A Step-By-Step Guide
When employees suffer a work-related injury or illness, they are expected by law to seek retribution through their employers’ workers compensation insurance. Unfortunately, the process is not always straightforward, as the steps needed to obtain fair compensation may vary depending on the case. Worse yet, insurance companies routinely seek to limit how much compensation they award, with many cases being denied or awarded insufficient compensation to cover the injured worker’s medical expenses and lost wages.
Fortunately, our workers comp attorney, Ken Hesser, has years of experience representing and helping injured workers get the compensation they so rightfully deserve. Contact us today to schedule a case consultation.
In the meantime, learn more about the workers compensation process, what steps you need to take, and what to expect.
1. Report The Injury/Illness To Your Employer
In most cases, employees have up to 30 days to report a work-related injury or illness to their employer. However, we recommend you do so as soon as possible to ensure you get the financial and medical support you need right away. Failing to report to your employer on time could bar you from compensation entirely. The report can be oral or in writing but check to see if your employer has any special procedures.
2. Await A Decision
Soon after you report the injury or illness, you should receive a copy of the “First Report of Injury or Illness” (filed to your employer’s insurance company) and a brochure explaining your rights. If you qualify for compensation, you should start receiving benefits in the form of bi-weekly checks in the mail within 21 days since reporting the injury or illness. At this point, if everything has gone smoothly and you’re satisfied with your compensation, there’s nothing else left to do.
3. Try To Resolve Any Disputes With Your Employer & Their Insurer First
If you do not receive any checks or notifications from your employer’s insurance company within 21 days, or if the insurer raises a dispute against your claim, try to resolve the dispute with your employer and its insurer first before proceeding. Doing so is a necessary step required by Florida law and referred to as a “good faith effort.” If you’re unable to reach a favorable agreement with your employer and its insurer, you may then file a petition.
Regarding Managed Care Grievance Procedures
In some instances, if you do receive benefits but are dissatisfied with the amount or the insurer refused to cover a specialist treatment, you may need to go through a “managed care grievance” process before you can file a petition. If so, you may have to request and file a grievance form provided by your employer’s insurer. For your legal protection, remember to make a copy of all documentation received and submitted.
4. Contact A Workers Comp Attorney To Help You File A Petition
While the law does not require you to hire a lawyer to help you file a workers comp petition, doing so could significantly improve your chances of obtaining a favorable ruling. The claims process can be challenging to navigate and may include additional steps depending on the claimant’s particular situation. Nonetheless, filing a petition correctly is crucial to obtain the compensation you deserve.
With years of experience helping injured workers get the compensation they deserve, our workers comp lawyer, Ken Hesser, is your best ally against greedy insurance companies. Using his wealth of knowledge of the insurance industry, he will fight to maximize your compensation and ensure your claim goes through.
5. File & Serve The Petition
In most cases, injured workers have up to 2 years, from the date of injury or illness, to file a petition to the clerk’s office at the Office of the Judges of Compensation Claims (OJCC). You must also serve a copy of the petition to your employer and its insurer. Failing to provide the necessary information could result in a dismissed claim. To help ensure the process goes smoothly and without delay, seek legal counsel.
The petition form requires a significant amount of information, ranging from basic contact information to detailed descriptions of the accident and medical costs. Our experienced workers comp attorney, Ken Hesser, can help you fill out the form correctly and on time to avoid any complications. He can also advise for or against taking alternative approaches, such as suing your employer, based on your circumstances and winning chances.
6. Mediation & Hearings
Depending on the case, the OJCC may or may not order mediation. If it does, the injured worker, their lawyer, the employer, and its insurer will negotiate an agreement. If the parties fail to reach an agreement, the case goes to a pre-trial hearing, and then a final hearing before a Judge of Compensation Claims (JCC). Please note that some cases may skip negotiations and go straight to a final hearing.
At the hearing, the claimant must put forward evidence for their case — i.e., how the injury occurred and the extent to which it has hindered the claimant. While the law allows claimants to represent themselves in negotiations and hearings, seeking professional legal representation can significantly improve a claimant’ chances of obtaining a favorable outcome. Following the final hearing, the workers comp judge decision should arrive within 30 days.
7. Appealing The Decision
Claimants have 30 days after the final hearing to file a workers comp appeal letter to the JCC’s decision with the First District Court of Appeal. This court will then affirm, reverse, or reopen the decision for more proceedings. Consult our workers comp appeal guide for more information regarding this process or contact our law firm to schedule a consultation with our workers comp attorney, Ken Hesser.