Your benefit eligibility will be controlled by the law in effect at the time of your injury. There were major substantive changes to the law in 2003, 1994, 1990 and 1979, so that each time period has slightly different regulations and laws.
Basically, there are two categories of benefits that are available: 1) medical benefits; and 2) compensation (also known as indemnity) benefits.
A. Medical Benefits. Under the law, you are entitled to all reasonable and necessary medical treatment as the nature of the injury and course of recovery require. This covers a very wide array of potential medical care to diagnose and treat your condition (including, but not limited to, doctors visits, hospital stays, prescriptions, assistive devices, diagnostic testing, surgery, physical therapy, mileage reimbursement for transportation to appointments and the pharmacy, nursing and attendant care and any other medical care that is necessary). However, while your employer and their workers’ compensation carrier are responsible for providing medical care, they are not responsible for paying for medical care that they do not authorize (with the exception of emergency care). This means that the insurance company must set up and authorize the physician before you receive the medical care. (You cannot go out and get your own medical care and expect the workers’ compensation carrier to pay for it except in a few very limited circumstances.)
B. Indemnity (money) Benefits. These benefits are money benefits for disability or impairment that are due to you when you are disabled (either totally or partially) or have a permanent impairment. There are several different types depending upon your date of accident.
All indemnity benefits are paid based upon a measure of your pre-injury earning capacity called the Average Weekly Wage (AWW). In general, subject to some exceptions, the AWW is determined by taking a 13 average of all gross earnings that you had during the 13 weeks preceding your date of accident (excluding the week in which the accident occurred). The formula for determining the exact AWW differs depending on your date of accident, but in most cases it will be the gross wages during the 13 week period plus the cost of the Employer’s contribution towards group health insurance benefits and housing (if the employer was providing those benefits, but no longer is).
As your authorized workers’ compensation physician treats your injuries he also will determine whether you should be working in your regular capacity, whether you should be restricted as to certain work activities, or whether you should stop working altogether. The following are some of the types of workers’ compensation benefits that you may be entitled to:
1. Temporary Total Disability (TTD). These benefits are paid if your doctor tells you to stay out of work and you have not reached the point of Maximum Medical Improvement (MMI). MMI is the date after which further recovery from or lasting improvement to your injury can no longer reasonably be anticipated by the doctor. These benefits are paid by the workers’ compensation insurance company every two weeks at the rate of two thirds of your AWW.
2. Temporary Partial Disability (TPD). These benefits are paid when your doctor has restricted you from employment in some way (for example, limits on your ability to lift, stand, bend, stoop, walk, crawl, climb, or use your hands) and you are not able to earn at least 80% of your AWW. Many employers (especially in the construction industry) will not offer any light duty work, but will instead tell you to go home until you are fully recovered. For accidents occurring after 01/01/1994 TPD benefits are determined based upon the following formula:
((AWW x .80) minus light duty earnings x .80 = TPD benefit).
TPD benefits are also payable up until the date of MMI.
3. Rehabilitation Temporary Total Disability. If you have reached the point of MMI and your doctor has given you permanent work restrictions that prevent you from performing the job that you held at the time of your accident, you may be eligible to be retrained for a different type of work that is not as strenuous as your prior job. The State of Florida Department of Vocational Rehabilitation (under the Florida Dept. of Education) evaluates injured workers for retraining. If accepted into a retraining program, the workers’ compensation insurance company is required to pay total disability benefits while you attend retraining classes. These Rehab TTD benefits can be payable up to a maximum of 52 weeks (subject to a limit of 104 weeks of temporary disability benefits per claim.)
4. Permanent Impairment Benefits. When you reach MMI, your doctor is required to determine whether you have suffered a permanent impairment under the Florida Uniform Permanent Impairment Schedule. If you have, the doctor will assign a percentage of impairment to the body as a whole. This percentage will entitle you to impairment benefits for a set number of weeks. For each percentage point up to and including ten percent, you receive 2 weeks; for 11 percent to 15, you receive 3 weeks per percentage point; for 16 to 20, you receive 4 weeks per point, and for 21 percent and higher you receive 6 weeks per percentage point. These benefits are paid based upon ½ of your AWW. However, if you’ve returned back to work and are actually earning equal to or more than your AWW, the impairment benefit is reduced to 25% of your AWW.
5. Permanent and Total Disability (PTD). If you are physically incapable of engaging in at least sedentary employment within a 50-mile radius of your residence, you may be entitled to PTD benefits (for accidents occurring after 10/1/03). While permanent and total disability exists, benefits are paid until the age of 75. There is also a 3% supplemental benefit (cost of living increase) which is payable until the age of 62.