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How Do I Qualify for Workers' Compensation?

November 25, 2020

The workers’ compensation system exists to provide medical and financial relief to employees who get hurt on the job or suffer occupational illnesses. Generally speaking, workers’ comp is a mostly no-fault system that allows any eligible worker to file a claim for compensation from their employer’s insurance provider.

When the system works as it should, workers’ compensation benefits can ensure that employees who get hurt at work have the resources they need to recover.

In some cases, though, your employer or their insurance carrier may try to claim that you are not eligible for benefits or attempt to deny reasonable coverage requests. If you were injured at work or acquired an occupational illness and face this kind of refusal, you know what a frustrating and worrying situation it can be. You may be left wondering how you’ll access the treatments you need and afford your bills while you’re unable to work.

The most important thing you can do under these circumstances is to seek immediate legal advice. 

An experienced workers’ compensation attorney can explain the laws and regulations that apply to your unique case and take the appropriate legal steps to seek the benefits you deserve. Since 1976, the attorneys of Rue & Ziffra have helped thousands of Florida injury victims recover hundreds of millions of dollars in compensation. Our firm is staffed with knowledgeable and compassionate attorneys who deliver effective results. Contact our team today for a free initial review of your workers’ comp claim by calling us or by reaching out online.

What Makes an Injured Person Eligible for Workers' Compensation Benefits?

Most Florida employers are required by law to carry workers’ compensation insurance, so the majority of employees are eligible for workers’ comp benefits. To be considered eligible for workers’ comp benefits in Florida, workers must meet the following requirements:

  • They must be legally classified as an employee.
  • Their employer carries workers’ comp insurance.
  • Their injury or illness is work-related.
  • They must file claims by relevant legal deadlines.
  • They must appear for related medical exams and treatments.

These eligibility conditions sound straightforward, but many legal exceptions and gray areas exist. Some workers are part of select categories that either don’t qualify for workers’ comp or are covered under different but similar programs. These workers may include:

  • Certain independent contractors (Note that simply being called an “independent contractor” doesn’t make you one under the law.)
  • Undocumented and seasonal employees
  • Domestic employees
  • Agricultural, railroad, maritime, and mining employees
  • Federal workers

Workers' Compensation Eligibility & Requirements

If your position entitled you to coverage under workers’ comp laws, there are still several eligibility requirements you must meet to receive benefits. With few exceptions, Florida workers who file workers’ compensation benefit claims must:

  • Report their injury or illness to their employer within 30 days of either their workplace injury incident or becoming aware of a workplace ailment
  • Ensure their employers report their workplace injury to their insurance carrier within seven days of receiving an initial report
  • File petitions for workers’ compensation benefits within two years
  • Receive authorization from their employer’s workers’ compensation insurance provider for the physician who treats their illness or injury
  • Agree to refrain from suing their employer if they accept workers’ comp benefits, in most cases

After an injury has been properly reported, most insurance carriers should issue benefits checks to eligible workers within three weeks. When a claim is denied, the carrier is required to alert the injured worker of its denial within 120 days of an initial provision of benefits. If this should happen to your claim, you can file a lawsuit against your employer’s insurance provider with the help of a workers’ compensation lawyer.

Are Independent Contractors Entitled to Workers' Comp?

In many cases, employees who are denied workers’ comp coverage have their claims rejected because they are misclassified as independent contractors. To meet the legal definition of an independent contractor in Florida, workers must meet at least four of the following conditions:

  • Maintain a separate business with their own facilities, vehicles, or equipment
  • Hold or have applied for a federal employer identification number (EIN)
  • Receive compensation under a business name for their services
  • Hold one or more bank accounts in the name of their business
  • Have the ability to work for any other entity with no official employment process
  • Receive compensation on a “competitive-bid” or contractual agreement basis

If four of the above criteria are not met, Florida workers can still be legally classified as independent contractors if they meet any of the following conditions:

  • They perform work services for specific monetary amounts and have control over their means of performing the work.
  • They incur the “principal expenses” related to their work services.
  • They are responsible for the satisfactory nature of the services they provide.
  • They receive compensation for work services exclusively on a commission or per-job basis.
  • They could potentially turn a profit or suffer losses due to their work.
  • They have consistent or recurring business responsibilities or obligations.
  • The success or failure of their business directly depends on their profits and business expenses.

