WORKERS COMPENSATION
PROCESS AND PROCEDURE
PETITION FOR
BENEFITS (PFB): A PFB is a claim filed with the Judge of
Compensation Claims (JCC) requesting a variety of issues. These issues
range from a request for a new doctor, authorization for surgery, or
reimbursement for mileage/prescriptions, to a request Temporary Total or
Temporary Partial Disability benefits. Each time we file a PFB, you will
receive a Notice of Mediation, Pretrial, and Final Hearing within 45 days
of the date the PFB was filed.
COMPENSATION OR
INDEMNITY: Compensation or money damages are often referred
to as indemnity. It is a repayment for lost wages from the insurance
company and it comes in three forms: temporary benefits, impairment
benefits, and permanent benefits.
Temporary benefits – an injured
employee is eligible to receive temporary checks for up to 260 weeks or 5
years. These benefits insure that an employee unable to work will receive
some form of income while he or she is receiving medical care to repair or
heal an on the job injury.
Impairment benefits – when your
doctor tells you that you are healed, or at MMI, maximum medical
improvement, then he will assign an impairment rating to your injured body
part. These ratings range from 1% - 20%. You will be paid a check based
upon that rating.
Permanent benefits – If you are
unable to return to any kind of work because of your accident, then you
will considered permanently disabled, and are entitled to compensation
checks for the rest of your life.
AVERAGE WEEKLY
WAGE (AWW): Your average weekly wage is an average of the
13 weeks pay you received for the 13 weeks before the week you were
injured.
COMPENSATION
RATE: The compensation rate is based upon the AWW. It is
calculated at 67 2/3 % of your average weekly wage. Your temporary checks
will usually be roughly 68% of your gross income from your paycheck. The
only difference is workers compensation income is not taxable income, so
you will not have to report it on your annual tax return.
MEDIATION:
Mediation is a Court ordered settlement conference where the
parties meet and attempt to resolve the specific benefit that you have
requested in your PFB.
Q: Who attends Mediation?
A: Yourself, Mr. Cameron, the attorney for
the insurance carrier, and the Mediator for the State of Florida. The
Office of Judge of Compensation Claims pays for the mediator’s time, you
are not charged.
Q: Where is the Mediation?
A: It is always held at the Judge of
Compensation Claims office in Pensacola or Panama City, and you are
required to attend in person.
Q: What is the Mediation about?
A: The Petition for Benefits we filed on your
behalf, and the benefits you are seeking which the insurance company has
refused or delayed to provide you.
PRETRIAL:
The pretrial is a conference between the attorneys’ and the judge,
where each side explains what the actual legal or factual dispute is
about. We discuss the depositions that have been taken, the evidence we
plan to present, and any problems we have in the case at that time.
Q: Do I go to the Pretrial?
A: NO. On most occasions, the pretrial
stipulation is exchanged between the attorneys prior to the date
scheduled, and the Judge accepts it and sets the trial.
FINAL HEARING or
FINAL MERIT HEARING: The Final Hearing is the trial for
the claim (PFB) we filed requesting benefits from the Employer/Carrier.
Yes, you will attend the Final Hearing with Mr. Cameron.
Q: Will I meet with Mr. Cameron before the
Final Hearing?
A: Yes, but it will depend on the issues of
the claim (PFB). Our office will contact you should Mr. Cameron find it
necessary to meet with you.
DEPOSITION:
A deposition is one of a number of procedural “discovery” methods used
by the attorneys to “discover” information about your case. The witness
is the individual who must take an oath and answers questions posed by the
attorney requesting the deposition.
Q: Who attends the deposition?
A: Yourself, Mr. Cameron, the opposing
attorney, and a court reporter. Sometimes, but rarely, a representative
of the employer.
AMENDED NOTICE:
Amended Notices are sent out by the Judge of Compensation Claims
office when something previously scheduled has been changed.
Q: When will I see “Amended”?
A: You will see “Amended” in front of
several events. Example: Amended Mediation, Amended Deposition, Amended
Hearing, etc. This is simply to tell you that this event has been
re-scheduled and disregard the original notice.
RESPONSE TO
PETITION FOR BENEFITS: When we file the claim (PFB) for
you the law requires the Employer or the Insurance Carrier to respond to
our claim for benefits. They must give the Court a reason why they
haven’t timely provided the medical benefit or the compensation benefit
(check) that you have requested. It does not require anything from you,
and you should not concern yourself with the response. This office will
inform you if we are concerned with the response.
NOTICE OF ACTION
CHANGE: A Notice of Action Change (DWC-25 form) means the
insurance company has changed something in your case. If you are receiving
Temporary Total, Temporary Partial, Impairment Benefits, Statutory
Impairment Benefits, or Permanent Total Disability Benefits, you will
receive a Notice of Action Change when these benefits are changed in any
way. Normally you receive this when they start the checks and when they
end the checks.
STATUE OF
LIMITATIONS: Statute of limitations control when you may no
longer ask the Court for more help. This normally occurs after one year
in Florida. Be aware that each workers compensation case is controlled by
the Statute of Limitations. If will be your responsibility to either
visit with the workers comp authorized treating physician at least one
time each year, or be receiving checks from the Insurance Carrier. Should
you fail to treat medically or receive a check for a one year period of
time, you may lose the ability to claim any future medical benefit or
compensation benefit from the insurance carrier. Simply put, your workers
compensation case expires.
SETTLEMENT:
Settlement of a worker compensation is a voluntary process that only
the injured worker can agree to. The Insurance Company cannot force you to
settle your case, and the Judge cannot order you to settle your case. The
Judge can only decide medical or compensation disputes you present in a
Petition for Benefits.
When a person settles their
worker compensation case, they settle both the medical and the
compensation parts of their case. They cannot receive any additional
medical care or treatment and the Employer and its Insurance Carrier are
not responsible for paying any medical bills you have not given to them.
Also, when you settle your worker
compensation case, the Court will contact all counties in Florida to
ascertain whether or not there are outstanding child support orders or
payments that you owe. If they find child support arrearages those funds
will be deducted from your settlement without discussion.
