Workers’ comp is an extensive subject with many rules, guidelines, and best practices. Because there is so much involved, we have decided to do a two-part series about the two main categories: medical benefits and lost wages or indemnity benefits. This is second first part of the series, covering lost wages and indemnity. You can find the first part of the series, covering medical benefits, here.

As we mentioned in part one, workers’ compensation is a form of insurance that employers with more than four employees must have. Workers’ compensation, or workers’ comp, replaces wages and provides medical benefits to employees who are injured at work. If you have been injured at work, you may be eligible for workers’ compensation. Keep reading to learn what you need to know about lost wages and indemnity.

How Are Benefits Determined?

To determine how much you qualify for, your employer will look at your average weekly wage, or AWW, for the last thirteen weeks before your injury. The AWW usually includes the wages from your employer and from any concurrent jobs that you hold that you will not be able to work during your recovery period. Lost wages are paid through temporary disability or permanent disability.

Temporary Disability

Temporary disability falls under three categories under the law: temporary total disability (TTD), temporary partial disability (TPD), and retraining temporary total disability benefits.

Regardless of which category of temporary disability you fall under, you are only eligible to be paid for the first seven days that you are out of work if you miss working for more than twenty-one days. Otherwise, you will not be paid temporary disability for the first seven days of work that you missed.

Disability is only paid if your doctor orders that you reduce or limit your work. In order to receive disability payments, you must provide proof of your doctor’s restrictions to your employer. Also, note that TTD and TPD are payable for 104 weeks or if you have reached MMI—maximum medical improvement. There is currently a case in the Florida Supreme Court that may extend partial disability past 104 weeks, depending on the verdict.

• Temporary Total Disability (TTD)

If your injuries are severe enough that your doctor orders you not to work at all, then you will be eligible to receive TTD. TTD benefits are paid at 66 2/3% of your average weekly wage. You may not work and receive TTD benefits, as that is criminal workers’ compensation fraud.

• Temporary Partial Disability (TPD)

Injuries that result in TPD are generally less severe than those that result in TTD. In order to qualify for TPD, your physician must have given you physical restrictions that prevent you from doing some of your work, and therefore keep you from earning 80% or more of your average weekly wage.

Because you can still perform some work, just not work that can exacerbate your injury, your employer may offer you lighter work. If you turn down replacement work, you may not receive TPD benefits. If you are offered light work, speak with an attorney to understand your options.

TPD is paid at 64% of your AWW if you are not working. If you are working and earning some wages, but less than the required 80% of your AWW, then your TPD benefits will be figured by taking your gross earnings from 80% of your AWW, then multiplying that number by 80%.

Once you are placed at MMI by your doctors and given permanent restrictions, you may qualify for retraining through the Division of Workers’ Compensation. If you qualify for such retraining, then you are supposed to be paid TTD wages while going to school/retraining, but that program is underfunded and many deserving individuals do not qualify. The retraining TTD benefits are also currently subject to the 104-week cap on temporary benefits.

• Retraining TTD

Once you have reached MMI or exceeded the 104 weeks of disability benefits and you still cannot work your previous job, you may be able to receive retraining from the Division of Workers’ Compensation. In cases in which you qualify for retraining, you will be paid TTD benefits—remember, this is 80% of your AWW—for the duration of your training or up to 104 weeks.

Retraining is a poorly funded program, so it is difficult to qualify for this benefit. As always, speak with an attorney to discuss filing for retraining TDD.

Permanent Disability

If retraining is not an option, and you have reached MMI and received benefits for the maximum 104 weeks of temporary disability, you may qualify for permanent disability. There are two kinds of permanent disability—impairment benefits and permanent total disability benefits—and depending on your situation, you may qualify for one of them.

• Impairment Benefits

If your injury or accident has left you with a permanent impairment, you may be entitled to impairment benefits. This is a highly variable benefit which requires your physician to give you a permanent impairment rating. Your rating will determine how much you get paid (once again based on your AWW), and for how many weeks you receive payment.

Once you qualify for impairment benefits, you will receive them regardless of whether you are working. If you are employed and making as much or more than you made before, impairment benefits are paid at 33 1/3% of your AWW. If you are making less than you did before your injury, your benefits can be paid at 50% of your AWW.

Permanent Total Disability (PTD) Benefits

If the work restrictions given by your doctor are particularly severe when you have reached MMI, you may be eligible for permanent total disability (PTD) benefits. In order to qualify for these benefits, you must prove that you cannot work within 50 miles of your home under the restrictions set forth by your doctor.

In order to prove this, generally, you have to show a long and unsuccessful job search. You must be unable to find work, even part-time sedentary work, after a search of at least six months.

