Articles Posted in Workers’ Compensation

Recently, the First District Court of Appeal in Florida issued an opinion in an appeal involving claims from a teacher who suffered injuries after falling in a classroom where he worked. According to the record, the teacher sustained injuries after losing his balance because his leg fell asleep. The judge of compensation claims (JCC) denied his claims, reasoning that the teacher’s injury did not “arise out of” his work as a teacher.

The doctor performing the independent medical exam (IME) on behalf of the school district testified that the teacher reported occasional numbness before the accident. However, the numbness the teacher experienced after the fall was not related to any medical illness. Instead, the numbness the teacher experienced before the fall was likely the result of brief nerve compression. The teacher’s expert reached a similar conclusion. In response, the teacher argued that he sufficiently established “occupational causation” because the accident happened in the “course and scope” of his employment.

Florida’s Workers’ Compensation Act compensates an employee’s injury if it stems from an accident that “arises out of the work performed in the course and scope of employment.” Arising out of and in the course of employment refers to where and under what circumstances the incident occurs. Understanding that work causation is not always straightforward when the incident involves an idiopathic condition, the fact remains that there must be a causal connection between employment and injury.

Recently, an appeals court issued a decision in a Florida workers’ compensation case where the Employer appealed the Judge of Compensation Claims (JCC) order. In this case, the E/C granted the employee/claimant’s request for a one-time physician change. The E/C agreed and scheduled the Claimant with a new physician. The new doctor and E/C completed a new form fee agreement that exceeded the base amount under the workers’ compensation fee schedule. The Claimant argued that the higher-than-schedule fee transformed the physician into an independent medical examiner (IME) instead of a treating physician. As such, the JCC terminated the E/C physician and allowed the Claimant to receive a one-time physician change. The E/C claimed that it was an error to strike the physician based on a fee agreement.

Florida’s workers’ compensation code does not provide JCCs with authority to disqualify a treating doctor because a claimant was dissatisfied with the fee reimbursement agreement between the physician and E/C. Under Florida law, a JCCs role does not extend to resolving disputes about fee arrangements between treating doctors and E/Cs. Further, the workers’ compensation code permits higher-than-fee schedule agreements. Finally, the law does not provide claimants with a recourse for litigating complaints regarding reimbursements before a JCC.

In this case, the court reasoned that the JCC’s authority does not extend to striking a provider’s authorization in light of the law. Moreover, the court recognized that the form used by the E/C and doctor did not include the statutory language that the law requires. However, the E/C and physician amended their agreement before the Claimant‘s rescheduled appointment. Finally, the court found that the workers’ compensation code does not allow claimants to disqualify their E/C-authorized doctor before a JCC. As such, the court reversed the JCC’s final compensation order.

Work accidents can lead to serious physical injuries and psychological trauma. In some cases, the accident can be so severe that the employee suffers long-term injuries that can significantly impact their ability to engage in their activities of daily living and employment. In these situations, employees and their loved ones should contact an attorney to discuss their rights and remedies.

Florida’s Workers’ Compensation Insurance (WCI) is coverage that an employer or business purchases that provide employees with benefits if they suffer injuries at the workplace. The law requires most employers to participate in this program. There are certain exceptions to the requirement, such as non-construction-related companies that have four or fewer employees. WCI works to compensate the injury victim for their medical bills and lost wages. While the benefits include payments for hospitalizations, medication, and subsequent therapy, there are limitations to how much one can recover for lost wages, and Florida Workers’ compensation law can be challenging and complex. Further, the benefits do not cover pain and suffering. Issues often arise when the WCI fails to cover the extent of the injury victim’s losses.

In most cases, Florida’s workers’ compensation program prohibits employees from filing a personal injury or wrongful death lawsuit against their employers. However, there are certain exceptions to the rule that apply. The exceptions include situations where:

Workers’ compensation claims are meant to provide financial compensation to Florida workers injured on the job without having to go to court. In general, workers are able to receive benefits more quickly and are able to receive benefits without having to prove that the employer was at fault for the accident. But it also limits the amount of compensation some workers may receive, as it is often the only way workers can receive compensation after a work injury—though there are some exceptions. Employers also may deny workers benefits that they are due. In a recent case before a Florida appeals court, the court reversed a Judge of Compensation Claims (JCC) decision, denying her mental health benefits after a work injury.

