Under the Florida Workers’ Compensation Law, the employer/workers compensation carrier is required to compensate the injured employee during any period of disability with many limitations. There are four different types of disability benefits which you may be entitled to—(1) Permanent Total Disability (PTD); (2) Temporary Total Disability (TTD); (3) Temporary Partial Disability (TPD); and (4) Impairment Benefits (IBs). Your entitlement to these benefits can be tricky, so it is important that you talk with an attorney who handles workers' compensation law.
Each of these benefits considers the injured employee’s average weekly wage on the date of accident. Therefore, it is important that there is a clear understanding what is considered an employee’s “average weekly wage.”
Your average weekly wage is based upon your reported earnings and certain fringe benefits for the 13 weeks prior to your date of accident. Such fringe benefits may include health insurance benefits paid by your employer, employer, housing, car allowance, etc.
If the injured employee has not worked in such employment during substantially the whole of 13 weeks immediately preceding the accident, the wages of a similar employee in the same employment can be used.
If the employee is a seasonal worker, then the employee may use instead of the 13 weeks immediately prior to the accident, the calendar year or the 52 weeks immediately preceding the accident.
Wages earned in a second job can also be incorporated into the calculation of the average weekly wage. The employee is responsible for providing information concerning the loss of earnings from the concurrent employment. The carrier is not subject to penalties until after this information is provided.
An injured employee is entitled to Temporary Total Disability benefits when his or her authorized worker’s compensation doctor finds that the injured employee cannot work at all because of the industrial accident. A temporary total disabled employee receives just 66 2/3% of his or her Average Weekly Wage up to the maximum amount determined by the Division of Workers’ Compensation and is paid biweekly. These benefits are payable for a total of 104 weeks in combination with Temporary Partial Disability benefits OR until injured employee reaches Maximum Medical Improvement (“MMI”).
If the injured employee is able to return to work on a modified basis such as light duty and is earning less than 80% of his or her Average Weekly Wage, the injured employee is entitled to Temporary Partial Disability benefits. To determine the amount of TPD benefits, you must look to see how much the injured worker is able to earn on light duty. If he or she earns 80% or more of the AWW, then no TPD benefits are paid. If they earn less than 80% of the AWW, then the injured worker is entitled to 80% of the difference between 80% of her weekly AWW minus what the employee earned. These benefits are only payable for a total of 104 weeks in combination with Temporary Total Disability benefits OR until injured employee reaches Maximum Medical Improvement (“MMI”).
The workers’ compensation carrier and/or his or her attorney is required to provide the injured worker with Employee Earnings Report forms. These forms should be submitted once a month to the carrier by the employee reflecting any and all monies the employee has received during the said period.
Once the injured employee reached Maximum Medical Improvement (“MMI”), all temporary benefits end. In order to receive Permanent Impairment Benefits, the injured employee’s physician must opine that the injured employee has sustained a permanent impairment rating as a result of the work related injury and has reached maximum medical improvement (MMI).
If necessary, an authorized treating physician will assign a permanent impairment rating on the date of MMI or after a total of 104 weeks of temporary total disability/ temporary partial disability benefits have been paid. Should some physician assign an impairment rating, the injured employee is entitled to impairment benefits paid at the rate of 50% of his/her compensation rate (compensation rate is 66 2/3 of the average weekly wage).
These benefits are to be paid bi-weekly at a rate the rate of 75% of the worker’s compensation rate (not to exceed the maximum compensation rate). However, such benefit shall be reduced by 50 percent for each week in which the employee has earned income equal to or in excess of the employee’s average weekly wage.
The duration of these benefits depends on the injured employer’s impairment rating. For each percentage point of impairment from 1 percent up to and including 10 percent, two weeks of benefits are to be paid. For each percentage point from 11 percent up to and including 15 percent, three weeks of benefits are to be paid. For each percentage point from 16 percent up to and including 20 percent, four weeks of benefits are to be paid. For each percentage point from 21 percent and hire, six weeks of benefits are to be paid.
In the case of permanent total disability, the carrier is responsible to pay two-thirds of the employee’s average weekly wage during the continuance of the total disability. However, in most situations, entitlement to PTD benefits end when the employees reaches age 75. If the accident occurred on or after the employee reaches age 70, benefits shall be payable for a maximum of 5 years.
To be entitled to permanent total disability benefits, the injured employee must not physically capable of engaging in at least sedentary employment. The employee must establish that he or she is not able to engage in at least sedentary employment within a 50-mile radius of the employee’s residence due to his or her physical limitation.
The injured employee must apply for Social Security benefits and cannot be receiving Unemployment Compensation. Permanent and Total Disability benefits until the injured employee dies or is no longer permanently and totally disabled.
If death results from a work-related accident within one year thereafter or follows continuous disability and resulted from the work-related accident within five years thereafter, the employer/insurance carrier is required to pay death benefits. The employer/insurance carrier shall pay actual funeral expenses not to exceed $7,500.00. Further, the employer/insurance carrier shall pay the deceased employee’s dependents up to two-third of the deceased employee’s average weekly wage depending on the type of dependent (spouse, child, parent, etc.). In addition, the carrier would be responsible for payment of school of the surviving spouse. The maximum the employer/insurance carrier has to pay to the family for the death of an employee is $150,000.00.
The workers’ compensation statute contains a provision that allows the employer/carrier an offset against disability benefits in certain situations when the claimant receives either social security retirement or social security disability benefits. These provisions where intended to prevent a claimant from being paid twice and ending up with more income while on disability than while employed.