How Does Workers Comp Work in Florida?

Just like in any other state, you can claim workers’ compensation benefits if you got hurt at work in Florida.  Provided, however, that you meet the other requirements set by the state. The amount will depend on your injury and how long your recovery period will be.

So how does workers comp work in Florida? Here’s a quick guide to workers compensation benefits in the sunshine state.

Who Are Eligible for Workers Comp Benefits in Florida?

In theory, you should be able to get workers’ comp benefits if you got injured at work. But unlike most states, Florida doesn’t offer state-funded workers’ comp insurance. Instead, businesses have to secure a policy from commercial or private insurers. If you don’t have workers comp coverage, you won’t be eligible for workers comp benefits.

Florida’s workers’ comp laws require certain businesses to provide workers compensation insurance for their employees. This includes:

  • Businesses in the construction industry with one or more employees. This includes the owners of the business who are corporate officers of limited liability company (LLC) members
  • Businesses in the non-construction industry with four or more employees. This includes the owners of the business who are corporate officers or LLC members.
  • Businesses in the agricultural industry with 6 regular employees and/or 12 seasonal workers. They must have worked more than 30 days during a season but no more than 45 days in a calendar year.

If your employer doesn’t provide workers’ compensation insurance when they should have, you can report them to the state’s Division of Workers’ Compensation.

However, an officer of a corporation or a member of a limited liability company may apply for workers comp exemption if they wish to be excluded in the company’s workers comp coverage.

How to Apply for Workers Comp Benefits in Florida

Applying for workers comp benefits in Florida starts with informing your employer about your injury. They will then report it to the insurance company who will, in turn, evaluate your claim.

The state’s workers comp laws state that you need to report your injury to your employer within 30 days. Your employer must also report it to your insurance provider within 7 days after they’ve known about your injury. Failure to do so will give them a reason to deny your benefits.

If your employer refuses to report your injury, you can also report it directly to your insurance provider. Should you need some help, you may contact Florida’s Employee Assistance Office (EAO) at (800) 342-1741.

Aside from reporting your injury, you also need to include evidence to prove your claim. This can include:

  • medical records
  • accident reports
  • employment records
  • witness statements
  • videos and pictures of your injuries and the scene of the accident
  • proof of prior injuries to show that your workplace isn’t safe

Your insurance company will evaluate your claim based on the evidence you submitted. If there’s doubt about the authenticity of your injury, they may require more evidence or conduct their own investigation. Based on their evaluation, they can either approve or deny your claim.

What to Do If Your Claim is Denied

If your claim is approved, you can expect your workers comp check within a few days. But if your insurance provider denies your claim, you’ll usually have to go through a lengthy appeals process to get your benefits.

The first step to appealing a denied workers comp claim in Florida is to talk to your insurance adjuster. Maybe they just need more solid evidence to back up your claim. Or they haven’t realized the true extent of your injuries. If this doesn’t work, you can file a Petition for Benefits at the Office of the Judges of Compensation Claims (OJCC).

Once your petition is lodged with the OJCC, a mediation will then be scheduled. This is where you and your employer or insurance provider will attempt to reach a settlement agreement with the help of a state-assigned mediator. When a settlement still isn’t reached at this point, that’s when your claim will be taken to court.

But before the formal court proceedings, a pretrial will be scheduled to iron out some administrative details. A formal court hearing then follows where you will have to defend your claim in front of the administrative law judge. Depending on the evidence presented, the judge may approve or deny your claim.

If your claim gets denied again, you have 30 days to appeal the judge’s decision to the First District Court of Appeals. But know that this stage of the appeals process is quite complicated and usually takes years.

Construction worker staring at the cement truck at the site

Types of Workers Compensation Benefits in Florida

There are three types of workers comp benefits you can get in Florida: lost wage benefits, medical benefits, and any additional benefits.

Wage Loss Benefits

If your injury makes you unable to work, you can receive lost wages benefits in Florida. However, under the state’s law, you won’t be paid for the first seven days of your disability. It’s only if your disability extends to 21 days that you’ll get paid for the first seven days.

How much you’ll receive will depend on whether the disabilities are total, partial, temporary, or permanent.

Temporary Total Disability (TTD)

As the name suggests, temporary total disability is when your injury prevents you from doing any type of work but recovery is expected.

In Florida, you can get TTD benefits equal to 66 2/3% of your average weekly wage before your injury. Some types of severe injuries may also entitle you up to 80% of your wage for up to 6 months after the accident.

Once you reach maximum medical improvement (MMI), your temporary disability benefits will end.

Temporary Partial Disability (TPD)

This type of disability benefit is for those who can return to work but with restrictions. To qualify for TPD, you must not be earning more than 80% of your income before your injury.

TPD benefits are 80% of the difference between 80% of your pre-injury average weekly wage and the amount you’re earning now.

For example, you were earning $1,000 before you got disabled. Now, you’re only earning $600 because of the work restrictions. 80% of $1,000 is $800. The difference between that and your current earnings is $200 ($800 – $600). Your TPD benefits will be 80% of $200 which is $160.

Permanent Total Disability (PTD)

You’ll qualify for PTD benefits if your injury is so severe that you are left permanently unable to work. However, you can only start receiving PTD benefits once you’ve reached MMI. Once awarded, this benefit will continue up to the age of 75 or until death. The amount of PTD benefits will depend on the impairment rating assigned by your doctor. To get an idea of how much you’ll get, you can use the Florida Division of Workers Compensation impairment benefit calculator.

Permanent Partial Disability (PPD)

This type of wage loss benefit is for those who are permanently disabled but can still do some type of work. Just like PTD, permanent partial disability benefits will depend on your impairment rating.

Medical Benefits

In Florida, you don’t need to pay for medical treatment if you suffer from a work-related injury. Your workers’ comp covers all your medical expenses, like doctor visits and medications. Even emergency care and rehabilitation should be covered as per Florida law.

If you’ve already paid for emergency care, you can request reimbursement from your insurance provider.

However, you can’t choose your treating doctor. You can only receive treatment from an authorized health care provider. Doing otherwise can get your benefits denied.

Additional Benefits

Aside from wage replacement and medical benefits, workers compensation in Florida also entitles you to the following additional benefits:

Death Benefits

If you die because of work-related injuries, your eligible surviving family member will receive a death benefit. But this is only available for workers who died a year after the accident or five years after a continuous disability.

Under Florida law, you can receive funeral expenses of up to $7,500. Your dependents may also receive compensation as defined by law. Depending on your circumstances, your surviving spouse may also be entitled to educational benefits.

Vocational Rehabilitation

Depending on your age, education, or work history, you may avail of Florida’s reemployment services. This program is designed to assist injured workers so they can get back to work faster. It includes:

  • transferable skills analysis
  • job-seeking skills training
  • vocational counseling
  • selective job placement
  • training and education
  • other services as may be necessary

Getting injured can be stressful, especially if it might affect your ability to work. That’s why knowing your rights is essential, so you know what to do if something happens to you.

VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney

Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.

Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.

About The Author

Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.