Most people believe when they are injured at work, that the Employer is the party responsible for providing worker’s compensation benefits. While this is partially true, the main party that is providing workers’ compensation benefits to you as the injured worker is a workers’ compensation insurance carrier. If you have been hurt at work and are not satisfied with the way the insurance company is handling your claim, you may be looking to hire an attorney. While the attorneys at Rue & Ziffra are here to help, there are some things that the Florida law prohibits and disallows for pursuit of compensation.
Florida Statute 624.155 provides people the right to sue insurance companies for mishandling claims and causing financial damages. However, workers’ compensation insurance carriers are exempt from these provisions due to Florida Statute 440.11(4).
This statute provides the following: “Notwithstanding the provisions of section 624,155, the liability of a carrier to an employee or to anyone entitled to bring suit in the name of the employee shall be as provided in this chapter, which shall be exclusive and in place of all other liability.”
This means that injured workers are only limited to the provision of Chapter 440 of the Florida Statutes, including remedies when dealing with the workers’ compensation insurers. In most cases, these are suitable, but there is one single exception to the Chapter 440 remedies.
In the case of Aguilera v. Inservices, Inc., 905 So. 2d 84 (Fla. 2005), the Florida Supreme Court stated that employees can present independent civil tort claims against insurance carrier for conduct Intentionally causing harm.
Well, what is considered intentional to qualify for this type of remedy? The Court distinguished between gross misconduct and simple procedural delays or even routine bad faith in the handing of a workers’ compensation claim.
The Court explained the following: “With regard to the liability of a worker’s compensation insurance carrier, section 440.11(4) provided that ‘[n]otwithstanding the provisions of s[ection] 624.155, the liability of a carrier to an employee or to anyone entitled to bring suit in the name of the employee shall be as provided in this chapter, which shall be exclusive and in place of all other liability.’ Essentially, the system is designed for employers and insurance carriers to assume responsibility for limited amounts of medical and wage loss benefits resulting from workplace injuries without regard to fault in exchange for limitations on their liability, while the employee would correspondingly receive quick and efficient delivery of limited wage loss compensation and medical benefits. The workers’ compensation system was never designed nor was it intended to act as a shield for those engaged in intentional conduct inflicting injuries upon workers through the benefit process itself.”
Overcoming the civil immunity provision of section 440.11(4) is nearly impossible. Only demonstration of truly gross, intentional conduct can overcome them. The Aguilera case show the type of facts that would be necessary in a claim to bring a civil tort action arising from a workers’ compensation claim. The Carrier in this claim took concerted effort to deny benefits, block the injured worker from receiving emergency medication, and blocked testing of an emergency nature, and refused to authorize emergency surgery. The adjuster showed up secretly for an independent medical examination of the claimant and then urged the claimant to lie to his attorney and to deceive his counsel that the adjuster was not present at the examination. The surgery was finally authorized 10 months after his diagnosis was deemed an emergency.
The Aguilera decision was a big blow the insurance carriers and forced an immediate overhaul in claims handling to avoid this type of conduct in the future and better service injured workers. Although some levels of abuse still persist throughout the industry, gross misconduct of this nature has largely been eliminated. At this point, bringing an Aguilera claim is almost non-existent, as the fact have to be so egregious and the resulting damages have to be substantial and permanent in nature. Only a few claims have been brought forward and survived since the Aguilera claims.
Most people that are injured on a job outside of the state of Florida would not think that they would be eligible for Florida workers’ compensation benefits and may attempt to apply for workers’ compensation benefits in the state they were injured. While in some situations, that would be the proper way to address the injuries, section 440.09(1)(d) of the Florida Statute states that an employee injured outside of Florida may still be entitled to Florida workers’ compensation benefits in certain conditions are met.
“If an accident happens while the employee is employed elsewhere than in this state, which would entitle the employee or his or her dependents to compensation if it had happened in this state, the employee or his or her dependents are entitled to compensation if the contract of employment was made in this state, or the employment was principally localized in this state. However, if an employee receives compensation or damages under the laws of any other state, the total compensation for the injury may not be greater than is provided in this chapter.”
The key conditions to be met are (1) the contract of employment was made in Florida or (2) the employment was primarily localized to Florida.
Determining where an employment contract was made is based on (1) the authority of the person involved in hiring negotiations and (2) the place where the employment conditions are performed. Even if the majority of the claimant’s work is outside of the state of Florida, if the last act necessary to finalize an employment contract occurs in Florida, that may be enough to entitle an injured worker to Florida workers’ compensation benefits. The prime example is when an employee and employer interview outside of the state, but the final approval and execution of employment agreement occur in Florida.
In assessing the principal location of employment, section 440.09(1)(d) states that the principle location of the employees work, not the employer’s business, is the determining factor for jurisdiction purposes. Essentially what this means is that if the majority of the time spent working is in the state of Florida, the injured worker likely is eligible for Florida Workers’ Compensation benefits, despite the injured worker’s state of residence. We assess things like supervision, payroll, and work assignments in Florida to confirm principal localization.
Determining Florida workers’ compensation eligibility for out-of-state injuries requires analysis of the employment contract and the principal location of employment. Since these type of cases are above the norm, an injured would likely face resistance from a workers’ compensation carrier in acceptance of a claim under Florida’s jurisdiction. When faced with jurisdictional issues, consulting with one of Rue & Ziffra’s workers’ compensation attorneys is advisable to determine next steps and assistance with obtaining Florida workers’ compensation benefits when due and owing.
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