How to File a Workers Comp Claim in Florida

The filing process for Florida is a simple, but critical first step in the workers compensation system. Three parties are involved – injured employee; employer; and insurance carrier – and each one’s responsibility is vital to make the process work fairly and efficiently.

Workers Responsibility for Filing Claim

The claims process starts with the employee. Ideally, when a worker gets hurt in the workplace, he/she would inform their supervisor immediately, and, if necessary, go to the appropriate doctor, clinic or emergency room for medical treatment.

It also is vital that the worker collect evidence at the scene, if possible. The evidence could be photographs, names of witnesses or a summary of the accident that caused the injury.

Florida workers comp law says that workers have 30 days from the date of the accident to report an injury, but the longer you wait, the more likely there will be disputes about the legitimacy of your claim.

To be fair, there are occasions when it makes sense to wait a few days to report an injury because the worker may initially experience only mild discomfort with something like a cut or muscle pull and not seek immediate treatment. As time goes on, however, the cut could get infected, or the muscle pull get aggravated, and the employee suddenly realizes he/she needs to file a claim and get treatment.

The best advice is to report an injury to a supervisor right away. Get it on record that something happened that may require medical attention. You will not regret it.

Employer’s Responsibility for Filing Claim

When employers are notified of a work-related injury or illness, they have seven days to file a First Report of Injury with details about the injury to their insurance carrier.

The employer is required to file the  First Report of Injury form with the injured worker’s insurance carrier. The report should include the employer’s name, address, company name, phone number, plus identification information about the employee, including name, social security number, mailing address, phone number and occupation.

The report should include details about the cause of injury and specifics such as the month, day, and hour, where it happened and any other relevant information about the accident. Copies of the First Report of Injury should be mailed to the employee and employer to make sure the information reported is accurate.

The employer also must inform the insurance carrier within 14 days if the injured worker misses more than seven days of work because of the injury. On the eighth day missed, the employee is eligible for lost wages benefits.

To assist in the worker receiving benefits due, the employer should have up-to-date records on the employee’s contract, salary, W-2 statements, status, proof of insurance and records of past claims.

If the employer chooses not to report an injury, the employee can report it directly to the insurance carrier. There will be times when employers may choose not to report it because they are suspicious about the details, but they still must report it.

If an employee has questions about reporting, they can call the Florida Employee Assistance Office at 800-342-1741 or email wceao@myfloridacfo.com.

Insurance Carrier’s Responsibility with Claims Form

It is the insurance carrier’s responsibility to use information on the claims form to investigate workers comp claims and determine what benefits the worker is entitled to receive.

The carrier must approve or deny a workers’ claim within 14 days of being notified. If the carrier wants to review the claim further, it may use Florida’s “120-day” rule to approve benefits temporarily, pending further investigation completed in 120 days.

The insurance carrier must mail a brochure to the injured employee within three days of notification of the injury. The brochure clearly explains the rights, benefits, and procedures for obtaining benefits under workers comp. The document must explain the obligations injured workers and their employers have under Florida law and the penalties for violating those laws.

The carrier should consistently update the injured employee’s file with any new medical reports showing the condition of the employee and wage statements if the employee is due indemnity pay during recovery.

Deadlines for Florida Workers Comp Claims

The deadlines for filing workers compensation claims in Florida are clear, but it should be noted that an injured employee has up to two years to file a claim for benefits.

Here are the deadlines for the various players involved in workers compensation:

• Employee: It is best for employees to report an injury immediately, but the law allows 30 days from the time of the accident to report an injury to the employer.
• Employer: The employer must file an injury report with the insurance carrier within seven days of being notified. Employers also must notify the insurance carrier within 14 days if the employee has missed seven days of work because of the injury.
• Insurance carrier: The insurance carrier has 14 days to accept or deny a claim. If the insurance carrier wants to investigate the accident further, it must begin payments and has 120 days to continue investigating. Carriers also must send a brochure to the injured employee within three days of being notified of the accident. The brochure should outline their rights, benefits, and procedures for obtaining benefits, as well as their legal obligations.
• Occupational Diseases: If you are filing for death benefits due to occupational diseases, the death must have occurred within 350 weeks of the deceased’s last exposure to the source.