Workers’ compensation is a huge and complex issue that is difficult for many to grasp. There are so many facets of this coverage that many people do not know where to begin. If you think you should receive workers’ compensation, or that you are eligible for disability benefits, then contact C.W. Smith, Public Attorney, to find out what you are entitled to.

Living in Florida, it is extremely important to have the right automobile insurance coverage to protect you, your loved ones and your property. Florida is in the top five states nationally for uninsured drivers with a recent study showing over 23% of Florida drivers to be uninsured. The percentage of drivers in Florida who do not carry Bodily Injury or “BI” coverage may, however, be much higher as Florida law does not require drivers to carry BI coverage. The minimum coverage required by Florida law to license a vehicle is $10,000.00 in Property Damage coverage and $10,000.00 in Personal Injury Protection or PIP coverage. Some people mistakenly think this is “full coverage”, but this is just the bare bones minimum of auto coverage required. This means that being involved in a motor vehicle collision in Florida, it is highly likely that the at-fault driver will not be carrying enough insurance to cover you and your family for your injuries and damages.

Do You Have the Types of Coverage That You Need?

Now is always a good time to check your insurance coverage on your motor vehicle as changes in coverage do not apply retroactively to prior accidents which have already occurred. You will need the coverage in place before an accident occurs for it to cover an accident. There are many different types of automobile insurance coverage available in Florida and you should be aware of what each of those insurance coverages provides when purchasing or changing your coverage:

