job placement, and retraining opportunities.
Benefit #8: Death Benefits
Workers’ comp law has a provision for payment of death benefits within one year after an on-the-job accident or within five years if the injury results in a continuous disability. Death benefits are paid following an employee’s death that occurs while working and are payable to a spouse or dependent child.
The payments to the dependent child only continue until the child turns eighteen years old, or twenty-two years old if the child attends college. This does not mean that any death at work results in payment; rather, there must be some connection to work. For instance, if an employee is involved in a motor vehicle accident while working and dies, then workers’ comp death benefits may be payable.
The specific amount payable is dependent on the average weekly wage of the worker, up to a maximum of $150,000 in total benefits.
If you have lost a family member due to an on-the-job accident, consulting a workers' compensation attorney is the best course of action.
Benefit #9: Funeral Benefits
Funeral benefits are payable following the death of a person on the job. Much like death benefits, just because there was a death does not necessarily mean that funeral benefits are payable. The workers’ comp statute has many details that are subject to clarification by the appellate court and can be changed by the legislature.
Once again, in these cases consulting an attorney is the best course of action.
Benefit #10: Impairment Benefits
Impairment benefits are a series of payments made when an employee reaches Medical Maximum Improvement (also known as “MMI”).
An authorized doctor may place an injured worker on MMI status if the doctor believes that the injured employee will no longer improve from his or her work injury. The doctor is then required to give an opinion as to whether residual effects from the workplace injury are permanent. If so, the doctor must render an opinion according to the Florida Guide to Permanent Impairment.
Impairment benefits are paid in increments based upon both an the injured person’s compensation rate and the total impairment the authorized doctor believes the injured person has experienced.
If you have questions about your workers’ compensation claim you can download a FREE copy of Wade Coye’s book, Sharing the Secrets, Learning the Lies: A Guide to Florida Workers’ Compensation. You can also contact our expert team by calling (407) 648-4940 today or by filling out a contact form.