Understanding Workers Comp Benefits in Florida

The purpose of workers compensation is to provide medical care and income protection benefits to employees when they are injured or suffer an illness in the workplace.

There are three major categories of benefits in Florida’s workers compensation laws – medical; lost wages and death benefits – with several sub-categories that help determine what types of medical benefits are paid, how much you might receive in cash benefits and for how long.

These are all paid for by the employer’s insurance carrier.

Medical Benefits

The main goal of workers compensation is to get the employee healthy enough to return to work. In most cases, which means providing medical attention, whether it be in an emergency room, urgent care center or doctor’s office.

Paying for those medical costs is the foundation of workers compensation.

Medical benefits covered by workers comp in Florida:

• Medical treatment from an authorized doctor in an authorized facility
• If needed, use of an ambulance for transportation to the medical facility
• Hospitalization, if necessary
• Visits to doctor’s offices for continuing care
• Medical tests
• Any prescription drugs ordered by treating doctors
• Physical therapy
• Attendant care, if needed
• Prostheses
• Mileage reimbursement for travel to appointments, procedures, or pharmacies

All necessary costs to get an injured worker treated are paid for by workers compensation insurance, but that comes with some warnings of missteps that might cause your benefits to be denied.

Those warnings include:

• Do not skip appointments.
• Do not go to your private doctor and expect to be reimbursed.
• Do not pay a bill for treatment that is sent to you. Send it to your employer or the insurance carrier to handle.
• If your accident requires you to go to an emergency room, tell the staff there you were hurt on the job, give them your company’s name and phone number or the number for the insurance company that handles workers comp for your company.

Failure to follow those guidelines could result in benefits claim being denied.

If you aren’t sure about something, talk to the claims adjuster from the insurance company. Expect there to be differences of opinion on what treatments, therapies, drugs, etc. are “necessary” to get you healthy. That is where problems start.

Ask the adjuster and that should limit arguments over what is or what isn’t covered care.

Lost Wage Benefits

The bills don’t stop coming just because you got hurt, which is why lost wage benefits are probably most attractive advantage available. You should know ahead of time that workers compensation is not the pot of gold some employees envision.

Injured workers receive 66.7% of their weekly wages while out of work because of an injury. The maximum you may receive in the state of Florida is $1,260 a week. You would have to be making $1,890 a week to earn that maximum benefit.

“I don’t know anyone who can afford to lose one-third of their salary and think they’re going to stay on the same level economically,” Glen Wieland, who has been practicing workers compensation law in Orlando for 40 years, said. “What if you just bought a house? Or a car? And now you’re trying to pay that monthly bill with one-third less income. Nobody can make that happen.”

Here is a look at sub-categories for last wage payments.

Temporary Total Disability

This is when you receive 66.7% of your average weekly salary because your injury is so severe, you can’t return to work, at least for the foreseeable future. The lost wages benefit for temporary total disability is in the lawbooks to last for 104 weeks (two years), but a court case extended that to 260 weeks.

The Florida Supreme Court ruled in a 2016 case (Westphal vs. City of St. Petersburg) that limiting benefits to 104 weeks for a person who was totally disabled, but had not reached maximum medical improvement, was unconstitutional. The benefits were extended to 260 weeks (five years).

If you are out only seven days or less, you won’t receive any lost wages compensation. You will start receiving lost wages benefits on the eighth day.

If you are out 21 or more days, you will be compensated for the first seven you missed.

If your injury is deemed critical, you may receive 80% of your regular wages for up to six months.

Temporary Partial Disability

Temporary partial disability benefits are payable when your doctor says you can go back to work, but only for limited duty with some restrictions.

That usually means you can’t do the job you were doing, or perhaps you can only do it for 4-6 hours a day, instead of eight and thus you’re not making the same income you were.

If you work less hours or get assigned to a job that pays less than what you regular weekly pay was, there is a formula used so that you end up with slightly less than 80% of your former salary.

You may collect temporary partial disability benefits for 104 weeks (two years), which could be extended to 260 weeks (five years) if it’s combined with total temporary disability benefits.

Impairment Income Benefits

These benefits are paid to workers who doctors say have reached Maximum Medical Improvement, meaning they’ve tried all the treatments they can and you’re not going to get any better than this.

The formula used to determine how much you will receive is to take 75% of the rate you were receiving when you got 66.7% of your weekly pay. So, for example, if you usually made $600 a week, 66.7% of that would be $400. Now, multiply that by .75 and your weekly impairment benefit would equal $300.

So, before you got injured, you were making $600 a week and if you are given impairment benefits, it is for half that, or $300. And you only receive that for a limited time frame.

Doctors evaluate your capabilities and determine if you have lost use of some part (or parts) of your body, assign that a rating from zero to 100% that signifies how much of your whole body is lost to that impairment.

There could be more than one body part that is no longer functional. If there are multiple parts, you add the assigned percentages. So, for example, you may have lost use of one eye and one hand. The eye might be rated 10% and the hand 5% so your total impairment rating would be 15%.

That number is plugged into a formula that determines how many weeks you will collect the weekly impairment benefit of $300 that we calculated above. In this case, it would be for 35 weeks, meaning the total you would collect would be $10,500 and your impairment benefits would run out.

Permanent Total Disability

When it is determined that an employee’s disability is judged to be permanent, he/she will receive 66.67% of their average weekly wage until they reach the age of 75.

There are some severe injuries that are presumed to be examples of permanent total disability. Those injuries include paralysis, amputation of an arm, hand, or foot; severe brain injury; second and third-degree burns on 25% or more of their total body; total blindness.

If the worker does not have one of those, he/she must prove that they are not able to engage in at least sedentary employment within a 50-mile radius of their home because of physical limitations.

Death Benefits

The death benefits awarded to survivors could be considered the most controversial – and least rewarding – benefits of any offered through workers compensation. Wieland’s one-word comment on death benefits: “HORRIBLE!”

If a worker dies within one year of the date of the accident or within five years of continuous disability, compensation to the survivors is capped at $150,000. That’s not much, and it’s not even paid out in a lump sum.

The surviving spouse is paid 50% of the worker’s weekly salary until the $150,000 runs out. If there is a child involved the percentage would go up to 66.7% of the weekly salary.

So, if the worker made $600 a week, the surviving spouse would get $300 a week until the $150,000 cap was reached, which would be two weeks shy of 10 years.

Limits on Workers Comp Benefits in Florida

Florida’s time limits are consistent with those of most states around the country, though their maximum payment allowed is among the highest in the nation.

Here is a look at the limits on workers comp benefits in Florida:

• Workers on temporary total disability can receive benefits for up to 260 weeks at a maximum rate of $1,260 per week. The employee would have to be making $1,890 or more per week to reach the maximum payout. For comparison purposes, the maximum amount allowed in New York in 2023 was $1,125 per week.
• Workers receiving temporary partial disability also may receive benefits for 104 weeks. The weekly payout for temporary partial disability may not exceed 66.67% of the worker’s average weekly salary at the time of the accident.
• Workers receiving permanent total disability benefits receive it until they reach the age of 75 or until it is proven they are capable of performing at least sedentary employment within a 50-mile radius of their home. The amount of benefits follows the $1,260 per week maximum allowed by the state.
• Workers receiving impairment benefits have a time limit and payout based on a formula devised by the state’s Division of Workers Compensation. See Rule 440.15 number (3) (g) for details on how it is calculated.