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The Basics Of Benefits, Coverage, & Qualifying Injuries

The Basics Of Benefits, Coverage, & Qualifying Injuries
Workers’ Compensation Law In Florida: Benefits & Medical Care

Workers’ compensation law in in the State of Florida is designed to provide two primary classes of benefits to workers who have sustained injuries while actively engaged in their job duties. The first category encompasses indemnity benefits, including compensation for missed work time or earnings loss and reimbursement for certain expenses related to industrial accidents.

The second category is geared toward guaranteeing that workers have access to the medical care that they need. Here, it’s important to note that injured workers are entitled to continue receiving medical benefits for their entire lives, as long as the treatment is reasonable, medically necessary, and related to the initial accident.

Employers’ Responsibilities & Workers’ Compensation Coverage

In Florida, most employers are subject to the workers’ compensation law. The general rule is that any employer with four or more employees is legally required to have workers’ compensation coverage. However, there’s an important exception to this rule: Employers who have even one employee within the construction sector are legally required to secure workers’ compensation coverage, regardless of how small the team of employees is.

With this in mind, it’s important to note a special provision for individual owners of construction businesses. These employers have the choice to file for personal exemptions with the state. In such cases, these exemptions must be submitted before any potential accidents or injuries occur, rather than retroactively. This provision highlights the state’s commitment to protecting workers while offering flexibility to certain types of employers.

So, in short: Most, but not all employers in Florida are required to maintain workers’ compensation insurance. Employers with fewer than four employees who do not work in the construction industry have the option to decide whether or not to carry this coverage. This allows certain employers outside of construction the choice to opt in or out of coverage if they deem it beneficial for their business and employees.

What Makes A Qualifying Injury

A key part of workers’ compensation claims is determining whether the employee has a qualifying injury, formally known as a compensable injury. A compensable injury occurs when:

  1. An accident occurs while an employee is engaged in the course and scope of their employment.
  2. The injury or accident arises out of the employment.

Injuries That Arise Out Of Employment

As of August 2023, the rules of determining whether an injury “arises out of employment” have been a topic of extensive litigation in the Florida legal system. In fact, a recent appellate case illustrates the complexity of this issue.

In the appellate case, an employee was shot when returning to the main office from a rental car kiosk on the worksite. However, factors in the case suggested that the shooting occurred due to tension unrelated to the nature of the man’s employment. So despite this work-related context, the court ruled that the accident did not arise out of employment. Its verdict hinged on the determination that the shooting, despite taking place at the workplace and during work hours, was not directly tied to the nature of employment.

This scenario underscores the complexities involved in assessing whether an injury is genuinely connected to employment. As the law continues to evolve, those who suffer workplace-related injuries that fall in the gray area of “arising out of employment” would be well-advised to seek experienced legal counsel. While straightforward cases, like a carpenter accidentally injuring themselves with a nail gun while on the job, are more easily identifiable, the differences between qualifying and non-qualifying injuries can be very subtle and require deft legal consideration.

Injuries That Occur In The Course Of Employment

Under workers’ compensation law, the term “in the course of employment” holds a very specific meaning. It specifically refers to situations when an accident or injury happens while an employee is actively performing work tasks directly tied to their job. This definition goes beyond just physical engagement in work and includes times when an employee is still connected to their job-related responsibilities.

For instance, consider an electrician who is injured in a motor vehicle accident while traveling between work sites during the workday. Even If they are not physically engaged in a specific task directly related to work at that moment, the injury is still considered to have occurred in the course of employment. This acknowledges that activities like work-related travel are naturally tied to their employment.

In essence, the term “in the course of employment” accounts for the bigger picture in which work-related accidents or injuries happen. It serves to ensure that employees are protected under workers’ compensation coverage for incidents that are closely linked to their job duties, whether or not they are physically performing a task at the precise moment of the incident.

Injuries That Occur When Coming And Going

The “coming and going rule” is an important concept in Florida workers’ compensation law. Generally, it outlines that employees who operate from a fixed workplace location are not eligible for compensation if an accident occurs en route to or from work, as opposed to when they are actively performing their job duties. The “coming and going” rule clearly separates the time spent in transit and the time spent engaged in job-related activities.

For example, consider a paralegal who lives five miles away from the law firm at which they work. The time they spend traveling from home to work is considered as “coming and going” – not as part of their actual job. As you can see, this rule is essential for employees and employers alike, as it underscores the criteria for eligibility when it comes to workers’ compensation claims related to accidents or injuries occurring during the commute.

Ultimately, what matters most is that the employee was actively working, regardless of whether they were physically. The main criteria are rooted in the concept of whether the injury arises out of the employment and if the employee was in the course of performing work-related tasks. This approach ensures that the complexities of modern work arrangements, like remote work, travel, or other non-traditional setups, are appropriately accounted for in determining eligibility for workers’ compensation benefits.

Florida’s No-Fault System

In the context of Florida workers’ compensation law, being partially at fault in an accident that leads to a workplace injury is inconsequential in most instances. This is due to the foundational principle that Florida’s workers’ compensation is a no-fault system. In this framework, the focus shifts away from assigning blame and instead centers on making sure that employees are granted compensation when in the course and scope of their employment, with injuries directly linked to their job duties. In practice, this means that even if an employee contributed to the circumstances leading to their injury, the question of fault is largely set aside.

The main focus is on providing timely support and assistance to injured workers, regardless of whether they had any part in causing the incident. This approach shows a strong commitment to keeping workers safe and fostering a system that prioritizes their protection. In the end, Florida’s workers’ compensation law follows a fundamental principle: If an employee is injured on the job and their injuries are connected to their work, they can get compensation without having to prove fault (or a lack thereof).

For more information on Workers’ Compensation Law In Florida State, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (386) 388-6260 today.

Working For Workers

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(386) 388-6260
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