THE DIVISION OF WORKERS’

COMPENSATIONPresents

AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM FOR EMPLOYERS

Chapter 440Florida Statutes

Lloyd Harger, Phone (850) 410-3925E-mail: HargerL@dfs.state.fl.us

TOPICSTOPICSWhat is Workers’ Compensation? What’s the Purpose?Who Are the Major Parties in the System?Why Do We Have “Workers’

Compensation?”What Role Does the Division Play?

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

GOVERNOR’S COMMISSION ON WORKERS COMPENSATION

REFORMThe Relative Availability and Affordability

of Workers’ Compensation Insurance in Florida As Compared to Other States With Similar Relevant Characteristics.

Impediments to Quick Resolution of Disputes and Statutory Changes Necessary to Facilitate Quicker Resolution of Workers’ Compensation Cases.

GOVERNOR’S COMMISSION ON WORKERS’ COMPENSATION

REFORM

Major Cost Drivers in the Workers’ Compensation System and Statutory Changes Necessary to Reduce the Cost of Workers’ Compensation Insurance in Florida.

The Adequacy of Compensatory Benefits for Injured Workers and Statutory Changes Necessary to Equitably Compensate Injured Workers in the Workers’ Compensation System.

MAJOR PARTIES IN THE FLORIDA SYSTEM

EMPLOYEES

EMPLOYERS

Health Care ProvidersRehabilitation Providers Insurance Carriers/AgentsAttorneys/JudgesGovernment AgenciesGeneral Public

EMPLOYER MUST HAVE COVERAGE IF...

1. Employer Has Four (4) Or More Employees 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

BUREAUBUREAU OFOF

COMPLIANCECOMPLIANCE

Phone (850) 488-2333

EMPLOYER MAY OBTAIN COVERAGE BY...

Purchasing a Standard Policy on the Open Market

Individual Self- InsuranceGroup Self- Insurance FundJoint Underwriters

Association

PolicyPolicy

HOW MUCH DOES IT COST?

Type of IndustryAmount of PayrollExperience

Modification

INSURANCE PREMIUM DETERMINATION

Employers Manual Rate = Payroll/100 Times Class

Code Rate Experience Rating Drug Free Workplace Program Credit Safety Credit Other Debits and Credits

INSURANCE PREMIUM DETERMINATION

Overall Rate Level ChangeIndustry Group Changes

Manufacturing Contracting Goods & Services Office & Clerical Miscellaneous

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 ProgramDOI--Department of InsuranceAHCA--Agency for Health Care AdministrationFIRG--Florida Impairment Rating Guide

WHAT IF...?What If It’s His/Her Fault?What If It’s Due to the

Employer’s Negligence?If the Employer has Coverage,

Can They Still be Sued?

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) 921-6966Laboratories, 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 Rehire

4. Division Sponsored Training and Education5. The Bottom Line: Return To Work

“Welcome Back to the Team”

Phone (850)488-3431

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

PENALTIES FOR EMPLOYER’S LATE FILING

DWC-1 First Report of Injury or Illness up to $500.00

DWC-1a Wage Statement $10 Per Day Up To $100

Delays in Filing Forms Delays Benefits to Injured Employees Phone (850) 488-2031

Bureau of MonitoringBureau of Monitoring and Auditand Audit

ADDITIONAL FORMS TO BE

COMPLETED BY EMPLOYER

1. DWC-1a Wage Statement*

2. Complete and Send to Carrier Within 14 Days of Knowledge Of Lost Time Case

3. Give Employee Copy *Average Weekly Wage is a Highly Litigated Issue

EMPLOYER MAY FURNISH NECESSARY MEDICAL CARE

THROUGH A MANAGED CARE ARRANGEMENT*

Agency for Healthcare AdministrationNot Mandatory for Employers After October 1,

2002Carrier Submits Plan of Operation

Agency for Healthcare Admin. (850) 922-6830 or (850) 922-6481 * Employer’s Choice

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

INDEMNITY BENEFIT TYPES

Temporary Total Temporary Total at 80% Temporary Total

Rehabilitation Temporary Partial Impairment Income Benefits Supplemental Income Permanent Total Death Benefits

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

401 Weeks From Date of Accident for All Indemnity Benefits Excluding Permanent Total

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

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..

QUESTIONS?