Workers Comp in Jacksonville

When it comes to workers compensation claims in Jacksonville, it pays to know which set of laws is going to govern your case: state or federal.

Word to the wise: It can’t be both.

Jacksonville’s multi-pronged economy has the usual base of construction, tourism, manufacturing, finance and distribution jobs, whose employees’ accident claims come under Florida Workers Compensation Laws.

Jump to: How to File a Claim

However, there is a substantial part of the economy fueled by the Jacksonville port that includes the Mayport Naval Station, home to Navy’s 4^th Fleet and the third-largest naval facility in the country. Workers at the port and in some of the businesses associated with the Mayport Naval Station, are covered by the federal Longshore and Harbor Workers Compensation Act (LHWCA)

The LHWCA offers nearly identical coverage and compensation as the Florida Workers Compensation laws, with one outstanding difference: “The threshold for proving causation of an injury is much lower with the Longshore Act,” Jacksonville attorney Zach Tucker said.

Under Florida workers compensation laws, the work accident has to be more than 50% of the cause of your injury for it to be compensable. With the Longshore Act, any percentage of contribution, whether it’s 50% or 5% or anywhere in between, is compensable.

“The number one thing about the Longshore Act is there is a presumption that the injury was the result of the work the person is performing,” Tucker said. “That can be rebutted, but at least they’re starting off on the right foot and there is a better chance of getting the benefits they are due.”

Tucker has been practicing workers compensation cases in Jacksonville for more than 10 years. He is the Co-Chairman of the Longshore section of the Workplace Injury Law and Advocacy Group and sits on the Board of Directors for Florida Workers Advocates. He says the type of work done in Jacksonville lends itself to workers compensation claims.

“There is a lot of heavy labor work in our area,” he said. “These guys are loading and unloading cargo ships; they’re building and repairing vessels; they’re crane operators and all the work that’s involved in construction … it’s full duty work.  There are not a lot of accommodations for light duty work.”

Jump to: How to Appeal a Denial

How to File a Workers Comp Claim in Jacksonville, FL

Like most places, the onus for successfully filing a workers compensation claim in Jacksonville starts with the injured worker, but is shared by both the employer and the insurance carrier. All three are vital in making the workers compensation system  provide the benefits due.

The injured worker obviously is the starting point. When a worker is injured, he/she should inform their supervisor immediately, and alert co-workers who may have witnessed the accident. If necessary, the employee should seek medical treatment from the appropriate doctor, clinic or emergency room.

Florida law allows workers 30 days to file a claim. In some cases, the worker may initially experience only mild discomfort with something like a cut or muscle pull and not seek immediate treatment. However, if the cut gets infected or the muscle pull is aggravated and the employee suddenly realizes he/she needs treatment.

That’s why it’s so important to report an injury right away. Make sure your supervisor puts it on record that something happened, and it may require medical attention. It could be the dealbreaker in getting a claim approved.

Employer’s Responsibility for Filing Claim

Once an employer has been notified of a work-related injury or illness, he/she has seven days file a report to their insurance carrier.

The initial report should contain as much detail as possible, including the employer’s identification information such as name, address, type of business. Similar information about the employee’s name, social security number, mailing address, phone number and occupation is necessary.

The report should tell the important facts about the injury, such as the day, month and hour of the accident, what type of injury was suffered, what caused it, statements from witnesses, where it happened and any other relevant information.

There are times when an employer chooses not to report an injury. Often, it’s because the employer’s insurance premiums from going up. If that happens, the employee can report it directly to the insurance carrier.

If an employee has any concerns about the way the accident was handled, they can call the Employee Assistance Office for Jacksonville at 800-342-1741 or email wceao@myfloridacfo.com.

Insurance Carrier’s Responsibility with Claims Form

The insurance carrier takes over at this stage and must file a form called “The First Report of Injury” (FRI) with Florida’s Division of Workers Compensation (FDWC). The form tells the state what employee was injured and how the accident happened. The employer and employee should receive copies of the FRI so they can verify the information reported.

The carrier has three days to provide the employee with information that explains the rights, benefits and procedures for obtaining benefits. The brochure should explain the obligations injured workers and their employers have under Florida law and the penalties they face if they are found in violation of those laws.

The employee is eligible for lost wages if he/she misses eight days of work because of the injury. If that happens, the carrier must notify the FDWC within 14 days.

