Frequently Asked Questions for Injured Workers

Is the insurance company allowed to pick my doctors? Can I have any say on which doctor to see?

Answer Unfortunately, the insurance carrier controls the doctor that you see. Only an “authorized” medical provider is allowed to give an opinion in a workers’ compensation case. You are entitled to a “one time change” if you are dissatisfied with your medical care. That is a choice that must be very carefully considered because the insurance carrier gets to pick the new doctor as well. A better idea is to obtain an independent medical expert (IME). Although that doctor is only allowed to give an opinion on the care you need to receive and cannot take over your care, YOU get to pick the doctor. You should consult with an expert Florida workers’ compensation attorney as to the choice of your IME doctor.

I have been assigned an impairment rating. How was this calculated? What are impairment benefits?

Answer Once your authorized treating physician has given an opinion that you have reached “Maximum Medical Improvement” (MMI) that doctor should consult the Florida Impairment Guides to determine what your impairment rating should be. Once you reach MMI, your bi-weekly temporary benefits come to an end unless you are found to be permanently and totally disabled. At that point, you should receive permanent impairment benefits for a length of time depended on your impairment rating. For impairment ratings of less than 10%, you will receive 2 week of impairment ratings for every percentage point of your impairment rating. For Example, for a 7% rating you would receive 14 additional weeks of benefits at 75% of your compensation rate. You should consult with an expert Florida workers’ compensation attorney to determine if your impairment rating and permanent impairment benefits have been correctly calculated.

How did the insurance company figure out the amount of my benefits?

Answer The insurance carrier is supposed to contact your employer and obtain a complete record of your gross wages for the 13 weeks prior to your accident. By dividing by 13, they should determine your average weekly wage (AWW). Your compensation rate (CR) is 66 2/3% of your AWW. If you did not work for the majority of the 13 weeks before your accident, the insurance carrier will use a “similar employee” to determine your AWW. A similar employee is an employee of the same company who was doing the same job for the same rate of pay as you were earning. If such a person does not exist, the “contract of hire” will be used. You should consult an expert Florida workers’ compensation attorney to make sure the insurance carrier has correctly calculated your AWW and CR.

Are my medical benefits available for the rest of my life?

Answer Your medical benefits are available for the rest of your life as long as you do not let 1 year go by without seeing your authorized treating physician and the doctor continues to state that the “major contributing cause” of the need for the medical care remains the work accident. A new accident or injury after your work accident can break the chain of causation and get the insurance company off the hook for future medical care. If you are being denied medical care you should contact an expert Florida workers’ compensation attorney.

Is the insurance company required to pay my mileage to the doctor? What about mileage to therapy or the pharmacy?

Answer Absolutely. You are entitled to mileage for trips to the doctor, therapy, the pharmacy or any other medical appointment. You should use a program such as “MapQuest” to determine your exact mileage to the doctor, therapy or pharmacy. Be careful! You can be prosecuted for fraud for filing for exaggerated mileage. Contact our office to obtain the proper form to submit a mileage claim.

My employer is threatening to fire me. Can they do that?

Answer Absolutely. It depends. An employer cannot fire or retaliate against an injured worker for filing a workers’ compensation claim. Florida Statute 440.205 prohibits this. An employer can, however, terminate an employee if their injuries prevent them from doing the job they were hired to perform. There is no legal obligation to provide “light duty” work. If an employer fires you and you are not yet at MMI, you are entitled to temporary workers’ compensation benefits. If you feel you have been unfairly retaliated against by your employer for filing a workers’ compensation claim, you should contact an expert workers’ compensation attorney.

Can I apply for Social Security Disability? What effect will that have on my case?

Answer You absolutely can apply for Social Security Disability benefits. Bear in mind, however, that Social Security Disability benefits are very difficult to get unless your injury prevents you from doing any kind of work and that inability to work will last for at least 12 months. If you successfully obtain Social Security Disability benefits it is a good indication that you may qualify for Permanent Total Disability Benefits (PTD) in your workers’ compensation case. If you have sustained an injury that makes you eligible for Social Security benefits, you should definitely contact an expert Florida workers’ compensation attorney.

Am I allowed to collect unemployment benefits while I am out of work?

Answer Yes, but, any money you get from unemployment will be offset against your workers’ compensation benefits. In addition, unemployment requires that you be looking for work and be ready willing and able to accept employment. That can be problematic and can hurt your case if your workers’ compensation doctor has you completely off work. If your authorized treating physician has released you to return to work, you should always contact your employer first to see if they have work within your work restrictions. Contact an expert Florida workers’ compensation attorney before you apply for unemployment benefits to discuss whether it will hurt your case.

My doctor says they cannot do anything else for me. Must I accept that opinion?

Answer Absolutely not! This is the appropriate time to utilize your one time change or independent medical expert (IME). Note, just because the doctor says he or she cannot do anything else for you does not mean you should stop scheduling appointments. If you let a year go by without seeing an authorized treating physician, your future medical benefits will end. Do not let that happen! Contact an expert Florida workers’ compensation attorney.

: I had a second job when I got hurt, but my workers’ compensation benefits only include the wages from one job. Is that right?

Answer No, it is not right. You have the burden of notifying the insurance company of the contact information for the second employer. After that, the insurance carrier has the obligation of contacting that employer and getting your payroll records. Your wages for that 2nd job will be included in your 13 week wages in order. If you think your workers’ compensation benefits are not correct, contact an expert Florida workers’ compensation attorney.

Can I get a “second opinion” on my case?

Answer True medical second opinions are not available in the Florida workers’ compensation system. The best way to get a true second opinion is to obtain an independent medical opinion (IME). There are significant benefits to following this procedure. The most important is that YOU get to pick the IME Physician. The unfortunate thing is that you must also pay for the IME. IME doctors charge between $1,500.00 and $2,500.00 for an IME. It is possible, in most cases, to obtain an advance of up to $2,000.00 to pay for the IME. You should never attempt to obtain an IME without first consulting with an expert Florida workers’ compensation attorney.

My doctor says I have reached MMI. What does that mean?

Answer Maximum medical improvement (MMI) means that you have reached that point in your treatment where you are not going to get any better. Note that this does not mean you are better. You may reach MMI with significant physical limitations. You must reach MMI from all of your injuries. For example, if you have a shoulder and back injury from your accident, you must reach MMI from both injuries before you are at true MMI. Once you reach MMI, your workers’ compensation benefits will end with the exception of permanent impairment benefits and medical benefits. Another exception is permanent total disability benefits (PTD). If it is determined that your injuries prevent you from returning to any kind of employment, you may be eligible for PTD benefits until age 75 (or 5 more years if you are over 75 years old at the time of you are determined PTD.) PTD cases are very complicated and PTD cases are very hard to win. You should consult with an expert Florida workers’ compensation attorney if you believe you are permanently and totally disabled.

Can I get a $2,000.00 advance on my benefits?

Answer In many cases it is possible to obtain a $2,000.00 advance on your benefits. In order to obtain an advance, you must fill out a financial affidavit and file the appropriate motion with the Judge of Compensation Claims (JCC). Although financial troubles such as an inability to pay your rent, can serve as a basis to obtain an advance, you should use your advance with care as it may be necessary to use an advance for an IME (See Above). It is difficult to obtain more than one advance on a case.

Florida Workers’ Advocates (FWA) is an organization of civil justice attorneys representing injured workers in Florida.

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