THE DIVISION OF WORKERS’ COMPENSATION Presents

1. THE DIVISION OF WORKERS’ COMPENSATIONPresents • AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM Chapter 440 Florida Statutes Lloyd Harger (850) 413-1856 E-mail: Lloyd.harger@fldfs.com November 2005

2. WHAT IS WORKERS’ COMPENSATION? • State-administered Insurance Program That Benefits Employers and Injured Employees • The Injured Employee Receives Medical Treatment and Wage Replacement Benefits. • Exclusive Remedy: a Work-related Accident Is Compensated Through the Workers’ Compensation System Not Through the Tort System. • The Employer Pays a Premium Based on Its Payroll, Class Code, Rate, and Individual Experience.

3. SELF-EXECUTING Accident Timely Benefits Return to Work

4. May 23, 1935

5. EMPLOYER MUST HAVE COVERAGE IF... 1. Employer Has Four (4) Or More Employees (Full or Part Time) 2. One (1) or More If Employer Is in the Construction Field 3. Corporate Officers 4. Sole Proprietor Or Partnership 5. Agriculture Industry Over Five (5) Regular, Twelve (12) or More Seasonal BUREAU OF COMPLIANCE Phone (850) 413-1609

6. EMPLOYER MAY OBTAIN COVERAGE BY... • Purchasing a Standard Policy on the Open Market • Individual Self- Insurance • Group Self- Insurance Fund • Joint Underwriters Association

7. EXCLUSIVE REMEDYs. 440.11 F.S. • Protects Employee • Medical Treatment • Portion of Lost Wages • Protects Employer • Civil Lawsuit • Third Party Actions • Subrogation

8. VOLUNTEERS s.440.02(15)(d)6. and s.440.02(17)(b)3.,F.S. Are NOT Employees Except… Volunteers for a State, County, Municipality or Other Governmental Entity Volunteer Firefighters

10. ACRONYMS(THE LANGUAGE OF THE SYSTEM) TTD--Temporary Total Disability TPD--Temporary Partial PIR--Permanent Impairment Rating AWW--Average Weekly Wage MMI--Maximum Medical Improvement IME--Independent Medical Evaluation EMA--Expert Medical Advisor PT--Permanent Total

11. SDTF--Special Disability Trust Fund E/C--Employer/Carrier JCC--Judge of Compensation Claims UR--Utilization Review IIBs-Impairment Income Benefits SIBs--Supplemental Income Benefits HCP--Health Care Provider ER--Employer EE-Employee CR--Carrier MCC--Managed Care Coordinator

12. MCA--Managed Care Arrangement EAO--Employee Assistance Office TPA--Third Party Administrator OJT--on the Job Training T&E--Training and Education 1St DCA--First District Court of Appeal DFWP--Drug Free Workplace Program DFS--Department of Financial Services AHCA--Agency for Health Care Administration FIRG--Florida Impairment Rating Guide

13. POSSIBLE WAYS TO REDUCE ACCIDENTS AND COSTS 1. DRUG FREE WORKPLACE PROGRAM 2. AN EFFECTIVE SAFETY PROGRAM 3. REEMPLOYMENT PLAN

14. EMPLOYER MAY HAVE A DRUG FREE WORKPLACE PROGRAM • 5% Premium Credit • Agency for Health Care Administration • Customer Service Office (850) 413-1601 • Laboratories, Collection Sites, M.R.O.’S s. 440.101, 440.102 F.S.

15. REEMPLOYMENT AND RETURN TO WORK 1. Reemployment Plan 2. Light, Limited, Modified, And Transitional Duty 3. Obligation to Rehire 4. Division Sponsored Training and Education 5. The Bottom Line: Return To Work Phone (850)245-3470

16. EMPLOYER SHOULD MAINTAIN OPEN COMMUNICATIONS WITH... • Injured Employee • Health Care Provider • Insurance Carrier or Service Company • Other Employees • Why? Avoid Possible Litigation Through Communications

17. THE EMPLOYEE MUST… Report The Accident As Soon As It Happens And No Later Than Thirty (30) Days. Failure to Do So May Result in Claim Being Denied… Two (2) Years to File Petition for Benefits s.440.185, (1), F.S.

