There is a procedure in Florida Workers Compensation that allows an injured worker to file a Petition for Benefits ("PFB") to contest an insurance company's denial of benefits. The insurance company can choose to provide medical benefits, yet deny wage benefits; provide wage benefits, but deny medical benefits; or deny a workers compensation claim entirely. A PFB is a formal complaint filed with the State of Florida that sets forth the benefit that is being sought. Once the PFB is filed, the workers compensation Judge is required to schedule a mediation within a certain time period after the filing of the PFB.
Mediation is a face to face negotiation with the insurance company to attempt to resolve any benefit disputes that may exist. It is also the time when you will have a chance to obtain a "lump sum" settlement of your case. The mediation will take place with an impartial mediator employed by the State of Florida. Sometimes the insurance company will agree to pay for a private mediator for more complex cases, or for cases that appear as if they may settle. It is at mediation that a discussion of settling your claim usually will take place.
Insurance companies are interested in settling workers compensation cases for a variety of reasons, but usually because the insurance company can limit any future financial exposure to paying benefits to the injured worker. When an insurance company and an injured worker in Florida agree to settle the workers compensation claim, the insurance company will pay a lump sum of money in exchange for the injured worker to close his/her workers compensation claim, and agree to not seek any further medical treatment or wage benefits through workers compensation.
Settling a Claim
The amount of money a workers compensation insurance company will pay to settle a claim varies from case to case. The settlement amount is based primarily on the amount of financial exposure an insurance company has to any particular claim in the future. For example, for an injured worker that has completed his medical care, has had an excellent recovery and returned to work without any need for future medical care, wage benefits or vocational re-training, an insurance company will not offer a large amount to settle because there is very little future benefits it will have to pay for. However, for an injured worker that has been placed at Maximum Medical Improvement (MMI), but still needs more medical care, is not physically able to return to work, or needs job re-training to return to work, an insurance company will be more motivated (i.e. will pay more money) to settle the claim because it realizes its exposure is much greater.
Do You Have to Resign From Your Position?
One issue that always is raised in a Florida workers compensation settlement is whether the injured worker has to resign his position when settling his workers compensation claim. The facts about this worker's compensation requirement varies from employer to employer, and from insurance company to insurance company, but an injured worker should seek advice from an experienced Florida workers compensation attorney before settling his/her claim to make sure you obtain the maximum amount without giving up very valuable rights.
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