Workers’ Compensation And Indemnity Benefits
Indemnity benefits (money benefits) can be categorized into five areas. Compensation in workers’ compensation cases MUST fall into one of these categories in order to be payable. The only other circumstances where a workers’ compensation insurance carrier will pay money to a claimant is a) an advance, b) medical mileage reimbursement or c) a lump-sum settlement of the claim.
The five categories of indemnity benefits are:
Temporary Total Disability Benefits
If a doctor believes that an injured worker has not reached the level of maximum medical improvement, and should be completely off of work as a result of an injury, the person is entitled to receive Temporary Total Disability Benefits. These benefits are paid at a rate of 66 2/3% of the claimant’s average weekly wage. Average weekly wage is established by taking the average of the claimant’s earnings for the 13 weeks before the industrial accident. If a person did not work substantially the whole of the 13 weeks before the accident (at least 75% of those weeks), then alternate methods are used. One alternate method would be to determine whether there exists a similar employee who was performing the same type of work at the same rate of pay for a similar number of hours per week. If there was no similar employee, then the claimant’s actual earnings could be used during the limited period of time after the accident.
Temporary Partial Disability Benefits
If an individual who has not reached the level of maximum medical improvement, (i.e., a temporary disability capacity) has been released to return to some type of work within certain restrictions by his authorized treating physician, he is potentially eligible for temporary partial disability (TPD) benefits. During this period of TPD eligibility, the issue is whether the claimant is able to earn at least 80% of their average weekly wage despite the existence of the restrictions. If the individual is not able to earn at least 80% of their average weekly wage but is able to earn something, then calculations would be made based upon the total earnings made by the injured worker. If there is no work available for the claimant within his/her restrictions either with the employer with whom the claimant was employed at the time of the accident or another employer, then the injured worker would be eligible to 64% of their average weekly wage. While an injured worker is in a TPD status, it is common to complete Employee Earnings Reports or a DWC-19 form. Additionally, under certain circumstances, an injured worker in a TPD status may be obligated to document job searches.
Rehab Temporary Total Disability Benefits
If an individual who has achieved the level of maximum medical improvement is unable to earn at least 80% of his/her compensation rate (compensation rate is the figure that is two-thirds of the average weekly wage), he/she may eligible for retraining services through the Division of Workers’ Compensation. The state of Florida will provide tuition, books, and other material services to an injured worker if the state believes the individual possesses the necessary skills and aptitude to be enrolled in a state-sponsored retraining program. If such a program is awarded, the individual would become eligible for up to 52 weeks of rehabilitative temporary total disability benefits through the carrier. These benefits would be provided for an initial period of 26 weeks which could be extended by an additional 26 weeks if the person continues to be enrolled in the state-sponsored program and is making sufficient academic progress.
The RTTD benefits are available only if the claimant is enrolled in a state-sponsored program. The claimant cannot pursue a private rehabilitation program and then seek rehabilitative temporary total disability benefits through the state of Florida.
The total number of weeks of eligible rehab benefits falls within the overall cap of 104 weeks of temporary benefits. As such, if the claimant exhausts a certain number of weeks of temporary total and/or temporary partial disability benefits during their recovery process, they will only be eligible for the number of weeks remaining within the 104-week cap.
Impairment Income Benefits
In Florida workers’ compensation cases, once an individual has achieved the level of maximum medical improvement and an impairment rating has been assigned, the claimant becomes potentially eligible for impairment income benefits. These benefits are paid at the rate of two weeks for each percentage of impairment through 10%, three weeks for impairment ratings between 11-15%, four weeks between 16-20%, and six weeks for any percentages in excess of 20%. If an individual otherwise eligible for impairment income benefits has returned to work at his average weekly wage or greater, then the amount of the impairment income benefits to which he is entitled is reduced by 50%. This formula applies to Florida workplace injuries with a date of accident subsequent to Oct. 1, 2003.
Permanent Total Disability Benefits
Under the Florida Workers’ Compensation Act, an individual can qualify for permanent total disability benefits if he/she can demonstrate that they are unable to engage in any type of employment within a 50-mile radius of their home as a result of injuries sustained in a workers’ compensation accident. This is a very strict, difficult standard to meet, particularly for individuals in fairly large metropolitan areas, with many job opportunities available. Permanent total disability is properly thought of as a combination of a claimant’s physical capabilities coupled with their vocational background. Physical restrictions reference the individual’s residual capability to engage in certain types of physical activities. Vocational preparation refers to an individual’s age, educational background, past relevant work experience, and the transferability of any skills that they may have acquired in the course of their life to that point.
If an individual qualifies for permanent total disability status, they are eligible for benefits through the age of 75. If they are injured after the age of 70, then total eligibility lasts for a period of five years. In addition to the standard permanent total disability benefits, which is 66 2/3% of an individual’s average weekly wage, the individual also receives a 3% cost of living increase. This 3% cost of living increase continues until the individual reaches the age of 62.
Rules and laws pertaining to permanent total disability benefits have changed dramatically over the years. The description of potential and eligible benefits described in the preceding paragraphs references only individuals injured only after Oct. 1, 2003. Different eligibility/entitlement rules pertain to injuries prior to that date.