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How Florida Workers' Compensation Works-Indemnity Benefits Under Florida Workers’ Compensation Law,1

Chapter 2

Show Me the Money: Indemnity Benefits Under the Florida Workers’ Compensation Law

Part 1

When you suffer an on-the-job injury, the Florida workers’ compensation law entitles you to certain indemnity benefits (money) to replace your lost income while you recover. These benefits don’t fully reimburse you for your lost wages; the amount you receive depends on your past earnings as well as the work restrictions placed on you by the doctor authorized to treat you for the work injury.

Under Florida law, you will not be paid for the first seven days that you are injured unless your injury results in disability for more than 21 days. In that case, you will be paid back for the first seven days after the injury. Generally speaking, you can expect your first check 21 days after your accident. Your money benefits are tax-free.

Average Weekly Wage

The amount of money you get will be based on your “average weekly wage" (AWW). Your average weekly wage is calculated using the wages you earned in the 13 weeks prior to the date of your injury, not counting the week you were hurt. If you worked less than 75% of the prior 13 weeks with your current employer, the wages of a similar employee who did work 75% of those weeks will be used to make the calculation. If there is no similar employee who meets this test, then your full-time weekly wage will be used.

The average weekly wage may also include employer-paid fringe benefits such as health insurance, rent, and housing or lodging. If the employer discontinues these benefits, then in many cases you will be entitled to an increase in your average weekly wage. Be sure to report any change in benefits to your attorney so that the proper increase in your average weekly wage can be made.

If you were working more than one job when you got hurt, you are entitled to have the earnings from both employers combined in the calculation of your average weekly wage. This only applies if the employer at your second job carried workers’ compensation insurance. It is your responsibility to inform the insurance company of these additional lost wages. If you have any questions about this, you should talk to your attorney.

Types of Indemnity Benefits

The Florida workers’ compensation law provides for six kinds of money benefits:

· temporary total disability (TTD)

· temporary partial disability (TPD)

· permanent partial disability (PPD) or IBs

· permanent total disability (PTD)

· rehabilitation temporary total disability

· death benefits

Which category of benefits you’re eligible for depends on several different factors that I’ll cover below.

Temporary Total Disability Benefits

Temporary total disability (TTD) benefits are available if you’re injured and your authorized doctor places you on a “no work" status while you recover. If this happens, you are entitled to receive a check for 66 2/3 % of your average weekly wage. Temporary benefits are paid every two weeks. You should receive a check until one of the following situations occurs.

If you reach overall maximum medical improvement (MMI), then your TTD benefits will stop. MMI means that your authorized doctor determines that there are no other treatment options that will improve your condition. In other words, you’re as good as you’re going to get. This does not necessarily mean that you won’t have pain or other symptoms and won’t require any further treatment; it just means that any further treatment will only alleviate your symptoms or maintain you at your current level of functioning. It is possible for one doctor to put you at MMI and not another. If this happens, you would not be considered to be at overall MMI, and you could remain eligible for temporary benefits.

Under Florida law, you are entitled to a maximum of 104 weeks of temporary benefits, which includes both TTD and TPD (this is called “statutory MMI"). When you reach the 104-week mark, your benefits will be cut off, regardless of your medical condition, even if a doctor has not put you at overall MMI.

Temporary Partial Disability Benefits

If your authorized doctor says that you can return to work with some physical restrictions (e.g., no lifting more than 10 pounds, no prolonged standing or walking, etc.), you are entitled to temporary partial disability (TPD) benefits. If this occurs, it’s important to contact your employer immediately. You may forfeit your right to benefits if your employer can accommodate the restrictions. If you do go back to work but find that you can’t do the work within your restrictions, you should notify your doctor and your attorney immediately.

The amount of TPD benefits that you will receive depends on your work status. If you return to work but earn less than 80% of your AWW, then you are entitled to benefits equal to 80% of the difference between 80% of your AWW and the weekly salary you’re earning when you go back.

For example, if your AWW is $500 and your employer has a job for you licking stamps that pays $200 per week, your TPD would be calculated this way:

· $400 (80% of $500)-$200(amount earned licking stamps) = $200

· 80% of $200 = $160

· Weekly TPD benefit = $160

Your employer may not always be able to accommodate your restrictions. The employer is not required to create a job for you.

In the example above, if your employer wasn’t able to accommodate your restrictions, your TPD benefit would be $320. The calculation would be as follows:

· $400 (80% of $500)

· 80% of $400 = $320

· TPD benefit = $320

You could lose your TPD benefits if you’re terminated from your post-injury employment for misconduct or if you’re found to be voluntarily limiting your income. Before you make any decision regarding your work status, you should contact your attorney to discuss how it might affect your claim.

Permanent Partial Disability Benefits

Permanent partial disability benefits, also known as impairment income benefits (IBs), are based on the percentage of your total body that is impaired as determined by your authorized doctor. When your doctor determines that you’ve reached MMI, he will assign you a permanent impairment rating. This impairment rating is determined by using established medical guidelines. You will receive money benefits for a certain number of weeks based on the percentage of your impairment . For each week, you will receive a monetary benefit equal to 75% of your weekly TTD benefit.

The number of weeks you will receive IBs works this way:

· 1%-10% impairment rating: 2 weeks for each percentage point

· 11%-15% impairment rating: 3 weeks for each percentage point

· 16%-20% impairment rating: 4 weeks for each percentage point

· 21%-99% impairment rating: 6 weeks for each percentage point

Permanent Total Disability Benefits

In certain situations, your on-the-job injury may be so severe that you are unable to return to the work force. If this happens to you, you may be entitled to permanent total disability benefits (PTD). To qualify for PTD benefits under the Florida workers’ compensation law, you must meet at least one of two sets of criteria.

If you have suffered one of the following catastrophic injuries, the law presumes that you are permanently and totally disabled, entitling you to PTD benefits:

· spinal cord injury involving severe paralysis of an arm or leg or the trunk

· amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage

· severe brain or closed-head injury as evidenced by:

o severe sensory or motor disturbance

o severe communication disturbance

o severe complex integrated disturbance of cerebral function

o severe episodic neurological disorder or

o other severe brain and closed-head injury condition at least as severe in nature as any condition provided above

· second- or third-degree burns of 25% or more of the total body surface or third-degree burns of 5% or more to the face and hands

· total or industrial blindness

However, even if you have suffered one of these injuries, the employer or its insurance carrier can overcome the presumption of permanent and total disability by establishing that you can still work.

Even if you don’t have one of the listed catastrophic injuries, you can still establish entitlement to PTD benefits by proving that because of your injury, you cannot do at least a sedentary job within a 50-mile radius of your home. To prove this, you must have medical evidence from your authorized doctor showing that your on-the-job accident caused a permanent and total disability and that you can’t work even at a sedentary level. A determination about whether your injury is permanent cannot be made until you’ve reached MMI.

Once you’ve established permanent and total disability, you will be entitled to a weekly check equal to 66 2/3 % of your AWW. This money benefit will continue until you reach age 75 unless you are ineligible for Social Security disability benefits. You will also be entitled to weekly supplemental benefits equal to 3% of your weekly compensation multiplied by the number of calendar years since your injury. This supplement usually ends at age 62.

Additional resources provided by the author

To learn more about Workers' Compensation claims please go to our website at www.sullivanandhepler.com or call us at 1800-295-4193 to discuss your case.

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