Claims:  Frequently Asked Questions...

According to OSHA, "You must consider an injury or illness to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness."

To file a claim, you must submit a First Report of Injury Report with the insurance company. This can be done by either:

• calling their claim hotline number

• submitting a report online

• sending a report by e-mail, fax or mail.

If you don't have a First Report of Injury, you can either contact the insurance company directly or get the report off our website by clicking here

The quick and easy answer is... as soon as possible. But, depending on the extent of the injury, there may be other considerations. We recommend:

In the case of an Emergency:

• You should immediately get the employee to the nearest medical center and then report the claim "after the employee is stabilized."

In the case of a Non-Emergency:

• Report the claim to the insurance company "before taking the employee for treatment". They may want to direct you as to where to take the injured employee for medical care within their Managed Care Network.

Ultimately, the sooner you report the claim, the sooner the insurance company can begin to coordinate with the injured employee and the medical care providers to make sure he/she is getting the care and attention they deserve.

You should report it as soon as possible but no later than thirty (30) days or your claim may be denied.

The primary role of workers' compensation insurance is to provide medical care for any injuries sustained while on the job and return the employee back to work as soon as possible. After an on-the-job injury, a treating physician may place physical restrictions on their return to work to protect them from further injury and allow proper healing. Some examples of this may be:

• no lifting above 20 pounds

• no standing more than 20 minutes at a time.

Since it is always encouraged to return an employee to gainful employment as soon as possible, an employer may need to work with the injured employee to modify their work duties to stay within the doctor's restrictions and allow proper healing. (This is called "light duty" or "modified duty" work.)

By creating a way for the employee to return to work, the employee stays involved in the workplace, the employer get productivity out of the employee and the cost of the claim is reduced by lower wage benefits due to the employee. Everyone wins!

No, there is no provision in the law that requires your employer to hold the job open for you.

No. Per 440.205, "No employer shall discharge, threaten to discharge, intimidate, or coerce any employee by reason of such employee’s valid claim for compensation or attempt to claim compensation under the Workers’ Compensation Law.

A "Loss History Report" or a "Loss Run" is a report from your insurance company showing the claims that you have had. It normally includes:

1. Employee names

2. Dates of accidents

3. Description of the accidents

4. Amount paid to date

5. Reserves, or future amounts expected to be paid, and

6. Whether the claim is closed or still open and being paid.

You will be held responsible for any injuries suffered by anyone deemed to be an "employee" under the workers' compensation statutes. Further, you will not be able to claim any of the defenses offered under workers' compensation either.

440.06 - Every employer who fails to secure the payment of compensation, as provided in s. 440.10, by failing to meet the requirements of s. 440.38 may not, in any suit brought against him or her by an employee subject to this chapter to recover damages for injury or death, defend such a suit on the grounds that the injury was caused by the negligence of a fellow servant, that the employee assumed the risk of his or her employment, or that the injury was due to the comparative negligence of the employee.

The employee, or their estate, must file a Petition for Benefits (PFB) within 2 years of when they knew or should have known, that the injury or death resulted from work within the course and scope of their employment.

A PFB must also be filed within 1 year of when a wage payment is due or medical treatment is furnished on a filed claim.

The short answer is "Yes", however, you still have to adhere to the laws within the State of Florida. You are required by law to report any injury...

• that requires outside medical treatment to the insurance company.

• that results in the death of an worker. (You are required to report this to OSHA as well.)

You may choose to pay the medical bills for that treatment to keep the cost off your claims history, however, we do not recommend this. The insurance companies negotiate fee schedules with most medical facilities and providers that will save your firm a lot of money. Further, you really want to allow the claims adjuster to direct and maintain control over the claim. (We have seen far too many simple infections that they could have dealt with very easily turn into costly hospital stays.)

If you desire to pay for the lost wages portion of an injured workers' losses, that is something we do encourage at times. This is especially true during the 1st 10 days of a claim. By doing this, it allows the injured employee to continue to meet their financial needs and it can foster goodwill with the injured employee because, you, the employer, are providing a caring environment for them to work in.

There are legal responsibilities, moral responsibilities and then things that are simply good business and will protect you in the future aspects of the claim.

Of course, the first thing that needs to be done is to make sure that the employee receives the medical treatment they require.

Now, let's deal with the legal responsibilities:

An employer is required to

• Report the accident to their insurance company within 7 days.

• Report the accident to OSHA within 8 hours if a death occurs and within 24 hours in the case of amputation, loss of an eye, or inpatient hospitalization.

Beyond that, it is simply good business to make sure that you:

1. Investigate the accident.

2. Stay in contact with the employee during any injured period to follow their progress.

3. Return the employee to work, when they are capable of returning.

The last couple of items listed about the investigation of the claim and staying in touch with the injured employee can dramatically impact the overall cost of the claim. Making sure that you stay in touch with your injured employees is not only the right thing to do... it's good business. You can leave it to the insurance company to handle the claim, but it is up to you, the employer, to make sure that your employee is getting the attention they deserve. Stay in touch. Show you care. It's the right thing to do.

The short answer is "Yes".

An injured employee who is receiving temporary or permanent disability benefits may still be entitled to receive third party disability benefits, for example AFLAC.

Note: Review the terms of their disability insurance policy to see how your individual policy may respond.

The short answer is "Yes", but with further explanation...

An injured employee may qualify for social security disability while they are being paid temporary or permanent disability benefits. If they do, they must report the social security disability benefits to the insurance company periodically. The disability benefits will be offset by the social security benefits they receive.

The short answer is "No".

An injured employee who is receiving temporary or permanent disability benefits for a workers' compensation insurance claim is not entitled to receive state unemployment benefits.

First off, we would like to encourage all employers to make sure that their employees are legal to work in the United States. To do that, as an employer, you need to make sure you comply with the IRS requirement of completing an I-9 Employment Eligibility form at the time of hiring.

As to the question of compensability, all employees, whether legal or not, are eligible for medical benefits, if injured while on the job in the State of Florida. The indemnity portion of workers' compensation, (wage benefits), are only awarded to individuals that pay payroll taxes within the United States. For example, let me outline 3 possibilities:

1. An employee who is legal to work in the United States and is injured on the job would be eligible for both medical benefits and wage benefits.

2. An employee who is not legal to work in the United States, but pays taxes through an ITIN number, would be eligible for both medical benefits and wage benefits. (Please note that just because they pay taxes through an ITIN, that does not make them legal to work.)

3. A employee who is not legal to work in the United States and does not have an ITIN would be eligible for medical benefits, but not wage benefits.

If an employee suffers an on-the-job injury that requires outside medical attention and the employer has knowledge of the injury, they are required by State of Florida statutes to report the injury to the carrier within 7 days.

What is considered knowledge? If the owner, a supervisor, or a member of the administrative staff knows of the accident, that is knowledge.

If the employee doesn't require outside medical attention, we still recommend that you document the accident and that they refused medical attention. This way, if they need medical treatment later, you have a record of the accident and why you didn't report it.

An adjuster from the insurance company cannot start managing an employee's treatment if they don't know about it. If a claim is not reported quickly, the employee may be receiving treatment and missing work that is not managed. This can significantly increase the cost of a claim.

Now, as to the penalties:

If a claim is not reported within 7 days, the State of Florida can fine you up to $500. for the failure to report.

440.185 Notice of injury or death; reports; penalties for violations.—

If an employee is injured and you want to pay the medical bill, you can do that. But, you still have to report the claim in order to comply with the state's requirement.