Pensacola Workers’ Compensation Lawyers

Even if you are injured on the job, the insurance company can still deny your workers’ compensation claim. Sometimes they deny your claim for strategic reasons, like wanting to push you to settle, and sometimes they deny the claim as they may believe that they are not liable for the accident or injuries. It is important to know that the insurance company is not the final word. 

Under Florida law, you have a right to have an Administrative Law Judge who is knowledgeable of the workers’ compensation system hear your case and determine if you are entitled to workers’ compensation benefits.

However, you should contact an experienced worker’s compensation attorney to handle your case and to guide you through the complicated law. The attorneys at Talbott & Lampert, PA are experienced workers’ compensation attorneys and will provide you a free consultation to discuss your case.    

Under the Florida workers’ compensation law, once you reach maximum medical improvement, you are entitled to two types of benefits: impairment benefit or permanent total disability benefit. 

Impairment benefits are a nominal amount of benefits, usually a few thousand dollars, which compensate you for your impairment based on the permanent impairment rating that the physician has provided you. 

For example, if the physician gives you a 3% impairment to the body as a whole, you’re entitled to six weeks of impairment benefits.  If you have returned to work and are making the same amount of money as you were at the time of the accident, then the impairment benefits are simply 50% of your average workers’ compensation check.  If you have not returned to work or are not making the same as you were at the time of the accident, then the impairment benefits are 75% of the average compensation check. 

Impairment benefits cease when you’ve been paid the specific number of weeks of impairment benefits.  However, if an employee is unable to return to any type of gainful employment, then the employee could be entitled to permanent total disability benefits.  It is very hard to prove entitlement to permanent total disability benefits so you need to talk to your attorney about whether you would qualify.

If an employee is permanently totally disabled, then they are entitled to two-thirds of their average weekly wage until approximately age 75 (with exceptions).  The employee may also be entitled to a cost of living increase at the rate of 3% per year. 

Unfortunately, if the employee is not permanently totally disabled, then they would only be entitled to impairment benefits.  This leaves a significant gap for an injured worker who has a significant wage loss as the result of the injuries.

Maximum medical improvement (MMI) is simply a date, selected by your treating physician, where he indicates that you are “as good as you’re going to get”.

MMI does not mean that you are not having problems, that you are not having pain, or that you’re better. It just means that lasting improvement is not expected to occur within the next year.

Maximum medical improvement is important as it establishes the date for which temporary total disability benefits or/and temporary partial disability benefits cease. After the date of maximum medical improvement, the employee would be entitled to impairment benefits or permanent total disability benefits.

Under the workers’ compensation law, the treating doctor must communicate with the insurance company about your medical care and need for treatment. 

However, the nurse case manager does not have the right to go into the room with you when you are seeing the doctor. The employee has a right to control who attends the doctor appointments and has the right to keep the nurse case manager out of the room during the appointment.  We suggest that our clients do not have the nurse case manager come into the room when the employee is seeing the doctor as this often interferes with the doctor/patient relationship and because the nurse case manager may try to persuade the doctor to limit the medical care that you are entitled to. 

If you do not want the nurse case manager in the room with you, then simply advise them that you want to see the doctor without them in the room.

Many insurance companies like for the employee to use the insurance company’s mail-order pharmacy or local discount pharmacies, as it saves the insurance company money. However, this often causes issues with the employee getting the prescription filled or delays authorization for the prescription.

The employee does not have to use the insurance company’s pharmacy and is entitled to select the pharmacy that they want to use. At the Law Office of J.J. Talbott, we also recommend using companies such as Injured Workers Pharmacy as they provide significant help to injured employees.

The average weekly wage (AWW) is the claimant’s average weekly earnings during the 13 weeks prior to the on-the-job accident.

The AWW is important as this is the monetary amount for which the insurance company will calculate temporary total, temporary partial, permanent impairment, and permanent total disability benefits. Specifically, if the employee has worked for the employer for the entire 13 weeks prior to the accident, then the AWW will be equal to all the wages the employee earned during those 13 weeks and divided by 13. However, if the employee does not work the entire 13 weeks, then the carrier has to use other methods to obtain the average weekly wage.

