Understanding Workers Compensation Forms

The process of a worker's comp claim can be overwhelming, especially completing documentation that your employer and the insurance company will need or understanding the forms that they might send you. While this is not meant to be a complete list of work comp forms you may come across in your claim, it is designed to help you navigate the paperwork you may find being presented to you. As the old adage says, "No job is finished until the paperwork is done," but don't think you have to do it alone. The experienced attorneys at The Coye Law Firm can be of assistance while you travel this path on your road to recovery and potential compensation.

Medical Treatment Forms

The first and most important thing in any injury is your health. If you are injured in the course of your work duties, do not hesitate to seek medical attention immediately. Be sure to be honest and complete with your doctor and when filling out forms at medical offices, as these documents can become part of the workers compensation claims process and are official documentation relevant to your case. You should maintain visits with the same doctor or office consistently in order to keep uniformity in your evaluations and treatment. Be sure not to jump around to various doctor's offices, consistency is key both in the recovery of your health and the processing of any worker's comp claim.

Your employer will recommend a specific office or facility based on the worker's comp insurance they provide. Contact or visit this office primarily if possible, and request a documented referral to your specific doctor if you are more comfortable with maintaining treatment in the future from someone you have received it from in the past. Disagreement with any doctor can be understandable, but remember that your treatment toward the medical professionals you come in contact with could have an effect on your claim.
Personal expenses, such as mileage and the cost of gas incurred by driving to medical treatments, can be included as part of your worker's compensation claim and can be reimbursed to you. While it is not necessary to keep track of these in a specific format, it can be helpful to use a standard form to show the employer and the insurance company what these regular costs are. The Coye Law Firm has designed a simple Mileage Reimbursement Form to easily track these expenses.

First Report of Injury or Illness

Within 30 days be sure to file a First Report of Injury or Illness with your employer. This should be done as soon as possible and should be as thorough as you can make it. Be sure to include the date and time of the accident, where and how severely you were injured, as well as the circumstances of what happened, what exactly you were doing when it happened, and the names of any witnesses. Any pertinent information regarding the injury should be as detailed, accurate, and complete as you can make it. Include pictures, sound recordings, or video that you may have with the report if possible. If the injury was severe enough to require calling 911 emergency services, include that information just in case your attorney decides later to pursue access to that recording. If the accident occurred in an area which is under video surveillance, include that on the report so that the video can be referenced at a later date.

Florida law recognizes that verbally informing your employer is sufficient to begin a worker's compensation claim, however having this information and all the details in writing can prevent confusion, miscommunication, or the loss of details of "what really happened" which can occur naturally with time. Although this does not need to be completed using a specific document, the Florida Department of Financial Services provides a standardized form for all industries, and your employer may have specific forms which cover additional information pertinent to your industry. Take the time to speak with your employer about all these details and request copies of all documentation for your own records.

Wage Statement Form

The Wage Statement Form from the Florida Department of Financial Services is a form which the employer must submit to their claims-handler within 14 days of their knowledge of any accident which results in disability. It is an invaluable part of the process for injured employees because it will be used to calculate normal wages in order to determine reasonable payment for those lost wages due to the injury.

The weekly compensation for the employee is determined by calculating the average of their weekly earnings for the 13 weeks preceding the accident (not including the week in which the injury/accident occurred) for employees who were working full-time hours at least 10 of those 13 weeks. This calculation also provides for gratuity, commissions, and fringe benefits which the injured employee has lost. If the employer stops paying fringe benefits during the workers' comp claim process, they must file a corrected Wage Statement Form within 7 days of stopping those benefits.

Employee Earnings Report

The Florida Chief Financial Officer website also provides a standardized form called the Employee Earnings Report for employees to report to their employers, the department of worker's compensation, and the insurance company on the amount of money which they have received during the course of a worker's compensation claim. This form includes sections to report on self-employed earnings, insurance settlements, or worker's comp payments. The employee has 21 days to complete this form once it is requested of them. 

Notice of Denial

If an insurance company has decided to deny a worker's compensation claim they are required to submit a Notice of Denial within 21 days of a worker's request for benefits. There are many reasons an insurance company may decide to deny a claim, including Drug Free Workplace violations, evidence gathered under surveillance, or any situation where the insurance company can support a belief that the claim is fraudulent. The denial of a worker's comp claim may not be the end of the process and the injured worker has rights to appeal the denial.

Petition for Benefits

In the event that a worker's compensation claim is denied or disputed, the Office of the Judges of Compensation Claims is responsible for handling and resolving these disputes. The form an injured person would file with them to begin the process of mediation is the Petition of Worker's Compensation Benefits. This form provides space to report to them much of the same information as the First Report of Injury or Illness, and allows a person seeking worker's compensation for their injury to fully describe the history of their situation. Filing this form serves as a notice to the OJCC of the injured person's request to require the employer to pay the compensation for lost wages they feel they are owed.

These forms are a few among the many which can be crucial in the process of a worker's compensation claim. To see a complete list of forms for the FL Division of Worker's Compensation see here or for the Office of Judges of Compensation Claims see here . To speak with an experienced attorney about the process and your rights in a worker's compensation claim, contact the offices of the Coye Law Firm today. 

 

  • Do You Still Have Questions?

Call 407.648.4940 or contact Coye Law Firm today for a free consultation about your case.

The expert injury attorneys at Coye Law Firm are experienced with Florida, New York, Michigan, and District of Columbia law and are here to help the injured.

Discover POWERFUL SECRETS and COMMON LIES of Florida Workers' Compensation 


If you are someone you know is struggling with the workers' comp process, get a FREE hard copy of my workers' compensation book and you will be squared away in no time!

From my book you will learn...

  • The one thing you MUST do within 30 days of a work injury (page 16)
  • How to fill out a First Report of Injury form (page 20)
  • The first step you need to take to receive wage loss benefits (page 54)
  • What medical decisions your employer can make for you (page 26)
  • How to protect your benefits after being placed on light duty (page 38)
  • How to deal with rude workers' compensation doctors (page 39)
  • Disastrous workers' comp traps to avoid (page 83)
  • Others methods to pay for your medical costs (page 45)
  • What "maximum medical improvement" means for a claimant (page 63)
  • ...and much more.

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