Everybody always says that if you get hurt at work, you’ll be taken care of through workers’ compensation. Your Tampa workers’ comp lawyer will explain that your medical care will be taken care of by your employer’s insurance carrier.
The question is whether there’s a limit to how much the insurance company will cover in medical bills. The short answer to this question is – no.
Your Tampa Workers’ Compensation Attorney Must Prove You Qualify for Benefits First
Before you think about whether your medical bills will be covered, your Tampa workers’ compensation attorney must prove that you qualify for benefits. You are not automatically entitled to benefits simply because you claim that you suffered a work-related injury.
Even if you meet the basic criteria for workers comp, there is no guarantee that your employer will approve your claim. If your employer doubts that your injuries were caused at work, they will advise the insurance company to reject your claim.
What Are the Criteria for Workers’ Comp Benefits in Tampa, Florida?
To qualify for workers’ compensation, your workers’ comp lawyer in Tampa must demonstrate that you meet the following criteria.
- Your injuries occurred while you were acting within the normal scope of your employment.
- Typically, your injuries must take place on company time and on company property.
- You must report your injuries within 30 days.
- You cannot be under the influence of drugs or alcohol at the time of your workplace accident.
- You must submit to a drug test prior to treatment.
- You must agree to be treated by a state-approved workers’ compensation doctor.
If you meet these criteria, there is a very good chance that your claim will be approved.
Your Employer and Their Insurance Company Will Have the Option of Approving or Denying Your Claim
Once you submit your workers’ compensation claim, your employer will have seven days to review it. Before the seven days are up, they must submit a notice of your injury to their insurance carrier.
When they submit their paperwork, your employer must indicate whether they are filing a “medical-only claim” or a “lost time claim.” There is a big difference between the two claims.
A medical-only claim is filed when an employee is injured but will not miss more than seven (7) days of work. A lost time claim, on the other hand, is when an employee is seriously injured and is expected to miss more than seven (7) days from work.
If Your Claim is Approved, You’ll Receive Your Benefits in a Matter of Weeks
Usually, if your workers’ compensation claim is approved, you’ll start to receive your benefits in a matter of weeks. It is important to point out that you will not be paid for the first seven (7) days that you miss work.
Once you have missed your eighth day, your benefits will take. If you happen to miss more than twenty-one (21) days, without interruption, you will be entitled to a retroactive payment for the first seven (7) days.
Why Would Your Employer Deny Your Workers Comp Claim?
There are times when your employer may deny your workman’s compensation claim. If this happens, make sure you let your workers comp lawyer in Tampa know immediately.
Some of the more common reasons that we have seen workers comp claims be denied include the following:
- Your employer does not believe your injuries occurred while you were working.
- Your employer or the insurance carrier thinks that you are exaggerating your injuries.
- The workers’ compensation doctor that examines you states that you are not injured at all.
- You were under the influence of drugs or alcohol at the time of your workplace accident.
- You have only been with the company for a couple of months.
- You have a history of filing workers’ compensation claims.
- You refuse to be treated by a worker’s compensation doctor.
Of course, this list is not exhaustive. Your Tampa workers’ compensation attorney can certainly explain some of the other reasons why your claim may have been denied.
If Your Claim Is Approved, You Will Receive Two Types of Benefits
Presuming that your claim is approved, you will receive two different types of benefits. The good news is that your Tampa workers’ compensation attorney will ensure that you receive the benefits that you’re entitled to.
The first type of benefit that you’ll receive is medical coverage for your work-related injuries. The second type of benefit that you’ll receive is weekly replacement wages, which will be equal to 2/3 of your average weekly wages.
You’ll Receive Weekly Benefits Equal to Two-Third Your Average Weekly Wages
As briefly mentioned above, once your claim is approved, you’ll start to receive weekly benefits. These benefits will be equal to 2/3 of your average weekly wages.
When your employer submits your workers’ compensation claim to the insurance carrier, they must also submit your employment payroll records. Specifically, they must provide the insurance company with the last thirteen (13) weeks of your wages.
For example, if you normally make $1,000 a week, you will receive $666 per week while on workers comp.
Medical Treatment for Your Work-Related Injuries Will Be Covered as Well
In addition to weekly benefits, you will also be entitled to medical coverage for any treatment you need. Your medical care will be limited to treatment for work-related injuries only.
If your workers comp doctor believes that some of your injuries existed prior to your workplace accident, they will let the insurance company know. The insurance company may decide that they’re not covering all your treatment at that point.
If this happens, make sure you let your workers comp lawyer in Tampa know right away.
Your Medical Care Will Only Be Covered Until You Attain Maximum Medical Improvement
Your medical care will only be covered until you have reached something called maximum medical improvement. At some point, your doctor is going to conclude that you will not benefit from further treatment.
When this time comes, your Tampa workers’ compensation attorney will be notified. You will be expected to return to work, and your benefits will cease.
Your Tampa Workers Compensation Attorney Can Get a Second Opinion
If your workers’ comp lawyer in Tampa doesn’t believe that you have reached MMI, they can get a second opinion. It’s important that you understand that maximum medical improvement does not mean that you are 100% recovered.
Maximum medical improvement simply means that any future medical treatment would be futile.
The Odds of Exceeding Your Employer’s Policy Limits Are Low
If you are afraid that, at some point, your benefits will be cut off because of your employer’s policy limits, don’t be. Your employer is required to carry sufficient workers comp insurance to cover all workplace injuries suffered by their employees.
It is nearly impossible that any one employee would need such an inordinate amount of medical care that they would risk exceeding the company’s policy limits.
Let Your Workers’ Comp Lawyer in Tampa Help You Along the Way
Our workers’ comp lawyers in Tampa understand that the workers’ compensation system can be confusing. This is why we suggest you contact our office as soon as possible and schedule your free, initial consultation.