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12 Things to Know Before You File a Worker’s Compensation Claim

Workers’ compensation insurance provides injured workers certain benefits such as lost wages, payment of medical expenses, rehabilitation costs and some other out-of-pocket losses. It is insurance that compensates you if you were injured or became ill while in the course and scope of your employment, meaning while at work or substantially engaged in a related work activity.

There is no requirement that you prove your employer or some agent or representative of your employer was negligent or willfully caused your injury or illness.

Before you file a workers’ compensation claim, however, there are some things you should know so that you can be fully prepared for the process:

  1. Did your injury or illness arise out of the course and scope of your employment? If you fell off a ladder or an object fell on your head while working at a construction site, it is fairly obvious you were injured while at work.
  2. But if you had a heart attack or drove to the grocery store for your own benefit, does this constitute an injury or condition caused while in the course and scope of work?

Also, if you are heavy smoker with a history of heart disease and suffer a heart attack, it may not qualify but if you engage in heavy labor and did not smoke or have a history of heart complications, then your physician may have to be an advocate to support your claim. The work must have been a major contributing cause of your injury or illness.

  • Report your injury promptly. After 30 days, the insurer will likely reject your claim.
  • Know that you will not be paid for the first 7 days of your disability from work unless it lasts over 21 days.
  • If your employer has at least 4 employees, then Florida law requires your employer to have workers’ compensation insurance. Any construction employer must be insured.
  • If you feel that you have a medical condition that is preventing you from working, which was contracted or caused by a work-related activity or toxic substance found at your workplace, be sure to inform your doctor before you think about filing a claim. Your medical records and a physician’s report will have to substantiate your allegation.
  • Be aware that worker’s compensation does not pay you in full for lost time. You only receive 66 and two-thirds of your average weekly wage. This is based on the 13 weeks you worked before your injury, not including the work week in which you were injured or became disabled.
  • You do not have to report as income for income tax purposes any wages you are paid while you are on disability. If you return to light duty, however, you do have to report it.
  • If you are placed on TTD, or temporary total disability, or TPD, or temporary partial disability, your checks will come for no more than 104 weeks or about 2 years.
  • You can apply for and receive disability benefits from SSI or SSDI and receive workers’ compensation benefits at the same time. However, the payments combined cannot be more than 80% of your average weekly wages.
  • If you become disabled and qualify for workers’ compensation, it does not obligate your employer to hold your job for you but your employer cannot fire or terminate you. Your employer does have to make an effort to find you work when you return within your restrictions, if any.
  • You have 2 years to file a petition for benefits. Do not wait, however, to contact a workers’ compensation lawyer if your claim is denied or your benefits are abruptly terminated.
  • You can settle for a lump sum with the insurer but if you settle your medical benefits and you later require additional medical care related to your work-related injury, you will have to pay for the expense yourself or use other health insurance.

Call the Experienced Team of The Hoffman Firm

As a serious matter, you need an experienced workers’ compensation attorney fighting for your rights. Don’t delay, call our team today.

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Evan A. Hoffman

Evan A. Hoffman

Mr. Hoffman’s philosophy is "our knowledge and experience is your best defense." He has been a featured author on criminal law issues such as driving under the influence, domestic violence and illegal searches.

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