Many employees indicate that they are treated differently once they file a workers’ compensation case or indicate that the employer makes them work with restrictions.  As such, they indicate that they want to quit their job.

At the Law Office of J.J. Talbott, we do not recommend any employee quit their job.  If you quit your employment, then the employer will have a defense that you voluntarily limited your income and this could prevent you from receiving any type of temporary partial disability benefits or permanent total disability benefits.  Quitting your job could also reduce the value of your case.  Instead, we recommend that the employee make sure that the employer provides work within the restrictions and not work outside of the restrictions.

If you think your employer is making you work outside of your restrictions, you need to speak to an attorney immediately, but do not quit your employment.

In most cases, filing a workers’ compensation claim is your exclusive recourse for an on-the-job injury. Although you cannot sue for damages such as pain and suffering, there is a benefit in not having to go to court and prove negligence or fault in order to recover, provided you have the help of an experienced workers’ compensation attorney to guide you through the process.

There are limited instances where you can sue, however. For instance, if your employer engaged in willful or intentional misconduct which could be said to lead with a virtual certainty to an employee injury or death, you may be able to sue for the injuries caused. You might also be able to sue if your employer does not have workers’ compensation insurance. Additionally, you may have a cause of action against a negligent third party if you were injured by a defective product, in a car accident, or on another’s dangerous property, even if you were working at the time.

Any time that you are injured in an accident, we suggest that you immediately report the injury to your employer. Under Florida workers’ compensation law, an employer has a defense to a workers’ compensation case if the employee does not report the injury within 30 days (90 days if it is an occupational exposure case).

While an employee may injure themselves and think that they will simply get better, not reporting the accident and not seeking medical care may act to invalidate the employee’s workers’ compensation claim and/or establish a defense or the carrier of late notice. Therefore, notify your employer of the accident immediately. If the employer refuses to provide medical care, then put it in writing, whether by email, fax or have someone witness you reporting the accident to your employer.

Under the Florida Workers’ Compensation Law, the employer chooses all authorized treating physicians. However, if the employee is unhappy with their choice of treating physician, then they have a right to a one-time change in treating physician.

The employee must request this one-time change, usually in writing, and the employer has five days to select a new physician. If the employer selects the physician within five days, then the employer chooses the new physician. However, if the employer/carrier does not select a physician within five days, then the employee is entitled to select the treating physician.

Please note that you are only entitled to a change in treating physician for one time during the entire course of treatment. As such, at the Law Office of J.J. Talbott, we recommend that our clients do not select a change in treating physician early on in the case as it may be necessary to change doctors at a later date.

Initially, you are required to see a doctor designated by your employer, or more specifically, by your employer’s workers’ comp insurance carrier. If unhappy with the doctor, in Florida you are allowed to make a written request for a different doctor, but you can only do this one time. If the carrier doesn’t respond to your request within five days, you can choose your own lawyer to treat you. In Alabama, if unhappy with your doctor, you can select another doctor from a panel of four doctors provided to you.

When the doctor you see is chosen by and works for the insurance company, you may feel like they are biased, and this may be so to a certain extent. You are not prohibited from getting a second opinion from a doctor you trust. This will be at your own expense, but it may help you in your case to receive benefits and the proper treatment. Ask your attorney if unsure of what to do.

The number of denied Florida workers’ compensation claims has increased over the last 10 years and now exceeds 10%.  If the insurance company is going to deny your claim, they are required to file a Notice of Denial with the Florida Division of Workers Compensation.  You should receive a copy of the Notice of Denial.  However, sometimes the insurance company may wait to deny your workers’ compensation claims: Florida Law allows them 120 days to pay and investigate your claim if they are uncertain of their responsibilities.