The claimant was working in a correctional facility when an inmate placed her in a chokehold, causing her neck and throat injuries. Two weeks later, she was determined to have reached the maximum medical improvement (MMI) for her physical injury and was determined not to have a permanent physical injury. She was also referred for psychiatric and psychological treatment. She was diagnosed with acute stress and post-traumatic stress disorder (PTSD) and continued receiving psychological and psychiatric treatment. However, six months after she reached physical MMI, the employer stopped paying indemnity benefits, causing her to file a claim for temporary benefits from that point on for her mental injury. The JCC found that temporary indemnity benefits for mental injuries are only available for six months after a claimant reaches physical MMI, and precluded her benefits beyond that point. The JCC held that section 440.093(3) precluded her from receiving the benefits because more than six months had passed since she had reached the maximum medical improvement (MMI) for her physical injury.

The Florida appeals court reversed the JCC’s decision. The court explained that the six-month limit for temporary benefits does apply in cases where the claimant reaches physical MMI and the six-month limit on temporary benefits commences from the time a claimant reaches physical MMI. However, the court held that according to Florida law, the six-month limit did not apply to the claimant because she had not received any permanent impairment benefits. The court explained that the statute only applies to claimants who are receiving impairment benefits. Therefore, the claimant was entitled to the benefits. Thus, the appeals court found the JCC committed an error and reversed the decision denying her benefits for her mental injury.

Florida’s Workers’ Compensation Law provides workers with benefits if they suffer injuries at work or while in the scope of their employment duties. At first glance, the system appears as a quick and efficient way for Florida employees to obtain benefits for their injuries and return to work. However, the system inherently favors employers because, barring certain exceptions, employees lose their right to bring a common-law personal injury lawsuit against their employer. Exceptions to this rule exist in certain situations, such as if the employer did not maintain appropriate worker’s compensation insurance. Further, an exception applies if the employee suffered injuries because of their employer’s particularly egregious wanton gross negligence or intentional conduct. Finally, workers’ compensation does not protect employers from assaults against their employees.

In many cases, workers’ compensation insurance does not adequately cover all of an employee’s injuries and damages. Although employees may not assert personal injury claims against their employer, they may recover damages from other responsible third-parties. To succeed on a third-party claim, plaintiffs must be able to prove that they had a work-related accident, the third-party owed them a duty of care, they breached that duty, and the plaintiff suffered injuries because of the work-related incident.

For example, a Florida news report recently described a tragic accident at a St. Petersburg Home Depot. A delivery driver suffered fatal injuries when construction materials fell on him at the store. The driver was working as a third-party carrier for a building material company. The U.S. Occupational Safety and Health Administration (OSHA), the federal entity that ensures safe and healthy working conditions, reported that the incident is under investigation. Additionally, Home Depot commented that they were working with authorities to investigate the accident.

Under Florida law, employers with four or more employees must purchase workers’ compensation insurance. Additionally, construction businesses must provide this insurance for every employee. This coverage is essential to both business owners and employees, because it covers various expenses related to workplace injuries. The insurance is designed to cover injuries that an employee suffered on-the-job. It typically covers medical expenses, recovery costs, missed wages, and funeral and burial costs. Employers may obtain private or state insurance or self-insure their employees. Employees do not share in the cost of the insurance premium. However, in exchange for the coverage, in most cases, the law prevents Florida employees from suing their employers to cover expenses from their workplace injuries.

Fault is not a consideration in workers’ compensation claims; however, employers must still keep their workplaces safe. In some situations, employers do not meet this burden, and as a result, their workers may suffer exposure to dangerous conditions. In many cases, workers’ compensation does not adequately cover the extent of the employee’s damages. For instance, although the insurance covers medical bills and lost wages, it does not compensate for pain and suffering. The bar on recovery can cause serious financial hardship to employees.

There are certain exceptions to workers’ compensation laws that may allow victims to recover additional damages. Employees may file a lawsuit against employers who did not carry workers’ compensation insurance or failed to process a claim in a timely manner. Further, employees may file lawsuits for workplace injuries against negligent third parties. For example, if an employee is driving a company vehicle for work and suffers injuries in a car accident, the employee may file a lawsuit against the negligent driver. Further, employees can file a lawsuit if an employer denies a workers’ compensation claim in bad faith.

Recently, Florida’s First District Court of Appeal issued an opinion addressing a claimant’s eligibility to temporary partial disability benefits after an expert medical advisor opined that he reached maximum medical improvement.

