Workers Comp in West Palm Beach

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Palm Beach is the largest county in the state of Florida with 47 miles of beaches, 43 miles of intracoastal waterways, and 160 golf courses stretched across its 2,578 square miles.

That’s one side of Palm Beach County, the one most people know.

The other side is farmland that produces the most sugarcane, sweet corn and bell peppers in the nation and the most rice, lettuce, radishes, celery and other crops in the state of Florida.

The farmworkers come from Guatemala, Mexico and just about every country in South America. Some speak Spanish, some speak Mayan and some Portuguese. Only a few speak English. When a worker gets hurt, there may or may not be someone who can communicate with him or her.

“We have such a diverse population in Palm Beach County and, as you might imagine, a diverse amount of injuries from so many different occupations,” said Marc Golden, chairman of the Workers Compensation practice at Rosenthal, Levy, Simon and Sosa law practice in West Palm Beach.

“Everyone has a very unique set of circumstances dealing with their accident and a unique set of goals that they want to achieve. There is no one size fits all solution to their problems We find out what their goal is, and work toward that solution.”

The goal would seem obvious – get what’s coming to me! – but many cases require the injured worker to make a difficult decision regarding their future with that employer. Often times, when a cash settlement is involved, it means the workers will lose their job.

“Some people just want to get a money settlement and move on with their lives,” Golden said. “But the trend I’ve been seeing, is the injured worker telling me they don’t want to upset their employer, they want get better and go back to work without causing issues.”

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Reasons to Hire a West Palm Beach Workers Comp Attorney

The language barrier — do you understand the rights and benefits you are entitled to when hurt on the job? — is the most obvious sign a worker may need an attorney in Palm Beach County, but hardly the only one.

Here are more signals that you could use some legal help if you get injured on the job:

  • Your employer tells you not to report the injury because he is going to pay for all the medical bills.
  • Your employer delays reporting the injury.
  • Delays in reporting the claim lead to questions about whether the injury actually occurred on the worksite.
  • The doctor treating you doesn’t speak the same language and misunderstands when you explain what happened or what hurts.
  • The insurance carrier denies you claim.
  • You have been out of work for more than two weeks because of the injury, but have not received any wage compensation.
  • Your injury is serious enough that you may never return to work.

“It’s unfortunate that medical care that has been suggested by your treating physician gets ignored for a week, maybe even a month,” Golden said. “The only recourse you have if for a lawyer to file a claim and keep the insurance carrier and employer honest and keep them on task.”

What Does a Workers Comp Lawyer in West Palm Beach Do?

It is not uncommon for injured workers to think they can represent themselves when an accident happens. After all, just tell the judge what happened, what the bill is for medical treatment, how much money you missed out on in lost wages and we’re done. Right?

No, not really.

“There is no way you’re going to have a successful outcome in a workers compensation case unless you’re being represented by a competent lawyer,” Golden said. “This isn’t small claims court. You’re not going to be allowed the leeway of just telling a story and presenting hearsay evidence.”

Some of the things an attorney does that someone off the street wouldn’t know or be able to do to properly present a workers compensation case.

  • Depose doctors involved in the treatment.
  • Depose claims adjuster representing insurance company.
  • Get a full history of worker’s medical history.
  • Use experience with doctors, insurance companies and opposition lawyers to reach fair outcome for injured worker.
  • Use experience with trial judges to know what expert witnesses to call.
  • Handle all preparations and meet all deadlines if the case goes to a trial.

Golden, who has been representing clients for more than 30 years, said: “Once an insurance carrier denies a claim, they aren’t going to change their mind. The only way to get that decision reversed is to go to court with competent legal help.

“You have to come prepared and that means having a professional with experience in this form of law working for you. That’s really the only way to succeed.”

How Much Does It Cost to Hire a Workers Comp Lawyer in West Palm Beach?

The biggest misconception in workers compensation is that you can’t afford an attorney. You can.

Attorneys in workers compensation operate on a contingency basis, meaning they only get paid if they win the case.

“We have to succeed at what we’re doing,” Golden said. “We have to obtain a benefit, obtain a settlement, get some result on behalf of our client in order to get paid, so there should be no obstacle involved in hiring an attorney.”

What that means for an injured worker is that if the attorney takes your case, he/she has reason to believe there is a positive result to pursue.

