Workers’ Compensation: Benefits The Employer Or Employee?

Daniel Stahl was working as a nurse for Hialeah hospital in 2003, just a few months after the state made changes to its workers’ compensation system. During one of his workdays, Stahl lifted a patient and ended up injuring his back from the movement. In October of 2005, his treating physician found he had reached his maximum medical improvement (MMI) and assigned him to a 6 percent impairment rating. At this point, he was entitled to impairment income benefits stretching 12 weeks and compensated for $5,472. He was eventually left with a permanent impairment and was restricted from lifting heavy weights—eventually ending his career. Still, it was later determined that Stahl did not meet the definition of permanent total disability (PTD) and his claim for PTD benefits was denied. He was then forced to pick up a teaching position at a nursing school.

Background Information

According to the Insurance Journal, “In his petition to the court, Stahl claims that the benefits available to him, and all injured employees since October 1, 2003 when state’s workers’ comp reforms went into effect are “inadequate and therefore cannot be the exclusive remedy for on the job injuries.” The court documents filed say the state’s workers’ comp law, as it is today violates the U.S. Constitution. The plaintiffs also argue that the Florida legislature has eliminate injured employees’ right to sue and the availability of partial disabilities benefits without providing an adequate replacement. The suit also takes issue with the addition of a copay for medical visits after a claimant reaches their MMI.”[1]

As such, the petitioners help to argue what many worker’s comp advocacy groups have been stressing since the implementation of changes. To advocates, Florida’s lawmakers have disregarded worker’s rights in several instances, including retracting the right to withdraw from the system in 1970, reducing the temporary disability benefits limit to 104 weeks in 1993 and approving the 2003 amendment removing benefits for partial disability. Before such measures, temporary total disability benefits were limited to 350 weeks, while temporary permanent disability benefits were not to exceed five years [2].

Having to play into the worker’s comp system means that employees must give up their right to sue their employers for negligently inflicted injures in exchange for all over coverage. While this is the essence of workers’ comp–American workers used to rely on that compact in exchange for if/when they were to be injured on the job, their employers would pay for their medical bills and enough of their wages to help them get by while they recovered. Where other states allow the employees to opt out, in Florida, employees are getting the raw end of the deal; they have no choice but to suffer through the possibility of being denied coverage. As proof of this denial, ProPublica described in their article that they found, “Florida has cut benefits to its most severely disabled workers by 65 percent since 1994.”

They also found that, “Many states have not only shrunk the payments to injured workers, they’ve also cut them off after an arbitrary time limit—even if workers haven’t recovered.” What makes all of this worse is that there has been no federal government involvement after they stopped monitoring state workers’ comp laws more than a decade ago.

How does Florida’s Workers’ Comp Work Against You

In several ways, the laws that govern Florida’s workers’ compensation process works against the employee, rather than the employer or insurance company.

  • The law limits the amount of times you can receive worker’s comp payments. As described in the situation with Stahl, the system is built to get people back to work as soon as possible, sometimes overlooking proper treatment in favor of paying out lower amounts. As such, once doctors release you back to work, the insurance company does not have to keep issuing workers’ comp reimbursements to the injured employee, forcing an employee to go back to work, even when they aren’t 100% recovered.
  • The insurance company picks the doctor. Knowing that the doctor’s diagnosis is critical to the amount of benefits you receive, insurance companies vet out doctors that end up restricting benefits by giving the insurance company a diagnoses that allows them to deny coverage. The process of going to the doctor is to prove that you have suffered a work-related injury and to recommend a treatment plan, but if the doctor is employer-friendly, they may not offer up the best solution; they would rather offer up the option with minimal impact for insurance companies to pay out. By doing so, they may gloss over an underlying problem so that you get back to work before you really should.
  • There is no protection of your job. As the last two issues have stated how the program ensures that some employees will go back to work without fully being recovered, another issue is that there is no guarantee that your job is still there. Employers do not have to hold open the job for you for when you are able to return to work.
  • It’s challenging to validate disability. The insurance company is concerned with limiting liability and payouts to inured employees. To achieve those objectives, they will often deny benefits if the injured employee is able to perform any other job. That means that if you are injured to the point where you cannot perform your usual job, but there is another job you can perform, you could be denied benefits. Even if this job pays substantially less than your previous job, it doesn’t matter. As long as you are working, the insurance company does not have to fill the gap [3].

Dolman Law Group

Laws also make it tough for workers’ compensation attorneys to get paid. Lawyers are not paid directly by the clients they represent; rather they are paid either by the employer through a payout from the insurance company or directly by the insurance company. Other times, attorneys aren’t paid until the case is settled, which could take a long time. These restrictive and employer-friendly laws and policies make it even more imperative to consult an experienced workers’ compensation attorney in Clearwater.

If you or a love one has sustained an injury while working, it is important to speak with a workers’ compensation attorney to discuss your rights and legal remedies. The worker’s compensation carrier may provide some reason for denying your benefits that sounds legitimate or follow along with the discrepancies mentioned in this post. It’s often a difficult and challenging time, thus, it is crucial to get the proper representation. This is our job. The attorneys at Dolman Law Group have extensive experience in handling workers’ comp benefits and insurance carriers/ employers. Let us help you get what you deserve today. Contact us at (727) 853-6275 for a free consultation.

Dolman Law Group
5435 Main Street
New Port Richey, FL 34652
(727) 853-6275

https://www.dolmanlaw.com/legal-services/workers-compensation-attorneys/

References:

[1] http://www.insurancejournal.com/news/southeast/2016/01/31/396949.htm
[2] http://www.law360.com/articles/741932/hospital-urges-fla-high-court-to-end-workers-comp-fight
[3] https://www.propublica.org/article/the-demolition-of-workers-compensation

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