THE DIVISION OF WORKERS’

COMPENSATIONPresents

AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM

Chapter 440Florida Statutes

Lloyd Harger(850) 413-1856

E-mail: Lloyd.harger@fldfs.com

November 2005

WHAT IS WORKERS’ COMPENSATION?

State-administered Insurance Program That Benefits Employers and Injured Employees

The Injured Employee Receives Medical Treatment and Wage Replacement Benefits.

Exclusive Remedy: a Work-related Accident Is Compensated Through the Workers’ Compensation System Not Through the Tort System.

The Employer Pays a Premium Based on Its Payroll, Class Code, Rate, and Individual Experience.

SELF-EXECUTING

TimelyBenefits

Accident

Return toWork

May 23, 1935May 23, 1935

EMPLOYER MUST HAVE COVERAGE IF...

1. Employer Has Four (4) Or More Employees (Full or Part Time)2. One (1) or More If Employer Is in the Construction Field3. Corporate Officers4. Sole Proprietor Or Partnership5. Agriculture Industry Over Five (5) Regular, Twelve (12) or More Seasonal

BUREAU OF

COMPLIANCE

Phone (850) 413-1609

EMPLOYER MAY OBTAIN COVERAGE BY...Purchasing a Standard

Policy on the Open MarketIndividual Self- InsuranceGroup Self- Insurance FundJoint Underwriters

Association

EXCLUSIVE REMEDYs. 440.11 F.S.

•Protects EmployeeProtects EmployeeMedical TreatmentMedical TreatmentPortion of Lost WagesPortion of Lost Wages

•Protects EmployerProtects EmployerCivil LawsuitCivil Lawsuit

•Third Party ActionsThird Party Actions

•SubrogationSubrogation

VOLUNTEERSs.440.02(15)(d)6. and s.440.02(17)(b)3.,F.S.

Are NOT Employees Except…

Volunteers for a State, County, Municipality or Other Governmental Entity

Volunteer Firefighters

ACRONYMS(THE LANGUAGE OF THE SYSTEM)

TTD--Temporary Total DisabilityTPD--Temporary PartialPIR--Permanent Impairment RatingAWW--Average Weekly WageMMI--Maximum Medical ImprovementIME--Independent Medical EvaluationEMA--Expert Medical AdvisorPT--Permanent Total

SDTF--Special Disability Trust FundE/C--Employer/CarrierJCC--Judge of Compensation ClaimsUR--Utilization ReviewIIBs-Impairment Income BenefitsSIBs--Supplemental Income BenefitsHCP--Health Care ProviderER--EmployerEE-EmployeeCR--CarrierMCC--Managed Care Coordinator

MCA--Managed Care ArrangementEAO--Employee Assistance OfficeTPA--Third Party AdministratorOJT--on the Job TrainingT&E--Training and Education1St DCA--First District Court of AppealDFWP--Drug Free Workplace ProgramDFS--Department of Financial ServicesAHCA--Agency for Health Care AdministrationFIRG--Florida Impairment Rating Guide

POSSIBLE WAYS TO POSSIBLE WAYS TO REDUCE ACCIDENTS AND REDUCE ACCIDENTS AND

COSTSCOSTS1. DRUG FREE WORKPLACE PROGRAM

2. AN EFFECTIVE SAFETY PROGRAM

3. REEMPLOYMENT PLAN

EMPLOYER MAY HAVE A DRUG FREE WORKPLACE PROGRAM

5% Premium CreditAgency for Health Care AdministrationCustomer Service Office

(850) 413-1601Laboratories, Collection Sites, M.R.O.’S

s. 440.101, 440.102 F.S.

REEMPLOYMENT AND RETURN TO WORK

1. Reemployment Plan

2. Light, Limited, Modified, And Transitional Duty 3. Obligation to Rehire4. Division Sponsored Training and Education5. The Bottom Line: Return To Work

Phone (850)245-3470

EMPLOYER SHOULD MAINTAIN OPEN COMMUNICATIONS

WITH...Injured EmployeeHealth Care ProviderInsurance Carrier or Service CompanyOther Employees

Why? Avoid Possible Litigation Through Communications

THE EMPLOYEE MUST…

Report The Accident As Soon As It Happens And No Later Than

Thirty (30) Days. Failure to Do So May Result in Claim Being Denied…

Two (2) Years to File Petition for Benefits

s.440.185, (1), F.S.

BENEFITS PROVIDED BY LAW

Indemnity (Lost Wages)Employer Must Provide Necessary

Remedial Medical Care and Treatment Possible Screening, Job Placement

Assistance, Education & Retraining

WHEN AN ACCIDENT OCCURS THE EMPLOYER MUST...