The state of Florida has rules governing how much the attorney can charge, based on a percentage of benefits the worker receives. The maximum fees are:

  • 20% of the first $5,000 of benefits
  • 15% of the next $5,000 of benefits
  • 10% of all benefits over $10,000

You may waive these statutory percentages and agree to a set contingent fee in the attorney’s fee agreement. The judges in every case review the attorney’s fees to make sure the lawyer is compensated fairly and in accordance with the law.

Handling a Workers Comp Case on Your Own in West Palm Beach, FL

Most claims do not require the help of a workers comp attorney. When the system works as intended, you simply have to notify your employer to kickstart the process of filing a workers compensation claim. If things do not work out in your favor, you have the option to appeal a claim denial. This will require the help of a workers comp lawyer, but for reference, the step-by-step guide is detailed below.

Filing a Workers Comp Claim in West Palm Beach, FL

Filing workers compensation claims in West Palm Beach is a crucial first step in the workers compensation system and there are three parties involved  – injured employee; employer; and insurance carrier. All three have responsibilities that are vital in making the process work.

The injured worker obviously is the starting point. When a worker gets hurt in the workplace, he/she should inform their supervisor immediately, and, if necessary, go to the appropriate doctor, clinic or emergency room for medical treatment.

However, the law says that workers have 30 days from the date of the accident to report an injury. That deadline is important because 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

The employer has seven days after being notified of a work-related injury or illness, to file a report to their insurance carrier with details about the injury.

The initial report should include the employer’s identification information such as name, address, type of business. It should have similar information about the employee, including name, social security number, mailing address, phone number and occupation.

The report should have details about the type of injury, what caused it, statements from witnesses, the month, day and hour of the accident, where it happened and any other relevant information.

There could be occasions when the employer chooses not to report an injury. Often, it’s because the employer is worried about insurance premiums 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 West Palm Beach at 561-837-5716 or email wceao@myfloridacfo.com.

Insurance Carrier’s Responsibility with Claims Form

The insurance carrier is the third part of the process and is responsible for filing a form called “The First Report of Injury” with Florida’s Division of Workers Compensation (FDWC). The employer and employee also should receive copies of the First Report of Injury to 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.

If the employee misses eight days of work because of the injury, he/she becomes eligible for lost wages. In that situation, the carrier must notify the FDWC within 14 days.

It is in the carrier’s best interests to update the injured employee’s file with new medical reports and wage statements if the employee is due indemnity pay during recovery.

Deadlines for West Palm Beach Workers Comp Claims

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

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

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 expects 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.

Appealing a Workers Comp Denial in West Palm Beach, FL

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’s a walkthrough of what you’re facing on appeal of a workers compensation claim in Florida.

Step 1: Contact the Employee Assistance Office in West Palm Beach

The Employee Assistance and Ombudsman (EAO) office counts itself as the first step in the appeals process. Their job is to investigate the dispute and try to get both parties to come to a resolution before the process gets costly. The EAO is part of the Florida Division of Workers Compensation and has satellite offices around the state of Florida.

Employee Assistance Office

Email: wceao@myfloridacfo.com
Phone: (561) 837-5716
400 North Congress Avenue, Suite 105
West Palm Beach, FL 33401

Directions to the Employee Assistance Office in West Palm Beach:

Step 2: The EAO Contacts the Insurance Carrier

The EAO says it will contact the insurance company and see if it can resolve the issue to obtain benefits. 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

If things go well (that’s rare), 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

The next step for employees is to file a “Petition for Benefits” with the Offices of Judges of Compensation Claims (OJCC). This is the start of what could be a long paperwork process. Details are vitally important. 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.

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

A mediator is brought in to try and bring about a settlement. The Office of Judges of Compensation Claims has 40 days to set up a mediation. The mediator could be appointed by the OJCC’s office or, if both sides agree, a private mediator can be hired to try and resolve the issues. The mediator puts the two sides in separate rooms and goes back-and-forth between the two 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

When the situation gets this far, it has official reached a really serious level. 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 first step is a pre-trial hearing where the two sides identify disputed issues. The Judge sets a hearing date within the next 90 days. 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

If one side is still unhappy with the OJCC’s decision, there is an option for a final appeal to the First District Court. Rules say the appeal 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.

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About the author

Bill Fay has touched a lot of bases in his 45-year career. He started as a sports writer, gaining national attention for work on college and professional sports. He had regular roles as an analyst on radio and television and later became a speech writer for a government agency. His most recent work is as an internet content marketing specialist. Bill can be reached at bfay@workerscompensationexperts.org.