Rue Ziffra, PA

Workers’ compensation is a type of insurance that allows you to obtain medical care and compensation for lost wages. It is available to nearly all employees who suffer an injury arising out of and in the course of their employment.

Serious on-the-job injuries can cause the victim to temporarily or permanently lose the ability to perform his or her job. Injured workers often do not receive the appropriate wage loss or medical treatment needed, however workers’ compensation attorney can help injured workers receive pay while they recover and also get help paying for their necessary treatments.

There are three major benefits an injured worker may receive under workers’ compensation coverage:

Medical expenses

Includes the cost for hospitals, doctors and medical treatment. Your employer is responsible for providing medical treatment through an insurance carrier which includes, but is not limited to, the following:

• An authorized primary doctor and specialist(s) when medically necessary
• All authorized medically necessary care and treatment related to your injury such as doctor’s visits, hospitalization, physical therapy, medical tests, prescription drugs and prostheses
• Mileage reimbursement for travel to and from your authorized doctor and the pharmacy

Disability benefits

Benefits range from either temporary while you are getting back to normal, or permanent if you will never fully recover. The amount varies, but can be as high as two-thirds of your normal pay.

 »Temporary Disability Benefits- There are two types of temporary disability benefits that you may be entitled to during your recovery, to make up for some of your lost wages:

• Temporary total disability (TT): This level of disability reflects an injury that has rendered an employee completely unable to perform any job functions on a temporary basis. However, the employee is expected to make a full recovery and return to work. With this type of disability, you should receive money equaling 66 2/3% of your regular wages at the time you were hurt. This amount it subject to a statewide maximum reimbursement amount.
• Temporary partial disability (TP): This is a disability level where an injured worker is temporarily prohibited from performing a certain set of job skills but the doctor states they can return to work with restrictions. With this type of disability, you should receive money equaling 64% of your average weekly wage.

»Permanent Disability Benefits

• Impairment Benefits (IB): This disability level occurs when an injured worker’s condition is not expected to improve significantly. Upon reaching this state, the doctor states the worker is at Maximum Medical Improvement, and will have them evaluated for possible permanent work restrictions and an impairment rating.
• Permanent Total Disability Benefits (PT): A worker may receive permanent total disability benefits if their injuries are so severe that they are unable to return to work in any capacity after reaching Maximum Medical Improvement.
• Death Benefits: If a work-related death occurs within one year of the date of accident or five years of continuous disability, specific death-related benefits may be due and payable up to a maximum total of $150,000:

Vocational rehabilitation

If your injury renders you unable to perform the usual duties of your occupation, you may need re-training so that you can enter into a new trade or business. Also, you may need physical therapy to get your normal strength back. If you qualify for returning to work you may be eligible to be paid workers’ compensation while you retrain.

Upon being released back to work with restrictions, the injuries workers sustain may create obstacles when returning to your original work. You may need training services to assist you in learning different methods to completing your work, or assistance finding other work that will accommodate your restrictions.

Every state has a federally funded agency that administers vocational rehabilitation, supported employment, and independent living services. The services available under these programs vary widely depending upon the state.

»Available services may include:

• medical, psychological, vocational, and other types of assessments
• counseling and guidance
• physical and mental restoration services
• vocational and other types of training
• interpreter and reader services

• After an injury or illness occurs on the job, it is the employee’s responsibility to complete a notice of injury form and report it to their employer or the state workers’ compensation agency/board within 30 days of the injury.
• The employer is then obligated to report the accident to their insurance company, within a 30-day limit.
• The employer is given an opportunity to respond to the claim. If he does not contest the claim, payment of medical bills and wages will be made by the insurance company.
• The insurance company will then authorize the injured worker a doctor for medical treatment of the work-related injuries.
• During this time be sure to fully describe your injury to your doctor, and closely follow the guidelines set by your doctor.
• The injured worker is responsible for notifying the employer of their work status given by the authorized doctor.
• A hearing can be scheduled if the employer contests the claim or if the insurance carrier does not provide benefits recommended by the authorized treating physician.

The answer to this question is “maybe.” If the returning to work enables the employee to receive wages equal to or greater than he or she was earning prior to the injury, then it is likely benefits will be stopped.

If, however, the employee is still experiencing a wage loss greater than 20% of pre-accident earnings, due to his or her injury, he or she may continue to receive temporary partial wage loss benefits, although the benefits will most likely be for a lesser amount.

Injuries or illnesses are typically covered only when they “arise out of and in the course of employment.” There needs to be a nexus between the accident that caused the injury/illness and the scope of your employment duties.

Examples of compensable injuries are those caused by:

• lifting heavy equipment
• slipping on a wet or oily surface
• defective machinery
• fires or explosions

Illnesses that “arise out of and in the course of employment” can be covered under the workers’ compensation system where the working conditions present unusual or extraordinary risks of contracting an illness – such as computers where workers may experience carpal tunnel syndrome. Careful inquiry into the hazards arising out of the scope of your employment can determine whether the illness is one that is common to everyday life as opposed to risks of illness that are present in your particular employment situation.

State workers’ compensation systems establish technical and often tricky rules in this area. Often, you have the right to ask for another doctor at the insurance company’s expense if you clearly state you have a problem with the one the insurance company provides, although there is sometimes a waiting period before you can get a second doctor.

Workers’ compensation is typically carried solely by the employer, which usually purchases workers’ compensation insurance. This coverage is obtained by the employer either through self-insurance, private, or state insurance. The state’s role is to oversee the provisions of workers’ compensation benefits and to assist employees, employers, and others to resolve disputes that arise in the process.

The cost of workers’ compensation coverage cannot be charged to the employee.

If you decide to file a worker’s compensation claim against your employer because of an accident you received on the job, it may prove important to know some basic tips to help you receive the maximum compensation you deserve. Remember, you cana lways seek legal guidance from a worker’s comp. attorney who has experience handling individuals claiming to be hurt while on the job.

•  Do not delay in reporting your injury or illness. Your employer may authorize a doctor at the time of your accident, but the insurance carrier must authorize follow-up treatment.
• Tell the emergency room you hurt yourself on the job, if your accident results in emergency treatment. Also make sure to give them a contact name and phone number of your insurance carrier or your employer.
• Do not go on your own to your private doctor for treatment. The insurance carrier must authorize the doctor who is to treat you.

Unfortunately, many of the injured workers turned down for workers’ compensation benefits are often denied benefits two or three times before getting the compensation they deserve. If or before this happens, they can always seek help from a worker’s compensation lawyer who knows the legal and medical processes surrouonding worker’s compensation insurance.

The Florida worker’s compensation attorneys at Rue & Ziffra, P.A., are often able to quickly and effectively help injured clients by having an understanding of complex workers’ compensation laws and processes. We work closely with clients to make sure they recover what is owed to them swiftly and efficiently, so they can spend their time and effort concentrating on recovering from their injuries.

Rue & Ziffra, P.A. proudly serves areas throughout central Florida in Volusia County and Flagler County.