• Minimum Coverage in Florida – The minimum automobile insurance coverage required in Florida is $10,000 in Property Damage (to cover other vehicles and property damaged by your negligent operation of your vehicle) and $10,000 in Personal Injury Protection or PIP coverage. THIS IS NOT FULL COVERAGE but is bare bones coverage which you should only have if you simply cannot afford anything else (and even then is not recommended).
• Collision Coverage – Collision coverage is the coverage that insures your own vehicle from damage caused by your own fault or by an uninsured or underinsured driver. If you have a loan on your vehicle, this will likely be required by your bank or credit union to make sure that the vehicle you are paying off can be fixed after an accident. Unless your vehicle is worth less than your insurance premium, and you can afford to replace your vehicle, you should be carrying collision coverage for your vehicle. You should not carry a deductible larger than you could afford to pay on short notice to have your vehicle repaired, although raising your deductible will lower your premiums.
• Comprehensive Coverage – Comprehensive coverage insures your own vehicle for losses other than a motor vehicle collision, such as theft, vandalism, fire, or flood. If you carry comprehensive coverage, windshield damage and replacement without a deductible are included under Florida policies. Unless your vehicle is worth less than your insurance premium, and you can afford to replace your vehicle, you should be carrying comprehensive coverage for your vehicle.
• Property Damage Coverage usually applies whether you are driving your vehicle or another vehicle and you negligently cause damage to another vehicle or property (not your own vehicle). A minimum of $10,000 is required on Florida policies, but it is recommended that you carry coverage of at least $50,000 per vehicle or $100,000 per accident. With that coverage, you would have up to $50,000 in property damage coverage per vehicle and up to $100,000 per accident (if there were 2 or more other vehicles or buildings involved). More insurance is a good idea if you can afford it – this is just a minimum recommended. Although you should make sure that you have enough insurance coverage, going with only minimal property damage coverage is a bad idea as your license and vehicle title will likely be suspended and other insurance companies will likely take a judgment against you for any additional property damage caused by you for which you did not carry sufficient coverage.
• GAP Insurance Coverage – GAP coverage is just that; it covers the gap in between the value of your vehicle at the time of a collision and what you still owe on it. Given the significant drop in the value of many vehicles driving them off the car lot, GAP coverage is often a good idea if you are not putting much down on a loan or are “upside-down” or “underwater” on a loan (owing more than the vehicle’s value). Replacement coverage is also often available which would provide enough coverage to buy an equal or better vehicle if your vehicle is totaled, but it is not the same as GAP coverage and can still leave you upside down on a loan.
• Personal Injury Protection or “PIP” Coverage – Although required by law, there are changes which can be made to the general PIP coverage which you can purchase. The general PIP coverage is for up to $10,000 in related lost wages and reasonable and related medical expenses when an emergency medical condition or EMC exists. This is a combined total of $10,000 and not $10,000 for each and PIP pays at 80% of medical expenses and 60% of lost wages up to that $10,000 total. Many policies now define reasonable as 200% of Medicare rates for medical expenses, but that will depend on the insurance company with whom you shop and their policy language. If no authorized medical doctor has declared an emergency medical condition or EMC from the accident, then PIP can be capped at $2,500 of medical expenses paid by the insurance company but some companies ignore this restriction.
• 14 Day Treatment Requirement – Please note that if you fail to treat within 14 days of your accident, your insurance company will likely deny PIP payment of your medical bills related to your accident as the statute requires medical treatment within 14 days of the accident.
• PIP Deductibles – It is still possible to get a $500 to $2,500 deductible on your PIP coverage (meaning that losses must exceed that number before PIP pays anything), but it does not save you much money and is generally a bad idea because it will leave you responsible for those bills up front and can affect your ability to obtain a doctor.
• Waiver of PIP Wage Loss – You can waive PIP wage loss benefits as part of the coverage, which if you carry short term and long term disability insurance or do not work can reduce the cost of your insurance, but it is otherwise not recommended.
• Medical Payments or MedPay Coverage – MedPay pays in a supplement to PIP medical payments and if you do not have health insurance it is a good idea to carry $5,000 to $10,000 in MedPay, but be sure to read the fine print on MedPay coverage as it varies from company to company. It is not statutorily required so there can be many limitations placed within the policy on MedPay coverage, including a requirement of an EMC to obtain it. The restrictions placed on MedPay coverage by a few insurance companies make it not worth the expense.
• Bodily Injury or BI Coverage – BI coverage covers physical injury caused by you or someone driving your vehicle to other people and is actually not required in the State of Florida, except for some drivers who have been convicted of a DUI. As the at-fault driver’s insurance, and to a limited extent the owner of the vehicle’s insurance if different, pays for the damages caused to other individuals due to negligence, it is important to carry sufficient coverage to protect you and your family. Although more coverage is recommended, a minimal amount of BI that should be carried is $50,000 per person and $100,000 per accident. Please note that not carrying any BI coverage is a bad idea because you are likely to face a lawsuit and judgment either from the other driver or their insurance company (if they paid MedPay or UM benefits to their insured and you were at fault for the collision). If you carry BI coverage, you should also be provided with a legal defense to any such lawsuits against you to help protect you, but you will be on your own to hire your own attorney out of pocket if you did not carry BI coverage.
• Uninsured Motorist or UM / Under-Insured Motorist or UIM Coverage – Although often waived by insured, this is probably the most important (and comparatively cheap) insurance coverages you can purchase as it protects you and your loved ones for injuries and damages caused by uninsured and under-insured motorists. Do not ever waive UM/ UIM coverage! Although more coverage is recommended, a minimal amount of UM/ UIM coverage which should be carried is $100,000 per person and $300,000 per accident.
• Stacked vs. Unstacked Uninsured/ Under-Insured Motorist Coverage – If you own more than one vehicle insured on the same policy you should request that the coverage is “stacked” which essentially multiplies your coverage available based on the number of vehicles insured.
• Umbrella Policies – If you have substantial assets or are an individual against whom an attorney might consider taking a judgment against, it is a good idea to carry an umbrella policy as this will help cover you against a potential excess judgment above your BI limits. Umbrella policies are comparatively very cheap and can be purchased to provide excess coverage for potential judgments against you.
• Accidental Death & Dismemberment Benefits – Is self-explanatory and should be included in your coverage if you can afford it.
• Towing & Rental Vehicle Coverage – If you are a member of AAA and have extra vehicles at home this might not be an important coverage, but towing and rental costs can add up quickly at a time when you are already potentially out of work and incurring medical expenses. It is recommended.
• Coverage for Vehicle Owner – Note that if you have a minor or family member driving your vehicle, or loan your vehicle to another to use, then you can be liable for any accidents and damages they cause. Although the limits of the damages you can be responsible for are capped by statute in some circumstances, you should be sure to carry no less than $10,000 in PIP, $50,000/ $100,000 in Property Damages and $100,000/ $300,000 in BI coverage on any such vehicle to better protect yourself.
• BE SURE to disclose all family members and individuals living in your home or residence to your insurance company and to update them with that information in writing whenever it changes. Some insurance companies look for failures to disclose changes in residents at your residence as a basis to frequently deny claims.

Contact Us

Figuring out the proper motor vehicle insurance coverage for you can be complicated and time-consuming, but it will become a lot more complicated after an accident if you did not get good coverage in the first place. If you are not sure whether your coverage is sufficient, you should ask your agent or insurer for further information. But if you have already been in an accident or become entangled in a legal matter or a dispute with your insurance company, please contact us for the experienced insurance attorney that you need to ensure your rights are protected. Initial phone consultations for Florida personal injury cases and insurance claims are free and most cases can be handled on a contingency.