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

Deadlines for Jacksonville Workers Comp Claims

An injured employee legally has two years to file a claim for benefits, but the sooner the better.

Here are some deadlines for workers compensation claims in Jacksonville:

Employee: Florida law allows employees up to 30 days from the day of the accident to file an injury report, but all parties involved consider it best to do so immediately after the accident happens.

Employer: The employer must file an injury report with the insurance carrier within seven days of being notified.

Insurance carrier: The insurance carrier has three days to send a brochure to the injured employee that outlines their rights, benefits and procedures for obtaining benefits. If the employees expect to receive lost wages compensation, the carrier must report that to the FDWC within 14 days.

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.

How to Appeal a Workers Comp Denial in Jacksonville

If you haven’t hired a lawyer, this would be  good time to go down that road. Appeals are time consuming and paperwork heavy. It helps to know the system. The insurance carrier has 120 days from the time the injury was reported to tell the worker that a claim has been denied.  When your claim is denied, there is a system set up to resolve the dispute. Here a walkthrough of what you’re facing on appeal of a workers compensation claim in Florida.

Step 1: Contact the Employee Assistance Office in Jacksonville

The first step in the appeals process is to contact the Employee Assistance and Ombudsman (EAO) office. Their goal is to avoid expensive litigation by investigating the dispute and bring both parties to a resolution. The EAO is part of the Florida Division of Workers Compensation and has satellite offices around the state of Florida.

Email: wceao@myfloridacfo.com
Phone: (904) 798-5807
921 N. Davis St., Bldg B, Suite 250
Jacksonville, Florida 32209

Step 2: The EAO Contacts the Insurance Carrier

The EAO takes your case – and your argument to receive benefits – back to the insurance company to see if it can resolve the issues. There are common, and easily corrected mistakes with paperwork that can result in a denial. Sometimes the mistake is simply a miscommunication about what benefits are available and are easily resolved.

Step 3: The Insurance Carrier Issues a Denial

Things do not often get resolved when it’s just the state arguing on behalf of the employee. If they do, the worker receives benefits and the case is closed. If not, (more often the case), the carrier has 14 days to deny lost wage benefits. If the dispute is over medical benefits, the carrier has 3-10 days to deny the benefit, depending on the cost. If they insist on denying the claim, the injured employee must decide if he/she wants to continue the appeal. If so, we move on to …

Step 4: Injured Worker Files a Petition for Benefits

Now comes the critical stage in the process. The employee, or his/her lawyer if they have hired one, must file a Petition for Benefit with the Offices of Judges of Compensation Claims (OJCC). This is the start of what could be a long paperwork process. The Petition for Benefits has the usual identifying information (name, address, etc.), plus a detailed description of the injury, the employee’s responsibilities, the work assigned at the time of injury and a summary of the expected benefits.  Details are vitally important so if you’ve been keeping a notebook on things, you are in good shape.

Step 5: Insurance Carrier Responds to the Petition for Benefits

The carrier has 14 days to respond to the Petition for Benefits. They can choose to pay the claim or continue to deny it. Most claims are denied, and the process moves on to the next step.

Step 6: Mediation & Settlement Negotiation

The judges order a mediation and either appoint one or the two sides agree to hire a private mediator to speed things up. The Office of Judges of Compensation Claims has 40 days to set up a mediation. The mediator puts the two sides in separate rooms and goes back-and-forth with both sides to try and reach a settlement. If the two sides agree, the appeals process ends and that is what happens in most cases. If not, it’s on to a hearing.

Step 7: Workers Comp Hearing

Now it’s time for the judges to listen to arguments and things get really serious. The hearing must take place within 90 days after the failed mediation, but no more than 210 days after the original Petition for Benefits was filed. The two sides identify disputed issues at a pre-trial hearing and the judge sets a hearing date within the next 90 days. When the hearing begins, lawyers for both sides introduce evidence and call witnesses to support their claims. The Judge has 30 days to reach a decision.

Step 8: Option to Appeal

The judge issuing a ruling doesn’t mean the case is over. If the losing side wants to take one more crack at this, they can make a final appeal to the First District Court. This must be filed within 30 days of the OJCC Judge’s ruling, but this process often takes a year or more before the final appeal is granted or denied. The Court of Appeal receives the court records from the OJCC and both sides submit a written argument on the disputed issues. The Appeals Court can confirm the OJCC’s ruling; overturn that decision or turn it back to the OJCC for more findings.