YOU HAVE BEEN INJURED ON THE JOB WHAT YOU NEED TO KNOW FOR INJURIES ON OR AFTER OCTOBER 1, 2003 7/1/2012 DFS Division of Workers' Compensation 1
DIVISION OF WORKERS’ COMPENSATION EMPLOYEE ASSISTANCE AND OMBUDSMAN OFFICE The Employee Assistance and Ombudsman Office (EAO) is available to assist you at no cost with questions or concerns you may have about your workers’ compensation claim. EAO advocates on your behalf to resolve issues with your Workers’ Compensation Claim. EAO offices are located around the state to assist you. Contact EAO toll free at 1-800-342-1741. Visit the web site: www.myfloridacfo.com/wc Or email EAO : wceao@myfloridacfo.com 7/1/2012 DFS Division of Workers' Compensation 2
THERE ARE COMMON CONCERNS THAT FACE ALL INJURED WORKERS What do I need to do? Will my medical care be covered? Will I be paid any monetary benefits when I am off work? If so, how much and how often? What suggestions can help me with my claim? 7/1/2012 DFS Division of Workers' Compensation 3
WHAT ARE YOUR RESPONSIBILITIES WHEN YOU ARE INJURED ON THE JOB? Tell your employer you have been injured as soon as possible, but you must advise your employer of the injury within 30 days after the date of your injury or the initial manifestation of your injury. Failure to advise within 30 days may result in the inability to claim benefits. (Applicable statute: 440.185(1). Click Here to read.) Except for emergency treatment, you must specifically request initial treatment or care, and the employer or insurance carrier must be given a reasonable time period within which to provide the initial treatment or care. (Applicable statute: 440.13(2)(c). Click Here to read.) Sign and return the “fraud statement” provided to you by the insurance carrier/adjuster. (Applicable statute: 440.105(7). Click Here to read.) Obtain a copy of your accident report or first notice of injury from your employer. Ask your insurance carrier/adjuster for your claim number. Discuss with the doctor if your condition is work related. 7/1/2012 DFS Division of Workers' Compensation 4
WHAT ARE YOUR EMPLOYER’S RESPONSIBILITIES WHEN YOU HAVE BEEN INJURED ON THE JOB? Your employer must report your injury to their workers’ compensation insurance company no later than 7 days after the employer’s knowledge of your injury. (Applicable statute: 440.185(1). Click Here to read.) If your employer will not report your injury, contact the Employee Assistance and Ombudsman Office at 1-800-342-1741 for assistance. Non- construction employers are required to have workers’ compensation insurance if they employ 4 or more employees. Construction employers are required to have workers’ compensation insurance if they employ 1 or more employees. (Applicable statute: 440.02(17)(b)2. Click Here to read.) Your employer must furnish you with medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or the process of recovery may require. (Applicable statute: 440.13(2)(a). Click Here to read.) If your employer fails to purchase workers’ compensation insurance and was required to do so by law, you may elect to bring suit against your employer to provide you with workers’ compensation benefits under Florida’s workers’ compensation law or to maintain an action at law for damages. (Applicable statute: 440.11(1)(a). Click Here to read.) 7/1/2012 DFS Division of Workers' Compensation 5
WHAT ARE THE INSURANCE CARRIER’S RESPONSIBILITIES WHEN YOU ARE INJURED ON THE JOB? The insurance carrier has the responsibility to: Adjust your claim without harassment, coercion, or intimidation. (Applicable statute: 440.525(2). Click Here to read.) Respond to requests for medical treatment by authorized health care providers within 3 business days after receipt of the request. (Applicable statute: 440.13(3)(d). Click Here to read.) Pay the first installment of compensation for total disability or death benefits or deny the claim within 14 days after the employer receives notification of the injury or death, when disability is immediate and continuous for 8 days or more after the injury. (Applicable statute: 440.20(2)(a). Click Here to read.) Pay, disallow, or deny all medical, dental, pharmacy and hospital bills properly submitted to the carrier within 45 calendar days after the carrier receives the bill. (Applicable statute: 440.20(2)(b). Click Here to read.) Report your claim to the Division of Workers’ Compensation within 14 days after the employer reports the injury to the carrier - for injuries that result in more than 7 consecutive days of lost work time. (Applicable statute: 440.185(2). Click Here to read.) 7/1/2012 DFS Division of Workers' Compensation 6
