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THE DIVISION OF WORKERS’ COMPENSATION Presents. AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM. Chapter 440 Florida Statutes. Lloyd Harger (850) 413-1856 E-mail: [email protected] November 2005. WHAT IS WORKERS’ COMPENSATION?.

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the division of workers compensation presents
THE DIVISION OF WORKERS’ COMPENSATIONPresents
  • AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM

Chapter 440

Florida Statutes

Lloyd Harger

(850) 413-1856

E-mail: [email protected]

November 2005

what is workers compensation
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
SELF-EXECUTING

Accident

Timely

Benefits

Return to

Work

employer must have coverage if
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 Field

3. Corporate Officers

4. Sole Proprietor Or Partnership

5. Agriculture Industry Over Five

(5) Regular, Twelve (12) or

More Seasonal

BUREAU

OF

COMPLIANCE

Phone (850) 413-1609

employer may obtain coverage by
EMPLOYER MAY OBTAIN COVERAGE BY...
  • Purchasing a Standard Policy on the Open Market
  • Individual Self- Insurance
  • Group Self- Insurance Fund
  • Joint Underwriters Association
exclusive remedy s 440 11 f s
EXCLUSIVE REMEDYs. 440.11 F.S.
  • Protects Employee
  • Medical Treatment
  • Portion of Lost Wages
  • Protects Employer
  • Civil Lawsuit
  • Third Party Actions
  • Subrogation
slide8

VOLUNTEERS

s.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
ACRONYMS(THE LANGUAGE OF THE SYSTEM)

TTD--Temporary Total Disability

TPD--Temporary Partial

PIR--Permanent Impairment Rating

AWW--Average Weekly Wage

MMI--Maximum Medical Improvement

IME--Independent Medical Evaluation

EMA--Expert Medical Advisor

PT--Permanent Total

slide11

SDTF--Special Disability Trust Fund

E/C--Employer/Carrier

JCC--Judge of Compensation Claims

UR--Utilization Review

IIBs-Impairment Income Benefits

SIBs--Supplemental Income Benefits

HCP--Health Care Provider

ER--Employer

EE-Employee

CR--Carrier

MCC--Managed Care Coordinator

slide12

MCA--Managed Care Arrangement

EAO--Employee Assistance Office

TPA--Third Party Administrator

OJT--on the Job Training

T&E--Training and Education

1St DCA--First District Court of Appeal

DFWP--Drug Free Workplace Program

DFS--Department of Financial Services

AHCA--Agency for Health Care Administration

FIRG--Florida Impairment Rating Guide

slide13

POSSIBLE WAYS TO REDUCE ACCIDENTS AND COSTS

1. DRUG FREE WORKPLACE PROGRAM

2. AN EFFECTIVE SAFETY PROGRAM

3. REEMPLOYMENT PLAN

employer may have a drug free workplace program
EMPLOYER MAY HAVE A DRUG FREE WORKPLACE PROGRAM
  • 5% Premium Credit
  • Agency for Health Care Administration
  • Customer Service Office (850) 413-1601
  • Laboratories, Collection Sites, M.R.O.’S

s. 440.101, 440.102 F.S.

reemployment and return to work
REEMPLOYMENT AND RETURN TO WORK

1. Reemployment Plan

2. Light, Limited, Modified,

And Transitional Duty

3. Obligation to Rehire

4. Division Sponsored Training and

Education

5. The Bottom Line: Return

To Work

Phone (850)245-3470

employer should maintain open communications with
EMPLOYER SHOULD MAINTAIN OPEN COMMUNICATIONS WITH...
  • Injured Employee
  • Health Care Provider
  • Insurance Carrier or Service Company
  • Other Employees
  • Why? Avoid Possible Litigation Through Communications
slide17

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
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
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 FINES

AND PENALTIES

slide20

AND…

1. Report Death Cases by Telephone,

Telegram, or Fax to the Division

Phone (800) 219-8953

Within 24 Hours of Employer’s

Knowledge of Death

2. Give Employee His/Her Copy of the

DWC-1

types of accidents
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

slide23

CONCURRENT EMPLOYMENT

(Working Two or More Jobs)

The Employee is Responsible to Report Any

Concurrent Employment

If a Covered Employer, Must Add the

Wages Into the AWW Calculation

s.440.02(28), F.S.

injury defined
INJURY DEFINED
  • Personal 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 injury
NOT AN INJURY
  • Mental or Nervous Condition Caused Only by Stress, Fear or Excitement
  • Disability by Acceleration or Aggravation of Venereal Disease or Substance Abuse
  • Phobias Based on Ethnicity, Gender, Age or Handicap
employee s responsibilities regarding medical care
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
AMOUNT & DURATION PAID TO THE INJURED EMPLOYEE?
  • Medical Documentation Determines Disability (Indemnity) Type
  • 7 Day Waiting Period
  • Paid 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)

INDEMNITY BENEFIT TYPES
slide29

SETTLEMENTS

s.440.20(11),(a),(b),( c),F.S.

Are Not Automatic or Mandatory

Under the Law

However…

slide30

SPECIAL SITUATIONS

  • 1. Driving To and From Work
  • 2. Horseplay/Fighting
  • 3. Breaks and Lunch
  • 4. Company Parties/Picnics
  • 5. Police Officers, Firefighters/Paramedics
  • 6. Traveling Employees
  • Deviation from Employment
  • Aliens
what if self execution breaks down
WHAT IF SELF-EXECUTION BREAKS DOWN?!
  • Disagreements
  • Disputes
  • Early Intervention Program

Mediation

Hearing

Employee Assistance

Office

informal dispute resolution formal litigation
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
slide33

POP QUIZ

(TRUE OR FALSE)

  • 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.
slide34

POP QUIZ

(TRUE OR FALSE) cont..

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.

slide35

POP QUIZ

TRUE 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

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