THE DIVISION OF WORKERS’
COMPENSATIONPresents
AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM
Chapter 440Florida Statutes
Lloyd Harger(850) 413-1856
E-mail: [email protected]
November 2005
WHAT IS WORKERS’ COMPENSATION?
State-administered Insurance Program That Benefits Employers and Injured Employees
The Injured Employee Receives Medical Treatment and Wage Replacement Benefits.
Exclusive Remedy: a Work-related Accident Is Compensated Through the Workers’ Compensation System Not Through the Tort System.
The Employer Pays a Premium Based on Its Payroll, Class Code, Rate, and Individual Experience.
SELF-EXECUTING
TimelyBenefits
Accident
Return toWork
May 23, 1935May 23, 1935
EMPLOYER MUST HAVE COVERAGE IF...
1. Employer Has Four (4) Or More Employees (Full or Part Time)2. One (1) or More If Employer Is in the Construction Field3. Corporate Officers4. Sole Proprietor Or Partnership5. Agriculture Industry Over Five (5) Regular, Twelve (12) or More Seasonal
BUREAU OF
COMPLIANCE
Phone (850) 413-1609
EMPLOYER MAY OBTAIN COVERAGE BY...Purchasing a Standard
Policy on the Open MarketIndividual Self- InsuranceGroup Self- Insurance FundJoint Underwriters
Association
EXCLUSIVE REMEDYs. 440.11 F.S.
•Protects EmployeeProtects EmployeeMedical TreatmentMedical TreatmentPortion of Lost WagesPortion of Lost Wages
•Protects EmployerProtects EmployerCivil LawsuitCivil Lawsuit
•Third Party ActionsThird Party Actions
•SubrogationSubrogation
VOLUNTEERSs.440.02(15)(d)6. and s.440.02(17)(b)3.,F.S.
Are NOT Employees Except…
Volunteers for a State, County, Municipality or Other Governmental Entity
Volunteer Firefighters
ACRONYMS(THE LANGUAGE OF THE SYSTEM)
TTD--Temporary Total DisabilityTPD--Temporary PartialPIR--Permanent Impairment RatingAWW--Average Weekly WageMMI--Maximum Medical ImprovementIME--Independent Medical EvaluationEMA--Expert Medical AdvisorPT--Permanent Total
SDTF--Special Disability Trust FundE/C--Employer/CarrierJCC--Judge of Compensation ClaimsUR--Utilization ReviewIIBs-Impairment Income BenefitsSIBs--Supplemental Income BenefitsHCP--Health Care ProviderER--EmployerEE-EmployeeCR--CarrierMCC--Managed Care Coordinator
MCA--Managed Care ArrangementEAO--Employee Assistance OfficeTPA--Third Party AdministratorOJT--on the Job TrainingT&E--Training and Education1St DCA--First District Court of AppealDFWP--Drug Free Workplace ProgramDFS--Department of Financial ServicesAHCA--Agency for Health Care AdministrationFIRG--Florida Impairment Rating Guide
POSSIBLE WAYS TO POSSIBLE WAYS TO REDUCE ACCIDENTS AND REDUCE ACCIDENTS AND
COSTSCOSTS1. DRUG FREE WORKPLACE PROGRAM
2. AN EFFECTIVE SAFETY PROGRAM
3. REEMPLOYMENT PLAN
EMPLOYER MAY HAVE A DRUG FREE WORKPLACE PROGRAM
5% Premium CreditAgency for Health Care AdministrationCustomer Service Office
(850) 413-1601Laboratories, Collection Sites, M.R.O.’S
s. 440.101, 440.102 F.S.
REEMPLOYMENT AND RETURN TO WORK
1. Reemployment Plan
2. Light, Limited, Modified, And Transitional Duty 3. Obligation to Rehire4. Division Sponsored Training and Education5. The Bottom Line: Return To Work
Phone (850)245-3470
EMPLOYER SHOULD MAINTAIN OPEN COMMUNICATIONS
WITH...Injured EmployeeHealth Care ProviderInsurance Carrier or Service CompanyOther Employees
Why? Avoid Possible Litigation Through Communications
THE EMPLOYEE MUST…
Report The Accident As Soon As It Happens And No Later Than
Thirty (30) Days. Failure to Do So May Result in Claim Being Denied…
Two (2) Years to File Petition for Benefits
s.440.185, (1), F.S.
BENEFITS PROVIDED BY LAW
Indemnity (Lost Wages)Employer Must Provide Necessary
Remedial Medical Care and Treatment Possible Screening, Job Placement
Assistance, Education & Retraining
WHEN AN ACCIDENT OCCURS THE EMPLOYER MUST...
