Workers’ Comp | Social Security | Disability Insurance | Personal Injury
WORKERS' COMPENSATION
How are my wages calculated?
When is workers’ compensation supposed to pay me?
What if I have two jobs?
Who pays for my medical care?
Am I allowed to pick my own doctor?
Can I change my doctor?
Can I get medical care outside the workers’ compensation system?
How long does my medical care continue?
What is maximum medical improvement (MMI)
What are impairment benefits (IB)?
Is there a statute of limitations on medical care?
What other types of medical care does workers’ compensation provide?
Does my employer have to hold my job?
What if I can’t go back to my job?
Can I settle my case?
Can I sue for my employer for my injuries?
How does my lawyer get paid?
How are my wages calculated?
Your wages are typically calculated based on your average weekly wages. The AWW as it is known, is derived by taking the employees gross wages for the three months (91) days prior to the injury, and dividing by thirteen. Different rules apply if an employee has not worked the whole of the three months prior, the work is commission, or seasonal.
back to topWhen is workers’ compensation supposed to pay me?
Workers compensation payments will begin after the employee misses more than a week from work. If the employee misses less than a week, no benefits are paid. The first payment will issue at week three. Workers compensation will pay the employee for the first week if more than two weeks of work are missed. Payments continue until the employee is able to return to work, or maximum medical improvement is reached.
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What happens if I have two jobs?
If you were working two jobs at the time of your injury, this is referred to as concurrent employment. In that case, the wages from both jobs are added together to determine your average weekly wage.
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Who pays for my medical care?
Workers’ compensation remains responsible for paying for your medical care as long as the care is deemed reasonably and medically necessary, and the work related injury remains the major contributing cause.
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Can I pick my own doctor?
Generally not. Most workers’ compensation insurers operate out of a managed care network. The injured worker can select the primary care physician, but that is all. Most insurers will direct you to specialty physicians, although some adjusters might allow the worker to select the doctor, or give you a choice of several. All referrals must be approved by workers’ compensation. The injured worker should endeavor to always use authorized care, as the opinions of unauthorized doctors are not admissible in court, and workers compensation will not be responsible for the bills of unauthorized providers.
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Can I change my doctor?
Initially most workers’ are directed to a primary care physician, and allowed a one time change to an alternative primary care physician. The primary care physician makes all referrals to specialty physicians. Most insurers will also allow a one time change of specialty physician, or a second opinion.
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Can I get medical care outside the workers’ compensation system?
Yes, but only if the carrier fails to provide medical care within a reasonable time after care it requested. If it is later determined that the care was reasonable and medically necessary, and the carrier did not respond to a request for care, the injured worker may be reimbursed for any out of pocket expenses.
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What is an independent medical exam?
Either the carrier or the injured worker can select an independent medical examiner. This is almost always a medical specialist, who is asked to provide a medical opinion about the injured workers’ condition. The party requesting the IME, selects the doctor. The date of the injury controls how many IME’s you can have, and most importantly, who pays for the physicians services.
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What is maximum medical improvement (MMI)?
That is the point at which your doctor believes you have plateaued in your medical treatment. That you are as good as you are going to get. It is a significant point in your claim because; you will no longer be paid lost wage benefits after MMI unless you are permanently and totally disabled; and you will have a $10.00 co-pay for all future doctor visits.
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What are impairment benefits (IB)?
Impairment benefits are paid to an injured worker based on the impairment rating provided by their treating physician(s). The impairment rating is simply a number, expressed as a percentage, which is assigned by treating physician. The rating is designed to approximate the functional loss of the body as a whole, which the injured worker has sustained as a result of their injury. The doctor gets the rating from a book called the Florida Uniform Impairment Rating Guide. The length of time an injured worker receives impairment benefits is derived from the impairment rating, and the amount is a function of the average weekly wage. The calculation of these benefits differs by date of accident. Impairment benefits are not a “settlement” payment.
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Is there a statute of limitations on medical care?
Yes. Once you are two years post accident, there is a rolling one year statute of limitations on medical care. The injured worker must see his/her authorized treating physician at least once every year to avoid termination of medical care, assuming no lost wage benefits are being paid.
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What other types of medical care does workers compensation provide?
Workers’ compensation is responsible for prescription drugs, medical mileage, attendant care, prosthetics, radiology, and any laboratory diagnostics. Any necessary durable medical goods are also paid for, such as canes, wheelchairs, braces, splints, and in some cases vehicle modifications.
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Does my employer have to hold my job?
Unless you are under private contract, or have filed for Family Leave Medical Act (FMLA), your employer has no obligation to hold your job. That is why keeping in touch with your employer, keeping them updated on your medical progress is always a good idea. Let your employer know you have every intention of returning to work, and they may be less inclined to fill your position.
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What if I can’t go back to my job?
If medical restrictions just make returning to your former job impossible, you usually fall into one of several categories. If you are too injured to return to a physically demanding job, but you can still work at a lighter job, you need to find work as soon as you can. Workers’ compensation does not pay a lost wage benefit after you reach maximum medical improvement, so benefits can end, and you are out of a job. Retraining might be available under certain circumstances. Contact your local department of Vocational Retraining through the Florida Department of Education. If you are completely unable to return to any job, you may be permanently and totally disabled. If the carrier fails to pay you lost wage benefits in this case, you need to consult with a board certified workers’ compensation lawyer as quickly as possible.
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Can I settle my case?
The term “settling” a case means a lump sum settlement. This typically involves the injured worker giving up all rights to any future benefits under workers’ compensation, to include medical care, in exchange for a cash settlement. The settlement amount is negotiated between the parties, and the case only settles if both parties agree on a figure. A judge in a workers’ compensation case has no ability to set the settlement amount.
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Can I sue my employer for my injuries?
Only in very special circumstances can an injured worker sue their employer, or any fellow employees. The central idea behind workers’ compensation is that there is a mutual renunciation of common law rights in a workers’ compensation case. An employer of four or more employees must carry workers compensation coverage in the Sate of Florida and the policy will cover any employee for their on the job injuries, regardless of fault. In exchange for carrying this coverage, the employer receives immunity from any lawsuit instituted by the injured worker. This means if the employee’s injuries are covered under workers’ compensation, the employer may not be sued for damages by their employee. The rule of thumb is that you can sue anyone who is negligently responsible for your injuries, just not your employer. An example would be if a worker is injured while driving a vehicle for their employer. The worker is free to collect workers compensation, and they can sue the negligent driver of the other car. This is referred to as a third party case.
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How does my lawyer get paid?
All workers compensation cases are handled on a contingency basis. No fee is paid to the lawyer unless the lawyer secures the worker a benefit, either through litigation or lump sum settlement. The fee in some cases is paid by the carrier, and in other situations by the injured worker. The injured worker is never responsible for a legal fee unless money benefits are secured by the lawyer. All consultation with lawyer’s are free in workers’ compensation cases.
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