What does workers compensation cover?

You are here: Home » What does workers compensation cover

What does my workers’ comp cover” has to be the number one question the employment and workers compensation attorneys at the Gallardo Law Firm get asked by clients. The majority of workers compensation cases in Miami are fairly straight forward; an employee gets hurt at work, they report it to their human resources officer or department who in turn is required by law to report it to the insurance company and the employee files a claim through the workers compensation insurance. Complications commence if the employer does not carry workers compensation insurance or denies the injury occurred at work, in which case the injured party should absolutely explore their legal options with the aid of a workers’ comp lawyer.

The truth is no one ever wants to be in a position where they need an attorney and often put off calling a lawyer for as long as possible while their legal situation escalates or worsens. When attempting to collect workers’ compensation, time is of the essence, especially in our native state of Florida. The majority of cases involving minor injuries are not typically disputed. Once the injured party files a claim, a representative from the insurance company will ask for a detailed explanation of how the injury occurred and what kind of injuries were suffered, and if any medical treatment was received. The interview process may be repeated several times throughout the processing of the case. Employees should not be overly dramatic, or exaggerate the nature of the accident or symptoms and injuries. Upon processing the injured employee is compensated for medical bills and lost wages.

Larger more complex cases, such as those resulting in serious permanent injury or disability, may be denied in an effort on behalf of the insurance carrier attempting to avoid a large pay out. These kinds of cases often end up in mediation, arbitration, or being heard in front of a judge. The insurance company will have a team of attorneys arguing on their behalf, making claims to down play the nature of the alleged injuries or denying the injury occurred while at work. In the event of a denial of workers compensation benefits, injured workers are advised to seek an experience worker’s compensation lawyer.

Workers Compensation Benefits

In Miami, if an employee suffers an injury at work, the workers compensation insurance benefits they may be entitled to collect include:

  • medical care for the injury or illness
  • Replacement income: The maximum payable benefit is two thirds of the injured party’s regular salary and is not subject to any tax, but the insurance company may set a fixed maximum amounts which apply as well. As long as the injured party was making a living wage, they should not encounter any severe financial problems while they are recovering. Eligibility for wage replacement begins after a few days have passed after the injury occurred.
  • Retraining costs
  • compensation for permanent injuries
  • survivors’ benefits in the event the employee has died on the job

Under Florida Law, not all employers are required to carry workers compensation insurance. Any company which has less than four employers may forego coverage; with the exception of the construction industry where if company has just one employee they must be insured. Agriculture businesses are only required to be insured if they have six or more employees.

It is important for people injured at work to remember two things:

  1. Once workers compensation benefits are collected, they forfeit their right to sue the employer for the injury.
  2. Workers' compensation benefits do NOT cover pain and suffering.

Can I Sue My Employer instead of collecting Workers’ Compensation?

If the employer is not covered by workers’ compensation insurance, refuses to report the injury, or begins to retaliate, then a civil suit to cover lost wages, medical and legal bills may be the best course to take. Injured workers who choose to sue the employer waive their right to claim workers compensation benefits.

Workers’ Compensation was developed to not only to protect injured workers, but to protect business from defending injury claims. Those injured at work are entitled to collect workers compensation benefits even in the event that they were partially or completely at fault for the accident or injury; with some exceptions of course.

Getting Hurt at Work

What if, for example, the injury suffered is due to a punch to the face? In this case it may be a suit for an employer’s torts. A tort is defined as “a wrongful act that causes harm to someone else and covers a wide range of actions”. Tort injuries are not only limited to physical injuries; they encompass emotional and psychological damages as well. The most common torts in no particular order are

  • Battery – This tort encompasses the punch in the face mentioned earlier, and is defined as “personal injury caused by someone or something else”
  • Assault - an attempted battery, or the threat to commit a battery
  • Intentional Infliction of Emotional Distress – Suffering emotional and psychological trauma as a result of bad conduct
  • Fraud – A person’s lie or misinformation resulting in harm
  • Defamation – someone making false accusations about someone causing them harm, this includes libel and slander

Workers’ Compensation Medical Benefits

Following an injury at work, workers’ compensation benefits should cover medical expenses related to the accident such as emergency room visits, hospital stays, physical therapy, and adjustments made to the home like installing bars in the shower, or a ramp or lift to go upstairs. Long term coverage, like what is needed to cover ongoing physical therapy treatment, may be met with some resistance from the insurance company. If an insurance company refuses to pay for part of the treatment necessary in order to heal, it is time to call a workers’ compensation lawyer.

Have a Workers’ Compensation Attorney on Your Side!

Getting hurt at work is unpredictable and unfortunate. Most simple workers’ compensation cases do not require legal representation and can be resolved quickly and amicably. However, in Miami, not all employers comply with protocol and may deny a claim or have inadequate insurance coverage. If you or a loved one is in pain following an injury at work, call the Gallardo Law Firm. Our team of Workers’’ Compensation attorneys is well versed in defending employees’ rights. You deserve big firm representation at boutique pricing, call the Gallardo Law Firm and schedule a consultation.