In Miami, most employers must have workers’ compensation insurance in case of on-the-job injuries. If you suffer a workplace injury, you can file a claim and seek compensation for your medical expenses, lost wages, and potential disability, regardless of fault.
Unfortunately, your employer and their insurance company may try to minimize the value of your claim to save money. It is essential not to let them take advantage of you and deny you the rightful compensation you deserve. To protect your rights and pursue the maximum compensation available to you, it is vital to enlist the services of a proven and diligent Miami workers’ compensation lawyer and Miami personal injury lawyer.
How Does the Workers’ Comp System Work in Miami?
In Miami, eligible employers must purchase workers’ compensation insurance coverage from private insurers. Alternatively, an eligible employer may obtain the state’s certification for self-insurance. All workers’ compensation claims in Miami come under the purview of the Florida DWC (Division of Workers’ Compensation.)
Florida operates on a no-fault system for workers’ compensation. It means you are not required to prove your employer’s negligence to obtain benefits. If your injury occurs on the job or is caused by work-related activities, you are typically eligible for workers’ comp benefits.
Injured workers can receive various benefits, such as:
- Temporary disability benefits (to compensate for income loss)
- Impairment benefits (to compensate for permanent limitations, such as amputations)
- Necessary and reasonable medical treatment and care
- Vocational rehabilitation (education or training in a different field of work)
How to Initiate a Workers’ Compensation Claim in Miami?
To start the workers’ comp claim process in Miami, you must report your workplace accident and resulting injury to your employer within 30 days from the date you become aware of it or when your doctor diagnosed it as work-related. Failing to report within this timeframe may result in claim denial.
If you have a valid workers’ comp claim, it is prudent to act swiftly and follow the correct procedures to avoid complications. Workers’ compensation covers various injuries and illnesses, providing medical treatment, wage replacement, and various other benefits.
You could be eligible for benefits if you sustain an injury in the workplace or during work-related activities off-site. Additionally, if your existing health condition worsens or a new health complication develops during your employment, you may also be eligible for workers’ compensation in Miami.
The first step is to ensure that your employer carries workers’ compensation insurance. Your employer is required to participate in Florida’s insurance program if one or more of the following conditions are met:
- The employer is a local or state government agency.
- The employer has at least four full-time or part-time workers
- A construction business employer has at least one employee (including the business owner if they work in their company).
- A farming industry employer has at least six regular workers or at least 12 seasonal workers (hired for more than 30 days)
Which Industries Suffer the Most Workplace Accidents in Miami?
While workplace risks exist in various industries, there are three major sectors in Miami where workplace injuries are more prevalent: the construction, agriculture, and healthcare industries. Many personal injury cases are also filed by workers in these industries to pursue damages from negligent third parties.
Construction Industry
The construction business in Miami has high incidences of work-related accidents and injuries due to working at dangerous heights, operating heavy machinery and tools, unsafe construction sites, and insufficient personal protective equipment (PPE).
Agriculture Industry
The agriculture business also sees an above-average incidence of work-related accidents and injuries due to demanding physical labor in tough conditions, working with heavy agricultural machinery, exposure to toxic chemicals, and working in the harsh sun. Accidents involving tractors, ATVs, and other commercial vehicles are common in this sector.
Healthcare Industry
The healthcare business experiences a relatively high incidence of work-related accidents and injuries due to strenuous work, extended work hours, and dealing with hazardous medical materials. Injuries or illnesses among healthcare workers may include spinal cord injuries, head injuries, infectious diseases, and repetitive stress injuries.
Process After Reporting a Workplace Injury in Miami
Once you report your injury to your employer, they must notify their insurance carrier within a week. If your employer fails to report your injury, you can directly inform the insurance provider. The insurance adjusters will then assess your eligibility for workers’ comp benefits through an investigation process that may involve checking medical documentation, assessing job experience, skills, wages, medical examinations, and functional capacity evaluations.