Timely Complete and File All Forms

Call in (File) First Report of Injury or Illness (DWC-1)

Send to Carrier Within 7 Days of Knowledge (Except First-Aid Cases)

Send Both “Division” and “Carrier” Copy to Carrier

AVOID FINESAVOID FINESAND AND

PENALTIESPENALTIES

AND…1. Report Death Cases by Telephone,

Telegram, or Fax to the Division Phone (800) 219-8953

Within 24 Hours of Employer’sKnowledge of Death

2. Give Employee His/Her Copy of the DWC-1

TYPES OF ACCIDENTS

1. First Aid *

2. Medical Only

3. Lost Time

* Must Be Recorded on Form DWC-1 or an Alternate Division Approved Form, but Not Reported to Carrier

DWC-1

CONCURRENT CONCURRENT EMPLOYMENTEMPLOYMENT

(Working Two or More Jobs)(Working Two or More Jobs)

The Employee is The Employee is Responsible Responsible to Report Anyto Report AnyConcurrent EmploymentConcurrent Employment

If a Covered Employer, Must Add theIf a Covered Employer, Must Add theWages Into the AWW CalculationWages Into the AWW Calculation

s.440.02(28), F.S.

INJURY DEFINEDPersonal Injury or Death by Accident

Arising Out of and in the Course and Scope of Employment, and Such Diseases or Infection As Naturally or Unavoidably Result From Such Injury.

Dentures, Eyeglasses, Orthotics, Prosthetics Included, If Damaged in Conjunction With Accident.

NOT AN INJURYMental or Nervous Condition Caused

Only by Stress, Fear or ExcitementDisability by Acceleration or

Aggravation of Venereal Disease or Substance Abuse

Phobias Based on Ethnicity, Gender, Age or Handicap

EMPLOYEE’S RESPONSIBILITIES REGARDING

MEDICAL CARE 1. The Employee Must Request Medical Care and Treatment From Employer

2. The Employee Cannot Seek Treatment on His/Her Own Unless Employer Refuses or Ignores Request

3. Keep All Medical Appointments and Follow Instructions of Authorized Physician

AMOUNT & DURATION PAID TO THE INJURED EMPLOYEE?

Medical Documentation Determines Disability (Indemnity) Type

7 Day Waiting PeriodPaid 66 2/3% of Average Weekly Wage (AWW)AWW Calculated on 13 Weeks Prior to Accident (Excluding Week in Which Injury

Occurred), Similar Employee, or Contract of Hire.

INDEMNITY BENEFIT TYPES

Temporary Total Temporary Total at 80% Temporary Total

Rehabilitation Temporary Partial Impairment Income Benefits

Permanent Total Death Benefits ($7,500.00

Funeral)

104 Weeks Maximum for “Temporary Benefits”(including Temporary Total Rehab)

SETTLEMENTS s.440.20(11),(a),(b),( c),F.S.

Are Not Automatic or MandatoryUnder the Law

However…

SPECIAL SITUATIONS1. Driving To and From Work2. Horseplay/Fighting3. Breaks and Lunch4. Company Parties/Picnics5. Police Officers, Firefighters/Paramedics6. Traveling Employees7. Deviation from Employment8. Aliens

WHAT IF SELF-EXECUTION BREAKS DOWN?!

DisagreementsDisputesEarly

Intervention Program

Employee AssistanceOffice

Mediation

Hearing

INFORMAL DISPUTE RESOLUTION & FORMAL LITIGATION

Employee Assistance Office Phone (800) 342-1741

Mediators (Mandatory, Use State or Private Mediators)

Judges of Compensation Claims

1st District Court of Appeal

POP QUIZ (TRUE OR FALSE)

1. A Former Employee Comes to You and Says He/She was Injured 10 Years Ago. Employee Did Not Report it in the

Required 30 Days. Tell Them to Go Away.

2. Your Employee is on His/Her Way to Work, Stops and Picks Up Printing for You and is Injured in an Auto Accident on Way to Office. Employee is not Covered Because He/She is Not On the Clock.

3. You Must Report Medical Only and Lost Time Cases to Your Carrier but Not First Aid Cases.

4. MMI is an Acronym for More Money Invested.

5. You Have Four (4) People Working for You and are Required to Have Workers’ Compensation Coverage.

6. Two (2) of Those Employees are Part Time So You Don’t Have to Have Coverage.

7. As Long As You Have Coverage, You Can Never be Sued in Circuit Court.

POP QUIZ (TRUE OR FALSE) cont..

POP QUIZTRUE OR FALSE (Cont…)

8. Because it is so Common, Stress is Automatically Covered Under Workers’ Compensation in Florida

9. Temporary Indemnity Benefits are Limited to 104 Weeks Except for Rehab – Retraining Temporary Total.

10. Upon the Death of an Employee, the Total Amount Payable for Funeral Expenses is $10,000.

11. An Employer Must Report the Employee’s Injury to the Insurance Carrier within 45 Days

12. Injured Workers Receive Compensation of 66 2/3% of Their Take Home Pay the Week of Injury

QUESTIONS?