Some reasons that the insurance company may deny your claim include:

• The application for Compensation was late or incomplete
• Discrepancies between the accident report and the claimed injuries.
• The employee did not seek medical care from the employer’s doctor.
• The injury did not happen at work.
• The employer claims a pre-existing condition
• There were no witnesses to the accident
• The injury was caused by the employee or the use of drugs
• No Medical evidence that an injury occurred

The attorneys at Talbott & Lampert, PA are experienced workers’ compensation attorneys and will provide you a free consultation to discuss your case. Contact us today.

A medically necessary treatment is any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to your diagnosis and status of recovery, and is consistent with the location of service, the level of care provided, and applicable practice parameters. Such treatment should be widely accepted among healthcare providers and not be experimental in nature.

As you can see, terms like “medically necessary treatment” have both medical and legal components to them. See an approved doctor for your diagnosis and treatment, but see an experienced workers’ compensation attorney when filing your claim or appealing a denial of benefits.

The workers’ compensation laws in Florida and Alabama are very complex.  While the law was initially drafted in order to provide the claimant medical care in a quick fashion, the insurance company usually takes every opportunity to prevent the employee from getting medical care or limit the amount that they have to provide the employee for medical and/or indemnity benefits. 

That is why we recommend that you at least get a free consultation with a worker’s compensation attorney, like the attorneys at the Law Office of J.J. Talbott, as they can help the employee understand the workers’ compensation law, can provide quality advice and can assist you in obtaining all the benefits that you are entitled. 

Under the Florida Workers’ Compensation system, an insurance carrier can select to provide benefits under a managed care arrangement. If the carrier has elected to provide benefits under a managed care arrangement (MCA), then this provides the claimant additional rights, but greater duties in order to seek medical care.

Perhaps the most significant duty or obligation of the employee is that they have to exhaust the managed care agreement procedure prior to seeking assistance from the judge compelling medical care. Specifically, under most managed care arrangements, if the insurance carrier does not authorize care, then the employee has to request the medical care from the insurance adjuster, the medical care must be denied, then the employee must file a grievance, and the grievance procedure must be exhausted before the employee can seek help form the Court.

Unfortunately, this causes some delay in getting medical care authorized. On the other side, the MCA does provide additional benefits to an employee, which we feel are very helpful. For example, under most managed care arrangements, the employee is entitled to a change in treating physician, they are entitled to a second opinion, they’re entitled to an employer paid independent medical examiner (the employee actually gets to choose a doctor and have that physician issue an opinion concerning their need for medical care or treatment), and very importantly, the claimant is entitled to their choice of primary care physician.

A primary care physician is usually a general practitioner doctor, or family practitioner, and acts as a gatekeeper for the claimant during the entire course of care. Many insurance carriers imply that this would be the urgent care physician or the first physician that the claimant sees, but this is not necessarily so. Likewise, the claimant gets to choose their primary care physician. This provides the claimant some significant benefit in controlling their medical care.

Often, the workers’ compensation carrier delays paying medical bills for various reasons. In our practice, we have had employees communicate concerns that the carrier’s failing to pay the medical bills will affect their credit.

Under Florida Law, if the insurance carrier authorizes treatment, then the insurance carrier, and not the employee, is responsible for the payment of medical bill. If the carrier does not pay the medical bill, then the employee may be required to seek assistance from the Division of Administrative Hearing to get the medical bill paid.

At the Law Office of J.J. Talbott, we help our clients to get their medical bills paid by using other laws and statutes against the insurance company.

Under the Florida’s Workers’ Compensation Law, an injured employee does not receive “lost wages” while they’re recuperating from their injury, but instead they may be entitled to temporary total or temporary partial disability benefits.

Specifically, if you are taken totally off work by your treating physician, then you’re entitled to temporary total disability benefits. If you are returned to work with restrictions, then you may be entitled to temporary partial disability benefits.

These benefits are not intended to totally compensate the employee for their lost wages, but intended to provide the employee some money while they’re recuperating.

Moreover, an injured worker is only entitled to receive temporary total disability benefits or temporary partial disability benefits up to the point that they reach maximum medical improvement. Once they’ve reached maximum medical improvement, the employee would then become eligible for either impairment benefits or permanent total disability benefits.