Steps to Filing a Workers' Compensation Claim

Workers’ compensation systems protect workers and employers after a workplace accident. The system guarantees medical benefits for workers that are injured on the job. It also protects employers from lawsuits for work-related accidents.

Florida’s workers’ compensation system places very few responsibilities on an injured worker. Instead, many of the tasks for filing and approving a workers’ compensation claim fall on the employer and the employer’s workers’ comp insurer.

Here are the steps to filing a workers’ compensation claim in Florida.

What Steps Do I Take After the Accident?

After a work-related injury, you must take action to preserve your rights and commence the claim process.

Report the Accident to Your Employer

You must report your accident to your employer within 30 days after the injury. If you fail to report your injury within this period, you may lose your right to claim compensation. 

However, there are several exceptions to this rule if:

  • Your employer knew about the injury
  • Your employer failed to notify workers of the reporting requirement
  • Other exceptional circumstances exist

You should always report an accident. But if your supervisor witnessed the accident, you may not need to report the accident. Similarly, a co-worker can notify your employer of the accident on your behalf.

If you only became aware that your employment caused an injury after a medical diagnosis, you have 30 days after the diagnosis to report the injury. 

This typically occurs for injuries caused by:

  • Repetitive motions
  • Toxic exposures
  • Working conditions, like loud noises or poor ventilation

In some cases, you might need to notify a prior employer about injuries if you left the place of employment.

Seek Medical Treatment

A workers’ compensation claim covers medical treatment for work-related injuries. If you fail to seek medical treatment, your employer’s insurer may doubt the validity of your claim.

In an emergency, you can seek medical treatment at the emergency room. Your employer’s insurer should cover the costs when it approves your workers’ comp claim.

In a non-emergency, you must receive treatment from a medical provider that the insurer approves. In other words, do not seek medical treatment from your regular doctor unless you are unaware that the injury is work-related. Workers’ comp will not cover medical treatment by an unapproved medical provider.

Receiving immediate medical treatment will help your workers’ compensation claim. Your treating physician will provide a diagnosis that will tell the insurer about the severity and extent of your injuries. It will also help you to show that you did not fake or exaggerate your injury.

Await the Insurer’s Decision

After you report your accident, your employer should file a claim with its insurer within seven days. If your employer does not do so within this time frame, you can contact the insurer directly. This will provide the insurer with notice of your claim. Your workplace should have a poster displayed with the insurer’s phone number on it.

The insurer will mail you a copy of the notice of your injury, along with a brochure explaining your benefits, within three days after opening your case. The insurer will begin investigating your claim to decide whether to accept or deny it.

The workers’ comp insurer does not have a deadline for deciding your claim. But it has an obligation to act “promptly” to either accept or deny the claim. In most cases, this means that the insurer will act within about three weeks.

You are not entitled to wage replacement benefits for the first seven days after your accident. But if you are out of work for more than seven days, the insurer must provide wage replacement checks every two weeks. 

If the insurer accepts your claim, they should send the first check no later than three weeks after your accident. If it fails to do so, the insurer risks being penalized with a fine from the state.

Challenge a Denial of Benefits

If the insurer denies your claim, you can challenge the denial. Under Florida law, you must make a good faith effort to resolve the dispute with the insurer before filing a Petition for Benefits with the Office of the Judges of Compensation Claims.

You should consider hiring a personal injury lawyer at this point. Negotiating with the insurer to accept your claim could require knowledge and experience with workers’ compensation law.

File a Petition for Benefits

If the claim adjuster persists in denying your claim, you can file a Petition for Benefits. This petition provides a detailed look at your case. It will outline your injuries and the accident or incident that caused them. It will also explain how your injuries affect your ability to work and outline the treatment that you need to return to work.

Attend Mediation

Within 130 days after filing the petition, the office could order you to mediate your case. This mediation will attempt to resolve the claim denial by putting you, your employer, and the insurer together.

Conduct a Hearing

If you cannot settle your claim, you will go through a pre-trial hearing and a final hearing before a Judge of Compensation Claims. These hearings resemble courtroom trials. 

You and the insurer will each present evidence. Common kinds of evidence introduced includes:

  • Medical records
  • Witnesses to the accident
  • Expert medical witnesses

The judge will resolve your claim based on the evidence and in accordance with Florida’s workers’ compensation laws. If the judge decides that you should have received the benefits and that the insurer wrongly denied your claim, the judge can order the insurer to pay for your attorney’s fees, as well.

Injury Lawyer’s Role in Filing a Workers’ Compensation Claim

Ideally, you would not need a lawyer to help with your workers’ comp claim. You would report your injury to your employer, who would contact the insurer. The insurer would accept your claim and pay your benefits promptly.

But the ideal situation does not always happen in the real world. An injury lawyer can help you battle insurers that deny claims or withhold approval for the treatments you desperately need.

To discuss your workers’ comp claim with an experienced injury lawyer, Contact our Cleawater law office at (727) 796-8282  for a free consultation. We’ll help you to fight for the benefits you deserve.