Workers' Compensation

Fraud is a defense to your entire case. Per FS 440.105, if you make a misrepresentation knowing that such statement contains any false, incomplete, or misleading information for the purpose of securing work comp benefits, your case may be dismissed for fraud. The most often examples where fraud is asserted relate to prior injuries or accidents or exaggerating the limitations from your work-related injuries.

Per FS 440.02(1), pre-existing conditions may also be covered under work comp, but only if the acceleration or aggravation of the pre-existing condition can be reasonably attributed to the accident. An example of this is someone who has arthritis but no pain or treatment until after the accident. It can be argued that your accident has accelerated the arthritis and made it symptomatic, and, but for the accident, you may have never had pain or needed treatment.

Per FS 440.02(1), exposures may be covered under work comp, but, in my experience, they are almost impossible to prove. The burden of proof in exposure cases requires being able to measure the exact amount to which you were exposed (the nearly impossible part) and then correlating it to your resulting condition(s). A prime example of this is having respiratory issues due to mold exposure, but, to have it covered under work comp, we would need to know the exact amount of mold spores to which you were exposed, which would be impossible if the moldy wall was destroyed before testing was done. Our burden of proof is also heightened, which makes it difficult to prove these cases.

This would be considered a repetitive-trauma accident, where you aren’t injured in one accident but, rather, in many smaller instances the result of which culminates in an injury. This may be covered under work comp, but, in my experience, will most likely be denied by the insurance company.

While not, per se, another SOL, there is a reporting requirement. Per FS 440.185(1), you have 30 days after the date of or initial manifestation of the injury to report your injury to your employer. Failure to do so may result in being forever barred from receiving work comp benefits again, except in certain circumstances. 

Per FS 440.19(1), you have to file a PFB within two years of the date on which you knew or should have known that your injury (or death) arose out of work performed in the course and scope of employment. If you do not do this, you may have violated the Statute of Limitations (“SOL”) and you may be forever barred from receiving work comp benefits again. 

Per FS 440.13(4)(a), your pay shall be equal to 80% of the difference between 80% of your AWW and the salary, wages, and other remuneration you are able to earn post-injury. Basically, depending on how much you’re making, you could be paid the difference in what you’re making and what you should be have been paid.

Per FS 440.14(1)(b-d), if you have not worked substantially the whole (75%+) of the thirteen weeks before your accident, then your AWW could be based on a similar employee, the calendar year (for seasonal workers), or your actual wages.

Per 440.14(1)(a), the amount of your work comp checks is based on what your employer has paid or contributed to you in the thirteen weeks prior to your accident, which is called your average weekly wage (“AWW”). Then, based on the level of your disability, you are paid a percentage of the AWW, usually every two weeks.