Timely Complete and File All Forms
Call in (File) First Report of Injury or Illness (DWC-1)
Send to Carrier Within 7 Days of Knowledge (Except First-Aid Cases)
Send Both “Division” and “Carrier” Copy to Carrier
AVOID FINESAVOID FINESAND AND
PENALTIESPENALTIES
AND…1. Report Death Cases by Telephone,
Telegram, or Fax to the Division Phone (800) 219-8953
Within 24 Hours of Employer’sKnowledge of Death
2. Give Employee His/Her Copy of the DWC-1
TYPES OF ACCIDENTS
1. First Aid *
2. Medical Only
3. Lost Time
* Must Be Recorded on Form DWC-1 or an Alternate Division Approved Form, but Not Reported to Carrier
DWC-1
CONCURRENT CONCURRENT EMPLOYMENTEMPLOYMENT
(Working Two or More Jobs)(Working Two or More Jobs)
The Employee is The Employee is Responsible Responsible to Report Anyto Report AnyConcurrent EmploymentConcurrent Employment
If a Covered Employer, Must Add theIf a Covered Employer, Must Add theWages Into the AWW CalculationWages Into the AWW Calculation
s.440.02(28), F.S.
INJURY DEFINEDPersonal Injury or Death by Accident
Arising Out of and in the Course and Scope of Employment, and Such Diseases or Infection As Naturally or Unavoidably Result From Such Injury.
Dentures, Eyeglasses, Orthotics, Prosthetics Included, If Damaged in Conjunction With Accident.
NOT AN INJURYMental or Nervous Condition Caused
Only by Stress, Fear or ExcitementDisability by Acceleration or
Aggravation of Venereal Disease or Substance Abuse
Phobias Based on Ethnicity, Gender, Age or Handicap
EMPLOYEE’S RESPONSIBILITIES REGARDING
MEDICAL CARE 1. The Employee Must Request Medical Care and Treatment From Employer
2. The Employee Cannot Seek Treatment on His/Her Own Unless Employer Refuses or Ignores Request
3. Keep All Medical Appointments and Follow Instructions of Authorized Physician
AMOUNT & DURATION PAID TO THE INJURED EMPLOYEE?
Medical Documentation Determines Disability (Indemnity) Type
7 Day Waiting PeriodPaid 66 2/3% of Average Weekly Wage (AWW)AWW Calculated on 13 Weeks Prior to Accident (Excluding Week in Which Injury
Occurred), Similar Employee, or Contract of Hire.
INDEMNITY BENEFIT TYPES
Temporary Total Temporary Total at 80% Temporary Total
Rehabilitation Temporary Partial Impairment Income Benefits
Permanent Total Death Benefits ($7,500.00
Funeral)
104 Weeks Maximum for “Temporary Benefits”(including Temporary Total Rehab)
SETTLEMENTS s.440.20(11),(a),(b),( c),F.S.
Are Not Automatic or MandatoryUnder the Law
However…
SPECIAL SITUATIONS1. Driving To and From Work2. Horseplay/Fighting3. Breaks and Lunch4. Company Parties/Picnics5. Police Officers, Firefighters/Paramedics6. Traveling Employees7. Deviation from Employment8. Aliens
WHAT IF SELF-EXECUTION BREAKS DOWN?!
DisagreementsDisputesEarly
Intervention Program
Employee AssistanceOffice
Mediation
Hearing
INFORMAL DISPUTE RESOLUTION & FORMAL LITIGATION
Employee Assistance Office Phone (800) 342-1741
Mediators (Mandatory, Use State or Private Mediators)
Judges of Compensation Claims
1st District Court of Appeal
POP QUIZ (TRUE OR FALSE)
1. A Former Employee Comes to You and Says He/She was Injured 10 Years Ago. Employee Did Not Report it in the
Required 30 Days. Tell Them to Go Away.
2. Your Employee is on His/Her Way to Work, Stops and Picks Up Printing for You and is Injured in an Auto Accident on Way to Office. Employee is not Covered Because He/She is Not On the Clock.
3. You Must Report Medical Only and Lost Time Cases to Your Carrier but Not First Aid Cases.
4. MMI is an Acronym for More Money Invested.
5. You Have Four (4) People Working for You and are Required to Have Workers’ Compensation Coverage.
6. Two (2) of Those Employees are Part Time So You Don’t Have to Have Coverage.
7. As Long As You Have Coverage, You Can Never be Sued in Circuit Court.
POP QUIZ (TRUE OR FALSE) cont..
POP QUIZTRUE OR FALSE (Cont…)
8. Because it is so Common, Stress is Automatically Covered Under Workers’ Compensation in Florida
9. Temporary Indemnity Benefits are Limited to 104 Weeks Except for Rehab – Retraining Temporary Total.
10. Upon the Death of an Employee, the Total Amount Payable for Funeral Expenses is $10,000.
11. An Employer Must Report the Employee’s Injury to the Insurance Carrier within 45 Days
12. Injured Workers Receive Compensation of 66 2/3% of Their Take Home Pay the Week of Injury
QUESTIONS?