Law Firm Blog

What is the Workers’ Compensation Claims Process in Florida?

Job injury victims are entitled to significant benefits, but insurance companies don’t give away these benefits.

This process almost always includes an initial denial. Since 2013, the initial workers’ compensation claim denial rate has increased 20%. Eventually, most job injury claims are paid. But frequently, job injury victims settle their cases for pennies on the dollar. Understandably, they are eager to take what they can get and try to move on with their lives. However, if job injury victims settle for less, the prospects for complete recovery dim considerably.

These prospects brighten considerably if a job injury victim partners with a Tampa workers’ compensation lawyer. Frequently, an attorney’s mere presence convinces the workers’ compensation insurance company that the victim means business and will not settle for anything less than maximum benefits. An attorney’s litigation and negotiation skills raise a claim’s settlement value even further. These benefits usually include lost wage replacement and payment of reasonably necessary medical bills.

Benefits Available

Most job injury victims receive two-thirds of their average weekly wage (AWW) for the duration of their temporary disabilities.

In most cases, the AWW is not just the average net pay from the last five or six paychecks. Net pay is just the beginning.

The AWW also includes non-cash compensation, like per diem and tuition reimbursement. Furthermore, the AWW looks forward as well as backward. If a job injury causes Steve to miss performance bonus milestones and overtime opportunities, his wage replacement benefit must reflect those losses.

Likewise, hospitalization is only the beginning of the medical bill payment benefit. This benefit also covers transportation, follow-up care, prescription drug, medical device, and physical therapy costs. Frequently, a Tampa workers’ compensation lawyer works with an independent doctor to determine a reasonable amount for future medical bills.

Initial Review

An attorney makes a big difference at an appeal hearing. But an attorney is handcuffed during an initial paper review. Claims Examiners often make decisions based on the medical bills and nothing else.

Additionally, Claims Examiners use procedural loopholes whenever possible. For example, if Steve’s workers’ compensation claim doesn’t include an obscure form, the Claims Examiner might deny his claim without even reviewing its merits.

Initial review often includes a second-look Claims Examiner review. Unless the initial examiner made a clear error, like losing part of the file, second-look examiners almost never overrule initial denials. Second-guessing someone else’s decision is always bad for office morale.

Insurance companies hope that early denials discourage victims and prompt them to abandon their claims. It’s important to realize that a denial, even a dual denial, doesn’t mean your claim is weak or meritless. Instead, a denial is just part of the process.

ALJ Appeal

The aforementioned handcuffs come off at an Administrative Law Judge appeal. ALJs allow lawyers to introduce evidence, challenge evidence, and make legal arguments. Basically, an ALJ appeal is like a trial without a jury or court reporter.

Insurance companies know they have the advantage of initial reviews, which is why the initial rate is so high. Likewise, insurance company lawyers know they are at a disadvantage when the ALJ considers an appeal. Therefore, many workers’ compensation claims settle out of court, and on victim-friendly terms, prior to the ALJ appeal.

Count on a Reliable Hillsborough County Workers Compensation Lawyer

The road to maximum benefits in a job injury case is often long and bumpy. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact the Rooth Law Firm. We do not charge upfront legal fees in these matters.