WHAT ARE THE INSURANCE CARRIER’S RESPONSIBILITIES WHEN YOU ARE INJURED ON THE JOB? CONTINUED The insurance carrier must send you: Within 3 days after the employer or employee informs the carrier of the work related injury, an employee brochure explaining your rights and benefits under workers’ compensation law. (Applicable statute: 440.185(4). Click Here to read.) Notice of services available to you from the State of Florida’s Employee Assistance and Ombudsman Office. (Applicable statute: 440.185(11). Click Here to read.) Within 5 days of knowledge of your release to restricted duty, an informational letter regarding return to work. The Monitoring and Audit Bureau of the Division of Workers’ Compensation is responsible for insuring that insurance carriers fulfill their statutory responsibilities under Chapter 440 of the Florida Statutes. 7/1/2012 DFS Division of Workers' Compensation 7
WHAT ARE YOUR AUTHORIZED TREATING PHYSICIAN’S RESPONSIBILITIES WHEN YOU HAVE BEEN INJURED ON THE JOB? After the initial examination and diagnosis, the physician must submit a proposed course of treatment to the insurance carrier to determine whether such treatment would be recognized as reasonably prudent. (Applicable statute: 440.13(2)(e). Click Here to read.) Your physician may provide you with a DWC 25, Florida Workers’ Compensation Uniform Medical Treatment/Status Reporting Form. This form will give you, your employer and your carrier information regarding your medical status, management and treatment plan, functional limitations and restriction, Maximum Medical Improvement and Permanent Impairment Rating, and follow up visits. 7/1/2012 DFS Division of Workers' Compensation 8
WHAT ARE YOUR BENEFITS UNDER FLORIDA’S WORKERS’ COMPENSATION SYSTEM? 7/1/2012 DFS Division of Workers' Compensation 9
MEDICAL BENEFITS Medically necessary treatment, care, and attendance for such period as the nature of the injury or the process of recovery may require, including medications, medical supplies, durable medical equipment, and prosthetics. Health care providers who provide services, other than emergency care, must be certified workers’ compensation health care providers and must receive authorization from the insurance carrier before providing treatment. (Applicable statute: 440.13(3)(a). Click Here to read.) Your work- related injury must be the “Major Contributing Cause” for medical treatment and must remain such to continue medical treatment. (Applicable statute: 440.09(1). Click Here to read). “Major Contributing Cause” means the cause which is more than 50% responsible for the injury as compared to all other causes combined for which treatment or benefits are sought. 7/1/2012 DFS Division of Workers' Compensation 10
MEDICAL BENEFITS CONTINUED You are also entitled to an Independent Medical Examination, which may be at your expense. The exception is if you are in a managed care arrangement. (Applicable statute: 440.13(5)(a). Click Here to read.) You are entitled to one change of physician during the course of treatment for any one accident. This one-time offering should be carefully considered. (Applicable statute: 440.13(2)(f). Click Here to read.) When your treating physician determines you have reached “Maximum Medical Improvement,” you will be required to pay a co -payment of $10 per visit for medical services. (Applicable statute: 440.13(14)(c). Click Here to read.) “Date of Maximum Medical Improvement” means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer be reasonably anticipated based upon reasonable medical probability. (Applicable statute: 440.02(10). Click Here to read.) 7/1/2012 DFS Division of Workers' Compensation 11
MEDICAL BENEFITS CONTINUED Payment of any indemnity benefit or the furnishing of remedial treatment, care, or attendance pursuant to either a notice of injury or a petition for benefits tolls the statute of limitations period on your workers’ compensation claim for 1 year from the date of such payment. This tolling period does not apply to the issues of compensability, date of maximum medical improvement, or permanent impairment. (Applicable statute: 440.19(2). Click Here to read.) 7/1/2012 DFS Division of Workers' Compensation 12
WHAT TYPES OF MONETARY BENEFITS ARE AVAILABLE ? Workers’ Compensation monetary benefits may be paid both prior to and after you have obtained Maximum Medical Improvement (Applicable statute: 440.15(3). Click Here to read.) 7/1/2012 DFS Division of Workers' Compensation 13
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