18. BENEFITS PROVIDED BY LAW • Indemnity (Lost Wages) • Employer Must Provide Necessary Remedial Medical Care and Treatment • Possible Screening, Job Placement Assistance, Education & Retraining

19. WHEN AN ACCIDENT OCCURS THE EMPLOYER MUST... • Timely Complete and File All Forms • Call in (File) First Report of Injury or Illness (DWC-1) • Send to Carrier Within 7 Days of Knowledge (Except First-Aid Cases) • Send Both “Division” and “Carrier” Copy to Carrier AVOID FINES AND PENALTIES

20. AND… 1. Report Death Cases by Telephone, Telegram, or Fax to the Division Phone (800) 219-8953 Within 24 Hours of Employer’s Knowledge of Death 2. Give Employee His/Her Copy of the DWC-1

21. TYPES OF ACCIDENTS 1. First Aid * 2. Medical Only 3. Lost Time * Must Be Recorded on Form DWC-1 or an Alternate Division Approved Form, but Not Reported to Carrier

22. DWC-1

23. CONCURRENT EMPLOYMENT (Working Two or More Jobs) The Employee is Responsible to Report Any Concurrent Employment If a Covered Employer, Must Add the Wages Into the AWW Calculation s.440.02(28), F.S.

24. INJURY DEFINED • Personal Injury or Death by Accident Arising Out of and in the Course and Scope of Employment, and Such Diseases or Infection As Naturally or Unavoidably Result From Such Injury. • Dentures, Eyeglasses, Orthotics, Prosthetics Included, If Damaged in Conjunction With Accident.

25. NOT AN INJURY • Mental or Nervous Condition Caused Only by Stress, Fear or Excitement • Disability by Acceleration or Aggravation of Venereal Disease or Substance Abuse • Phobias Based on Ethnicity, Gender, Age or Handicap

26. EMPLOYEE’S RESPONSIBILITIES REGARDING MEDICAL CARE 1. The Employee Must Request Medical Care and Treatment From Employer 2. The Employee Cannot Seek Treatment on His/Her Own Unless Employer Refuses or Ignores Request 3. Keep All Medical Appointments and Follow Instructions of Authorized Physician

27. AMOUNT & DURATION PAID TO THE INJURED EMPLOYEE? • Medical Documentation Determines Disability (Indemnity) Type • 7 Day Waiting Period • Paid 66 2/3% of Average Weekly Wage (AWW) • AWW Calculated on 13 Weeks Prior to Accident (Excluding Week in Which Injury Occurred), Similar Employee, or Contract of Hire.

28. Temporary Total Temporary Total at 80% Temporary Total Rehabilitation Temporary Partial Impairment Income Benefits Permanent Total Death Benefits ($7,500.00 Funeral) 104 Weeks Maximum for “Temporary Benefits”(including Temporary Total Rehab) INDEMNITY BENEFIT TYPES

29. SETTLEMENTS s.440.20(11),(a),(b),( c),F.S. Are Not Automatic or Mandatory Under the Law However…

30. SPECIAL SITUATIONS • 1. Driving To and From Work • 2. Horseplay/Fighting • 3. Breaks and Lunch • 4. Company Parties/Picnics • 5. Police Officers, Firefighters/Paramedics • 6. Traveling Employees • Deviation from Employment • Aliens

31. WHAT IF SELF-EXECUTION BREAKS DOWN?! • Disagreements • Disputes • Early Intervention Program Mediation Hearing Employee Assistance Office

32. INFORMAL DISPUTE RESOLUTION & FORMAL LITIGATION • Employee Assistance Office Phone (800) 342-1741 • Mediators (Mandatory, Use State or Private Mediators) • Judges of Compensation Claims • 1st District Court of Appeal

33. POP QUIZ (TRUE OR FALSE) • A Former Employee Comes to You and Says He/She was • Injured 10 Years Ago. Employee Did Not Report it in the Required 30 Days. Tell Them to Go Away. • 2. Your Employee is on His/Her Way to Work, Stops and Picks • Up Printing for You and is Injured in an Auto Accident on • Way to Office. Employee is not Covered Because He/She is • Not On the Clock. • 3. You Must Report Medical Only and Lost Time Cases to Your • Carrier but Not First Aid Cases.

34. POP QUIZ (TRUE OR FALSE) cont.. 4. MMI is an Acronym for More Money Invested. 5. You Have Four (4) People Working for You and are Required to Have Workers’ Compensation Coverage. 6. Two (2) of Those Employees are Part Time So You Don’t Have to Have Coverage. 7. As Long As You Have Coverage, You Can Never be Sued in Circuit Court.

35. POP QUIZ TRUE OR FALSE (Cont…) 8. Because it is so Common, Stress is Automatically Covered Under Workers’ Compensation in Florida 9. Temporary Indemnity Benefits are Limited to 104 Weeks Except for Rehab – Retraining Temporary Total. 10. Upon the Death of an Employee, the Total Amount Payable for Funeral Expenses is $10,000. 11. An Employer Must Report the Employee’s Injury to the Insurance Carrier within 45 Days 12. Injured Workers Receive Compensation of 66 2/3% of Their Take Home Pay the Week of Injury

36. QUESTIONS?