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Florida Workers' Compensation - Basic Concepts

This article is intended to give a very basic overview of the benefits available to injured workers in Florida.

Medical and Indemnity Benefits

There are only two types of benefits available to an injured worker: medical and indemnity. Medical benefits include emergency room visits, authorized primary care doctors for evaluation and treatment, specialist physicians on referral from other authorized doctors, physical therapy, prescription medication, and so on. Indemnity benefits are substitutes for wages that are lost as a result of the workplace injury or condition. There are two kinds of indemnity benefits: temporary and permanent. The switch from one to the other comes when the injured worker reaches "Maximum Medical Improvement" (MMI).

MMI is the the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability. This date is fixed either when the injured worker's doctors decide that this point has been reached or by operation of law once the injured worker has received 104 weeks of temporary indemnity benefits. As soon as the injured worker reaches MMI, the authorized workers' compensation doctors are required to assign a number called a permanent impairment rating (PIR). The PIR ranges from 0% up to 100%. It is intended to estimate the residual damage to the body left by the work-related accident. Thus, a 0% would mean that the assigning doctor concluded that there was no permanent impairment as a result of the accident. The percentage assigned must be based on objective medical evidence of a scheduled injury listed in a uniform guidebook.

Temporary Indemnity Benefits

There are two kinds of temporary indemnity benefits: total (TTD) and partial (TPD). An injured worker should be paid TTD benefits if: (a) s/he suffered an on-the-job accident, in the course and scope of employment, and (b) an authorized doctor has placed the injured worker on No Work status as a result of the accident. TPD benefits should be paid when the doctor has released the injured worker to return to work (although not necessarily the job s/he was doing at the time of the injury) with restrictions (such as 'no lifting greater than __ pounds') that arise from the accident. Both TTD and TPD will come to an end at MMI. At that point, permanent indemnity benefits, if any, will start.

Note that TPD benefits are not automatic, just because a doctor says that the injured worker cannot go back to the job that s/he was doing at the time of injury. Not only must the injured worker follow the reasonable recommendations of the authorized workers' compensation doctors (if not, s/he will be accused of being "medically noncompliant"!), but the reason for the lost wages must be related to the workers' compensation injury itself, not to outside factors, such as termination/layoff or the injured worker's personal belief that s/he just can't go back to work yet. If the adjuster feels that the injured worker is "voluntarily limiting his/her income," TPD benefits will likely be cut off.

Permanent Indemnity Benefits

There are two kinds of permanent indemnity benefits: total (PTD) and partial. If the injured worker has suffered a catastrophic injury, or it is determined that the injured worker cannot engage in at least sedentary employment within a 50-mile radius of his/her residence, then the injured employee will be presumed to be permanently and totally disabled and entitled to bi-weekly workers' compensation benefit checks indefinitely. If not PTD, then we look to the PIR. If greater than 0%, the injured worker will be paid a percentage of the pre-accident average weekly wage for a number of weeks based on a statutory schedule. These permanent partial disability benefits are commonly called Income Impairment Benefits (IIBs, or just IBs). For example, a 5% PIR arising out of an accident on or after 10/1/2003 would yield 10 weeks of IIBs. The percentage is assigned by a doctor using a book commonly referred to as the Florida Impairment Guide, which has scheduled listings of percentages for common injuries. Once IIBs have been paid out, no more indemnity benefits are generally owed.

Workers' Compensation Abbreviations

Because of all the abbreviations and acronyms that Florida workers' compensation lawyers and insurance adjusters use, outsiders (including other attorneys) tend to think that comp practitioners speak a foreign language. I have, therefore, put together a list to help people figure out exactly what we're saying. It includes MMI, PTD, and others that are discussed on this page.

 

Again, note that the above information is a basic listing of benefits, not a complete list. For questions related to any of the above, or to find out what other benefits might be available, please fill out our Contact Form or telephone our office directly.  Se Habla Español.

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Kenneth B. Schwartz, Esq., handles litigation, trials, and appeals of business and employment matters, including contract disputes, enforcement of noncompete and trade secret agreements, allegations of wrongful termination and discrimination, workers' compensation claims, unemployment compensation claims, Rule Nisi enforcement proceedings, resolution of stop-work orders and premium disputes, and construction defect litigation.

   News / Updates

April 3, 2014: Mr. Schwartz was advised that he has been selected as one of Florida's "Legal Elite" by Florida Trend magazine, which will be published in July 2014. The publication purports to recognize "the top attorneys in the state as chosen by their peers," and they claim that their list of "elite" attorneys represents fewer than 2% of the active Florida Bar members who practice in Florida.

More news here...

 

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