Florida’s workers’ compensation insurance covers almost all on-the-job injuries.
Most employers in Florida must carry workers’ compensation insurance. When employees get injured during the course and scope of their employment, the workers’ comp insurer pays their medical expenses and provides partial income replacement.
In this guide, we’ll discuss Florida workers’ comp and the benefits you can receive after a workplace injury.
Who Does Florida Workers’ Compensation Insurance Cover?
Florida law requires employers to buy workers’ comp insurance if they have:
- More than one employee (including owners) in the construction industry
- More than four employees (including owners) in a non-construction industry
- More than six regular workers or 12 seasonal workers in the agriculture industry
These rules mean that all construction businesses carry workers’ comp insurance. Most other businesses also carry workers’ comp insurance, with the exception of very small businesses with four employees/owners or fewer. Most farming and fishing operations must carry workers’ comp insurance, as well.
Some employers are allowed to forego workers’ comp:
- Homeowners do not need workers’ comp for domestic servants
- Businesses do not need workers’ comp for independent contractors
- Charities do not need workers’ comp for volunteers
- Professional sports teams do not need workers’ comp for athletes
- Entertainment venues do not need workers’ comp for independent performers
- Car services and taxi companies do not need workers’ comp for independent drivers
- Sponsors of amateur athletic events do not need workers’ comp for umpires and referees
These exceptions mean that most employers must cover their employees with workers’ comp insurance.
How Does Workers’ Compensation Work?
Workers’ compensation balances the interests of both the employer and the employee. Rather than forcing workers to pursue a lawsuit after a workplace accident, a worker can file an insurance claim to get compensation. This reduces costs to the worker as they seek money for their losses. It also speeds up the compensation process.
Employers also benefit from this system. As long as the employer has complied with Florida’s workers’ comp laws, the employer is immune from employee lawsuits for workplace injuries.
Florida law usually limits an injured worker’s remedies to workers’ comp benefits. Injured workers cannot file a lawsuit against their employers for their injuries, even if the employer or a fellow employee acted negligently.
Sources of Workers’ Compensation Insurance
Employers can get workers’ comp insurance in three ways:
Private insurance companies like those that sell homeowners’ insurance and business liability insurance also provide workers’ comp insurance. AIG, The Hartford, State Farm, and many other independent insurers sell workers’ comp policies.
Your employer buys a workers’ comp policy just like they would any other insurance product. The employer fills out an application, and the insurer decides whether to issue coverage or not. High-risk businesses might not receive approval.
Insurers set premiums based on the employer’s experience rating. Insurance companies determine the experience rating from the employer’s history of workers’ comp claims. An insurer may interpret the presence of a lot of claims to mean an unsafe workplace. If this happens, they will often charge a higher premium for coverage.
Florida Workers’ Compensation Joint Underwriting Association (FWCJUA)
Florida’s legislature created the FWCJUA as a non-profit corporation that offers workers’ comp insurance to employers who cannot get private insurance.
FWCJUA acts as the “insurer of last resort” so that businesses can get the insurance required by law instead of shutting down.
Large businesses can self-insure. This means that they act as their own insurer by putting money into a self-insurance fund. The business administers the fund just like a workers’ comp insurer.
What Does Florida Workers’ Compensation Insurance Cover?
Workers’ comp insurance covers on-the-job injuries and illnesses. To claim workers’ comp benefits, you must have developed your injury or illness in the workplace during the course and scope of your employment.
A workplace incident or environment must act as a major contributing cause of the injury. This means the workplace must have been at least 50% responsible for the injury.
The “major contributing cause” limitation can give a workers’ comp insurer grounds to reject a claim. Oftentimes, an insurer will deny a claim by saying that your injury happened on your own time or due to a cause unrelated to your employment.
Some of the most common ways that this issue can arise include:
Workers’ comp will not pay for injuries that did not arise from the scope and course of your employment. If you cannot lift boxes at work because of a back injury you suffered in college, the workers’ comp insurer can deny your claim.
But if your employment exacerbated your injury or caused it to flare up, you can claim workers’ comp benefits.
For example, suppose that your back injury allowed you to walk without pain before your employment. But after you began working, lifting and carrying boxes at work became a major contributing cause of severe back pain when you walk. In this case, you can claim benefits for the aggravation of your pre-existing condition.
Repetitive Stress Injury
Repetitive motions can cause inflammation, stress fractures, and nerve damage. They can wear down cartilage. These injuries take time to evolve and might not have a clear cause.
If you can show that your workplace was a major contributing factor to your repetitive stress injury, you can claim workers’ comp benefits.
Some workers are exposed to dangerous chemicals and particulates. When these play a major contributing factor in an illness, you can claim workers’ comp benefits.
The difficulty sometimes comes when you need to prove a connection between the exposure and your illness. An insurer might understand the connection between particulates and lung cancer. However, it might require more evidence to connect pesticide exposure to brain cancer.
Workers’ Compensation Benefits
Your benefits will cover 100% of your necessary medical expenses. You will need to visit an approved medical provider, but the insurer should cover everything you need, including treatment, therapy, and medication.
The insurer will also pay you two-thirds of your average weekly wage. This benefit keeps you afloat but encourages you to return to work as soon as you have recovered.
If the insurer denies your claim, you can petition for a hearing with Florida’s Office of Judges of Compensation Claims. The judge will review the insurer’s decision. You do not need to hire a workers’ comp lawyer for the hearing, but many workers opt to do so.