Workers’ Compensation Insurance

What is workers’ compensation insurance?

Workers’ compensation insurance is a mandatory coverage for employers in Florida that provides financial benefits and medical care to employees who suffer work-related injuries or illnesses. It ensures injured workers receive necessary medical treatment and wage replacement while protecting employers from lawsuits.

For instance, a construction worker who falls from a scaffolding and breaks their leg would receive workers’ compensation benefits to cover medical expenses and a portion of their lost wages during recovery. Similarly, an office worker who develops carpal tunnel syndrome due to repetitive motions may also qualify for workers’ compensation benefits to help with medical costs and wage replacement.

Need help with a matter related to workers’ compensation insurance? Schedule your consultation today with a top insurance attorney.

In Florida, which laws and regulations relate to workers’ compensation insurance?

In Florida, workers’ compensation insurance is governed primarily by the Florida Workers’ Compensation Law (Chapter 440 of Florida Statutes) and the rules and regulations set forth by the Florida Department of Financial Services, Division of Workers’ Compensation. These laws and regulations outline the rights and responsibilities of employers and employees, set the benefit amounts, and establish the procedures for filing claims and resolving disputes.

Critical aspects of the Florida Workers’ Compensation Law include:

• Employer Requirements: Employers with four or more employees (including part-time employees) must carry workers’ compensation insurance. For the construction industry, the requirement applies to employers with one or more employees.
• Employee Benefits: Injured workers are entitled to medical benefits, indemnity (wage replacement) benefits, and, in some cases, permanent impairment benefits.
• Reporting and Claim Process: Employers must report work-related injuries or illnesses to their insurance carrier within seven days of being notified, and injured workers must file a claim within two years of the injury or illness.

By adhering to the Florida Workers’ Compensation Law and related regulations, employers can ensure they comply with their legal obligations, while employees can access the benefits they need for recovery and financial support during difficult times.

What are common disputes regarding workers’ compensation insurance that lead to litigation?

The following disputes are among the most common in actions regarding workers’ compensation insurance in insurance procurement and coverage matters:

• Disagreements Over Compensability: Disputes may arise when an insurance carrier denies a claim, asserting that the injury or illness is not work-related or that the worker’s actions violated policy guidelines.
• Disputes Over Benefit Amounts: In some cases, the worker and the insurance carrier may disagree on the amount of compensation the worker is entitled to based on factors such as average weekly wage calculations or the degree of disability.
• Medical Treatment Disputes: There may be disagreements over the necessity or appropriateness of specific medical treatments, often involving pre-authorization issues or the selection of healthcare providers.
• Return-To-Work Disputes: Conflicts can occur when the worker’s ability to return to work is questioned, particularly when dealing with partial disability and potential job modifications or accommodations.

We are value-based attorneys at Jimerson Birr, which means we look at each action with our clients from the point of view of costs and benefits while reducing liability. Then, based on our client’s objectives, we chart a path to seek appropriate remedies.

To determine whether your unique situation may necessitate litigation, please contact our office to set up your initial consultation.

What measures should an insurance carrier take to minimize the risk of litigation over workers’ compensation insurance? 

To successfully mitigate the risk of litigation over workers’ compensation insurance in insurance procurement and coverage matters, insurance carriers should follow these steps:

• Thorough Claim Investigation: Ensure all claims are investigated thoroughly and promptly, gathering comprehensive information about the incident, injury, and any relevant pre-existing conditions.
• Clear Communication: Maintain open lines of communication with the injured worker and the employer, providing updates on the claim status and addressing any concerns that may arise.
• Compliance with Regulations: Stay current with Florida and federal laws, statutes, codes, regulations, and secondary sources, ensuring that all claims are processed in compliance with the applicable rules.
• Utilize Independent Medical Examinations: When disputes over medical treatment arise, consider using independent medical examinations to obtain an unbiased assessment of the injured worker’s condition and appropriate treatment.

