My Workers’ Compensation Isn’t Covering the Full Cost of My Injury. What Do I Do?

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My Workers’ Compensation Isn’t Covering the Full Cost of My Injury. What Do I Do?

The workers’ compensation system can provide convenient access to benefits after an injury. However, workers’ compensation benefits may not pay the full amount of losses you have experienced as a result of medical care, lost wages, and out-of-pocket expenses. For example, in the state of Florida, workers’ compensation benefits only pay for 66 ⅔ of the total amount of income lost while you recover. Also, unlike third-party injury claims, workers’ compensation does not provide benefits for your own personal pain and suffering.

In the event of an injury case where workers’ compensation appears that it will not cover the needed extent of your financial losses, injured workers have two main options:

1. Dispute the case with the workers’ compensation insurance provider (this must be done before a settlement agreement is signed)
2. Explore your legal options for filing a liability claim against a non-employer third party

Both options can be exercised simultaneously. Seeking out the assistance of an experienced Florida work injury lawyer can help you determine the best legal strategies to use, and it can provide you with legal representation to defend your rights throughout the process.

Disputing a Denial of Benefits From a Florida Workers’ Compensation Insurer

Unlike most other states, Florida does not provide a workers’ compensation fund for businesses to pay into in order to receive coverage for their workers. Instead, every non-exempt employer must arrange to obtain their own line of workers’ compensation insurance from a private or commercial insurance carrier.

Unfortunately, Florida’s system has the effect of eroding some protections offered to injured employees in other states. There is no formal appeals system, and once a settlement agreement is signed, there are very few ways to request more benefits.

Despite these limitations, workers’ compensation carriers operate similarly to any insurance company. They set policies stating that they will only cover certain types of “reasonable and necessary” health care as well as related expenses. They also set policies that help determine your level of disability, in coordination with a company-selected physician examiner.

Most situations where there is a partial denial of benefits is related to these two areas. Either the insurer determines that certain expenses aren’t covered, or they will allege that your level of impairment is not consistent with the types of benefits you have requested.

When you have received a denial of workers’ compensation benefits in Florida, it is important to quickly dispute the findings of the insurance adjuster. When working with a Florida workers’ compensation lawyer, your attorney can examine the specific language of the policy along with the examiner’s documentation. You can also obtain an independent medical exam to serve as evidence of a misjudgment on the part of the insurance company-selected physician. 

Disputes should be raised as quickly as possible since benefits will be delayed until a settlement is signed. However, don’t feel pressured to sign a settlement until you feel as if you have been offered the maximum amount of benefits that should be available for your condition.

Filing a Third-Party Liability Claim After a Work Injury

When another person or company was involved in the circumstances of your injury, this is known as a “third party”. This third party may have contributed to your injury in part or in full. When this occurs, you may be able to file a negligence claim against the party seeking damages.

In order to prove negligence, the injured worker must be prepared to establish the following:

1. The third party had a duty of care that would have protected the injured claimant from harm
2. The third party violated their duty of care by failing to exercise the needed level of care
3. That breach in duty directly caused an injury
4. The injury sustained has real costs that can be recovered through the legal system

If that sounds complicated, it can help to illustrate some common scenarios in which a third party might commonly be held liable for an accident.

Car Accidents at Work

When another driver on the road caused a wreck that left you injured, the driver’s negligence could become a factor. This is one of the most common work injury scenarios involving a third party.

Negligent Contractors

General contractors are responsible for the conditions of a job site. This can refer to a construction site as well as any workplace that relies on contract labor to fulfill job duties. When a foreseeable hazard exists, such as a faulty safety railing, it is the responsibility of the general contractor to have the condition corrected in a reasonable timeframe

Subcontractors could also be found negligent if their actions contributed to a work injury. For example, a custodial services company that neglected to leave out a wet floor sign could be held responsible for the results of a slip and fall injury at work.

Property Owners

The owner of the job site or workplace property has a responsibility to maintain safe premises. Sometimes, this responsibility is delegated to a tenant or general contractor. But in other situations, the property owner has sole responsibility. For example, if a building were to partially collapse, it is likely the fault of the property owner for failing to obtain regular inspections and to keep up with maintenance on the infrastructure of the building.

Defective Products Manufacturers

Workplaces that use heavy equipment or that involve dangerous duties can see injuries that sometimes result from defective products. If a machine had inadequate safety measures, for example, or if a defective part broke during use and caused an injury, then the company could be held liable for the resulting damages.

Similarly, manufacturers of defective workplace fixtures, materials, and other objects could be held liable — not just equipment and tool manufacturers. When a cubicle design uses sharp metal edges that could deeply cut someone, for instance, this could be a situation where a defective product is to blame.

Defective products can also include substances. Asbestos, lead, and benzene are all common workplace contaminants that can cause occupational-related illnesses. Products manufacturers are liable when the products they create, distribute, or market has unreasonable risks that lead directly to a chronic or acute illness.

Work With Florida Injury Lawyers Who Can Help You Seek Full Compensation

When you don’t receive the full amount of benefits you need to recover, it jeopardizes the financial health and well-being of your entire family. It is a sad fact that insurers have a financial motivation to deny claims or deny coverage for certain benefits. The work injury attorneys at Hoskins, Turco, Lloyd & Lloyd can assist you in disputing this denial while exploring other avenues for claims against third parties.

Schedule a free, no-obligation case review with a workers’ compensation lawyer near you when you call 866-460-1990 or contact us online.