According to state law, the insurance carrier should approve or deny the claimant’s workers’ comp benefits as soon as possible. Upon claim approval, you will begin receiving disability payments apart from other entitled benefits. However, it is important to note that workers’ compensation claims in Miami are often initially denied by insurance carriers. Therefore, you should consider getting good legal representation to pursue your Miami workers’ comp claim.
Types of Workers’ Compensation Injuries in Miami
Work-related injuries in Miami can range from minor to severe, resulting in disability, permanent disfigurement, workplace illnesses, stress, anxiety, and more. Some of the most severe injuries include traumatic brain injury, spinal cord injury, amputation, internal organ injury, burns, eye injuries, hearing loss, broken bones, repetitive stress injuries, sprains, strains, tears, cuts, punctures, lacerations, and disfigurement.
Workers’ compensation also covers occupational illnesses that develop over time due to workplace exposure. Occupational illnesses may include black lung disease, asbestosis, mesothelioma, and cancers. Proving a work connection for occupational illnesses can be challenging, requiring strong medical evidence linking the condition to workplace exposure.
Appealing a Denied Workers’ Compensation Claim in Miami
Not all workers’ compensation claims are approved as expected, and it can be disappointing to have a valid claim denied. While you have a right to represent yourself during the appeals process, injured workers generally have better outcomes when represented by an experienced and knowledgeable Miami workers’ compensation attorney to navigate the complexities of dealing with insurance companies and workers’ compensation boards.
To appeal a denied claim, you can first attempt to engage in negotiations with the insurer and file an appeal with them internally. If that doesn’t yield favorable results, you should file an appeal with the Florida DWC. Initiate the appeal process by filing a petition with the clerk of court in the OJCC (Office of the Judges of Compensation Claims). The appeal petition should include details about the accident, injuries, lost wages, and specific benefits you are seeking.
In Miami, there is a deadline for filing formal appeals. You are required to file the appeal within one year from your last treatment date. By hiring a diligent Miami workers’ comp lawyer to represent your claim, you can easily meet the necessary deadlines and increase your chances of a successful appeal.
What Happens After Filing an Appeal in Miami?
The OJCC Board of Appeals will review your case and notify your employer and the insurance company. The employer has two weeks to submit their response to your claim upon receiving notice. If they fail to respond, the legal theory of implied consent will apply, and the insurer will have to pay the claim.
In most cases, the employer’s insurance carrier will respond to the appeal, leading to a formal hearing if there is still disagreement regarding the benefits to be paid. Dedicated Miami workers’ compensation attorneys can provide support and capable representation during the judicial setting of the formal hearing.
Frequently Asked Questions
Do I need to pay income tax on my workers' compensation payments?
No, workers’ compensation in Miami is typically not subject to income tax. But if you return to work on limited or light work duty while still receiving care from your authorized physician, you will need to pay income tax on the wages you earn during that time.
When can I receive my first check?
Your first check should reach you within three weeks after you report your workplace injury to your employer.
If I have a temporary disability, how long will I receive these checks?
You can get Temporary Total or Partial Disability or a combination of both benefits for up to 104 weeks while you remain disabled.
Can I get workers’ compensation and social security benefits simultaneously?
Yes, workplace accident victims can receive both benefits at the same time. However, there may be a reduction or offset in your workers’ comp amount to ensure that the combined total is not in excess of 80% of your weekly wage before the injury occurred.
Can I get workers’ comp benefits and reemployment assistance simultaneously?
No, you cannot receive both benefits simultaneously. To qualify for unemployment benefits, you should be medically fit and available to work.
Injured at the Workplace? Protect Your Right to Receive Workers’ Compensation in Miami
Work-related injury claims in Miami can be complex, but you don’t have to navigate them alone while struggling with injuries and loss of work. 1-800-Injured is an attorney and medical directory service that can connect you with experienced Miami workers’ compensation lawyers. Call today to schedule a free consultation.