By following these steps, insurance carriers can better manage workers’ compensation claims, reduce the risk of litigation, and maintain a more positive relationship with employers and injured workers.

What must be proven to file a lawsuit regarding workers’ compensation insurance successfully, and what are common legal defenses to those claims? 

After satisfying administrative prerequisites, a claimant seeking to take legal action concerning their workers’ compensation benefits must generally establish the following facts at a minimum:

• Employment: Establish that the defendant employed them during the injury.
• Injury: Prove that they sustained a work-related injury or illness.
• Causation: Demonstrate that the injury or illness directly resulted from their employment or workplace conditions.
• Damages: The plaintiff has to provide evidence of the damages they have suffered due to the injury or illness, such as medical expenses, lost wages, and pain and suffering.

Defendants may raise the following legal defenses against workers’ compensation insurance claims:

• No Employer-Employee Relationship: The defendant may argue that the plaintiff was not an employee but an independent contractor and, therefore, not eligible for workers’ compensation benefits.
• No Causation: The defendant can claim that the injury or illness was not caused by the plaintiff’s work or workplace conditions.
• Failure to Follow Proper Procedure: The defendant may assert that the plaintiff failed to follow the required procedural steps when filing their claim, such as providing proper notice or filing the appropriate claim forms.
• Intentional Self-Inflicted Injury: The defendant can argue that the plaintiff intentionally caused their injury and thus should not be eligible for workers’ compensation benefits.
• Intoxication or Drug Use: The defendant may claim that the plaintiff’s injury or illness resulted from their intoxication or drug use, making them ineligible for workers’ compensation benefits.

To see what actions or defenses may be available for your unique situation, please contact our office to set up your initial consultation.

Frequently Asked Questions

What types of injuries or illnesses are covered by workers’ compensation insurance?

Workers’ compensation insurance generally covers injuries or illnesses arising out of and during employment. This can include traumatic injuries, occupational diseases, and repetitive stress injuries.

Can employees receive workers’ compensation benefits if they were partially at fault for their injury or illness?

In most cases, workers’ compensation is a no-fault system, meaning that an employee can receive benefits even if they were partially at fault for their injury or illness, as long as the injury or illness is work-related.

What benefits can an employee receive under workers’ compensation insurance?

Workers’ compensation insurance typically provides benefits for medical expenses, wage replacement, vocational rehabilitation, and death benefits for the employee’s dependents in the case of a work-related fatality.

Have more questions about a workers’ compensation insurance-related situation?

Crucially, this overview of workers’ compensation insurance does not begin to cover all the laws implicated by this issue or the factors that may compel the application of such laws. Every case is unique, and the laws can produce different outcomes depending on the individual circumstances.

Jimerson Birr attorneys guide our clients to help make informed decisions while ensuring their rights are respected and protected. Our lawyers are highly trained and experienced in the nuances of the law, so they can accurately interpret statutes and case law and holistically prepare individuals or companies for their legal endeavors. Through this intense personal investment and advocacy, our lawyers will help resolve the issue’s complicated legal problems efficiently and effectively.

Having a Jimerson Birr attorney on your side means securing a team of seasoned, multi-dimensional, cross-functional legal professionals. Whether it is a transaction, an operational issue, a regulatory challenge, or a contested legal predicament that may require court intervention, we remain a tireless advocate every step of the way. Being a value-added law firm means putting the client at the forefront of everything we do. We use our experience to help our clients navigate even the most complex problems and come out the other side triumphant.

If you want to understand your case, the merits of your claim or defense, potential monetary awards, or the amount of exposure you face, you should speak with a qualified Jimerson Birr lawyer. Our experienced team of attorneys is here to help. Call Jimerson Birr at (904) 389-0050 or use the contact form to set up a consultation.

Here are some blogs written by JB attorneys that provide more information about workers compensation insurance:

• Workers’ Compensation Requirements For The Construction Industry (jimersonfirm.com)