Under the Florida State Workers’ Compensation Program, employees who suffered injuries at their workplace or during the scope of their employment, have the right to recover costs associated with their medical expenses and lost wages. To collect benefits through the state’s workers’ compensation program, employees must report their injuries to their employer within 30 days of either the injury or when it was discovered to be related to work. Employees must provide as much information as possible, including details regarding the accident and the symptoms they are experiencing.

After reporting an injury, employers should contact their insurance company and send the employee to an occupational doctor of their choosing. The doctor will treat the patient until they reach “maximum medical improvement” (MMI). Under the statute, MMI is when a reasonable medical professional determines that an individual’s condition has reached a point where they should not expect any further recovery. A finding of MMI does not necessarily mean that an employee is fully recovered or that they are not experiencing functional limitations. Further, reaching MMI does not automatically terminate entitlement to treatment. However, reaching MMI is a critical point in the employee’s treatment, because once MMI is reached, an employee’s insurance carrier can reduce or terminate benefits. Issues arise because there are instances where doctors are under pressure to categorize patients as reaching MMI, even if that is not the case.

When someone is hurt in a Florida workplace accident, they can pursue a claim under the Florida Workers’ Compensation Act. If approved, a workers’ compensation claim provides an injured employee with medical treatment and ongoing compensation for the time they are unable to work. Doctors have a critical role in a workers’ compensation case because many of the determinations that dictate whether a claim is approved, the amount of benefits an injured worker receives, and the length of time that benefits will be paid are in a doctor’s hands.

Given the importance that the selected doctor plays in the claims process, one question that frequently arises in Florida workers’ compensation cases is whether an injured worker can request a change in doctors. The answer, as is often the case, is “it depends.” Generally speaking, an employer is able to select the treating physician except in cases of emergency medical care. However, there are several situations in which a worker can choose their own doctor. Both, however, require that an employer drop the ball when it comes to an employee’s request.

The first scenario involves a situation where an employee requests medical treatment, but an employer fails to provide treatment within a reasonable amount of time. In this case, an employee can seek out their own care, pay for it, and then ask to be reimbursed by their employer.

When someone is injured on the job, they can typically file a claim for compensation based on the injuries they sustained. There are two types of claims, Florida workers’ compensation claims and Florida personal injury claims. A workers’ compensation claim does not require an employee establish another party was at fault for their injuries. However, Florida workers’ compensation claims provide only for the recovery of medical expenses/disability benefits, meaning that an injured employee cannot recover for the pain and suffering the accident caused.

Alternatively, Florida personal injury cases allow accident victims to more fully recover for their injuries, including for non-economic losses. However, a plaintiff must be able to show that the defendant was negligent to recover these losses. In many Florida workplace accidents, the first question that arises is which type of claim should an injured employee pursue. In reality, it is less a question of “should” and more a question of “can.”

One way of thinking about this question is to consider who was at fault for the accident. In short, if an accident is caused by the negligence of the employer or the employee, an employee’s only remedy may be through a Florida workers’ compensation claim. This is because under Florida statutes section 440.11, while a qualifying employer is responsible for an employee’s injuries, a workers’ compensation claim is usually the injured employee’s “sole remedy.” This means that an employee whose injuries are the result of a covered accident may only be able to pursue a workers’ compensation claim. Section 440.11 extends this “sole remedy” provision to situations where an employee’s injuries are caused by a co-worker’s negligence.

Workers’ compensation cases do not necessarily end when a claimant receives a decision in the case. Employers that originally agreed to pay for treatment may try to stop paying for treatment at some point. In a recent case before a Florida appeals court, the court rejected an employer’s termination of benefits after paying for benefits for 15 years.

According to the court’s opinion, the claimant had worked in a building in Orlando from 1995 to 1997. Employees in the building experienced breathing problems, and after asbestos was discovered, employees were removed from all floors except the claimant’s floor. The claimant was not provided any protective gear and later developed breathing problems. The employer subsequently accepted compensability of the injury under the Workers’ Compensation Act, and accepted liability for the claimant’s illness due to air quality problems.

The employer paid for the claimant’s treatment, until 15 years later when the employer terminated treatment to the claimant. The employer argued that the work accident was no longer a major contributing cause of the need for medical treatment and that the treatment was not medically necessary. A workers’ compensation judge found the treatment was not medically necessary, and the claimant appealed.

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