Workers' compensation insurance provides certain benefits for employees hurt while at work. In exchange, employees agree not to sue their employers.
Who Must Provide Coverage
Workers’ compensation requirements depend on the industry in which the employer operates. Non-construction industry employers must get coverage if they have at least four full- or part-time employees. Agricultural employers must get coverage if they have at least six regular employees or 12 seasonal employees who work at least 30 hours per week.
Construction companies must get workers' compensation insurance if they have at least one employee. Construction companies that hire subcontractors must get proof of insurance from the subcontractors. If a subcontractor doesn’t have insurance, the construction company must get coverage for the subcontractor.
Who’s Eligible for Coverage
All employees are eligible for coverage if the company is required to have coverage. Non-construction sole proprietors and partners working full-time are also eligible for coverage. Independent contractors in the construction industry are also considered employees, thus are eligible for coverage. Employees who work outside of the state, but work for a company that operates in Florida, are also eligible for coverage.
Companies don’t need to provide coverage for workers who aren’t considered employees. These include independent contractors who work outside of the construction industry and casual employees. Companies also don't need to provide coverage for volunteer workers, taxicab and limo drivers. Essentially, coverage is not required for people belonging to the independent contractor category.
What Must Coverage Include
Coverage must include benefits for employees who are hurt while at work. Benefits include payments for medical care, wage replacement and death benefits for dependents. Medical care benefits include physician visits, hospital stays, and physical therapy and prescription drugs.
The state recognizes four types of disabilities that warrant reimbursements for lost wages:
- Temporary Total Disability
An employee who can’t work at all because of injuries can get 66 2/3 percent of the wages he earned at the time he got hurt. The first seven days is a waiting period, and the worker no payment unless he remains disabled for at least 21 days.
- Temporary Partial Disability
The employee can return to work, but with restrictions. Payments depend on the average weekly wages she earned the 13 weeks just before the incident occurred, her current wages and the year she became ill. Benefits are payable for up to 104 weeks.
The treating physician gives an impairment rating to employees who have conditions that will get better over time. Compensation in this category depends on the year the employee became disabled, the employee’s average weekly wages, the impairment percentage and whether the employee returned to work.
- Permanent Total Disability
In this category, the condition will not improve further, and injuries are so severe the employee can’t return to work.
If the worker dies within a year of the work-related injury or remains disabled for at least five years, the insurer must pay funeral expenses up to $7,500. The insurer also must pay compensation benefits to the dependents and educational benefits to the spouse. The state caps death benefits at $150, 000.
How To Resolve Benefit Disputes
If the insurer or employer denies a claim, the worker can contact the Employee Assistance and Ombudsman Office. The office investigates disputes and helps to mediate claim issues. The service is offered free to workers. If a claim can’t be resolved at this level, a worker can file an appeal with the Office of the Judges of Compensation Claims. The OJCC adjudicates disputes over workers’ compensation benefits. Workers who have representation can file online, otherwise they can visit the office in Tallahassee or fax their application.