Arguments Cited for Denying Workers' Compensation and How to Address Them

Some of the most common arguments an employer or insurance carrier may cite to deny you coverage include:

  • You are not an eligible employee under the law.
  • Your injury wasn’t work-related or didn’t occur at work.
  • You failed to notify your employer within 30 days.
  • You were intoxicated when your workplace injury occurred.
  • Your injury was the result of horseplay or roughhousing at work.
  • You did not receive treatment from an approved physician.
  • You refused to accept prescribed medical treatments.
  • You failed to file your claim paperwork before the deadline.
  • You became injured or sick due to a pre-existing condition.

No matter the reason, a Notice of Denial doesn’t necessarily mean the end of the road. A workers’ compensation lawyer can help you take several legal steps to address a denied claim. Usually, an attorney’s first step will be an attempt to obtain benefits from your employer’s insurance provider without the filing of a lawsuit.

If a benefit is not provided timely, a lawyer can assist you in filing a Petition for Benefits with the Office of the Judges of Compensation Claims (OJCC). Here, a judge will oversee formal mediation attempts or schedule a civil hearing. If you are denied the compensation you require after an OJCC hearing, your attorney can appeal the unfavorable decision before the First District Court of Appeals.

Types of Benefits Available From Workers' Comp in Florida

Florida workers’ comp benefits cover some, but not all, of the losses incurred by employees who become sick or hurt on the job. The types of benefits injured workers can claim in Florida are:

  • Medical benefits – Workers’ comp benefits pay for medical expenses related to the treatment of covered workplace injuries. As long as the worker treats with an authorized doctor, all related medical expenses, including associated travel costs, should be covered.

  • Temporary partial disability (TPD) – TPD benefits pay a portion of workers’ previous earnings if they suffer partial disabilities from on-the-job injuries. These benefits are available to employees who haven’t reached “maximum medical improvement” (MMI) but have been released to return to work by their doctors.

  • Temporary total disability (TTD) – TTD benefits cover workers who are rendered unable to work by their workplace injuries. These benefits are generally equal to two-thirds of your previous regular wages and may end after your doctor releases you to return to work, when you attain MMI, or once you receive the maximum allowable 260 weeks of temporary benefit payments.

  • Impairment benefits – Impairment benefits, or permanent total disability (PTD) benefits, pay employees for catastrophic workplace injuries that prevent them from doing any future work. PTD benefits can continue at the same rates as TTD benefits until recipients are old enough to draw Social Security. 

  • Death benefits – If a Florida employee is fatally injured by a workplace incident, their surviving spouse or dependents may be entitled to death benefits under workers’ comp laws. Generally, maximum compensation for death benefits is $150,000 to replace lost wages and $7,500 for funeral and burial costs.

  • Vocational rehabilitation – If a workplace injury or illness leaves an employee unable to return to their former job, Florida offers assistance to help them find new work. Placement services, vocational counseling, and training may all be covered under the law.

Contact Our Workers' Compensation Lawyers in Florida

If you were injured on the job, it’s crucial to pursue the full compensation amount you’re legally entitled to under Florida workers’ comp laws. The experienced workers’ compensation lawyers at Rue & Ziffra want to help.

Our firm works as a team to pursue the best possible results for workers’ compensation clients throughout north and central Florida. We offer free initial case reviews, and our clients never pay us unless we win compensation for them.

To learn more about the ways we can help your Florida workers’ comp claim, call us or fill out our online contact form now.

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Author

  • Attorney Darren Coleman has been practicing workers' compensation and personal injury law for over two decades. Originally from Virginia Beach, he received his Bachelor of Science degree from James Madison University in Harrisburg, Virginia. Mr. Coleman went on to Golden Gate University and received his law degree.

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