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If your business has employees in the state of Florida, you’ll need to make sure you adhere to Florida’s Workers’ Compensation Insurance laws. Workers’ Compensation provides medical and financial benefits for employees who suffer work-related injuries or illnesses or for their survivors in the case of an employee death.
Who needs Workers’ Compensation Insurance in Florida?
Florida requires all employers with four or more employees to obtain Workers’ Compensation Insurance, with special requirements for businesses in the agricultural and construction industries. Employers in the construction industry must carry coverage if they employ one or more employees, while employers in the agricultural industry must carry coverage if they employ at least six regular employees or 12 seasonal workers who work more than 30 days during a season but no more than a total 45 days in a calendar year.
In Florida, an “employee” is usually defined as any person who has entered into or works under a contract for hire or apprenticeship with an employer.
The Florida Workers’ Compensation Law (WCL) defines all of the requirements for Workers’ Comp in Florida, and the Florida Division of Workers’ Compensation (DWC) monitors, enforces, and administers the program. Ensuring your company is in compliance is critical, as there are serious penalties and fines for those who fail to abide by state regulations.
What employees are covered under Workers’ Compensation in Florida?
Almost all workers are covered under Workers’ Compensation in Florida. If you provide work or services for an employer, and you are not an independent contractor, you will likely be eligible for Workers’ Compensation Insurance.
The following are categories of employees that are eligible for Workers’ Comp coverage:
- Full-time and part-time employees
- Apprentices and interns
- Undocumented workers
- Sole proprietors
- Independent contractors and subcontractors in the construction industry
The following are categories of employees that are generally excluded from Workers’ Comp coverage:
- Casual employees
- Independent contractors who are not employed in the construction industry
- Domestic workers in private homes
- Real estate agents if paid solely on commission
- Volunteer workers, except those of certain local, state, federal, or emergency services organizations
- Owner-operators of motor vehicles transporting property under contract
What Workers’ Compensation benefits do employees receive?
Under Workers’ Compensation in Florida, employers are required to provide the following benefits to employees who are injured in the course of employment:
- Employers must cover employees’ medical expenses, including physician and hospital bills, prescriptions, remedial treatment, prostheses, attendant care, and other expenses.
- Employers must also cover mileage reimbursement for travel to and from an authorized doctor and the pharmacy.
- Employers may choose the health care provider or network that employees must visit to receive treatment for work-related injuries or illnesses. Employees have the right to one physician change request while being treated. Employers must grant the request within five days.
- If an employer does not provide appropriate emergency medical care to an employee, the employee may be treated by any health provider at the employer’s expense.
Temporary Total Disability
- Employees who are unable to work due to a work-related injury are eligible for Temporary Total Disability (TTD) benefits, which provides 66 and two-thirds percent of the worker’s average weekly wage before injury.
- Certain severe injuries may entitle an injured worker to 80 percent of wages for up to six months.
- TTD benefits are available for a maximum of 260 weeks or until the worker has reached maximum medical improvement (whichever comes first).
- The DWC establishes minimum and maximum benefit amounts, which change yearly. For accidents that occurred in 2021, the maximum TTD benefit was $1,011 per week, and the minimum benefit amount was $20 per week.
Temporary Partial Disability
- If injured employees are able to return to work in a partial or limited capacity while recovering, they may be eligible for Temporary Partial Disability (TPD) benefits. To be eligible, employees’ earnings must be less than 80 percent of their pre-injury wages. TPD benefits provide 80 percent of the difference between a worker’s pre- and post-injury average weekly wage.
- The maximum for TPD benefits is 66 and two-thirds percent of the employee’s average weekly wage.
- The DWC establishes minimum and maximum benefit amounts, which change yearly. For accidents that occurred in 2021, the maximum TPD benefit was $1,011 per week, and the minimum was $20.
- TPD benefits are available for a maximum of 104 weeks or until the worker has reached maximum medical improvement (whichever comes first).
- Employees are considered to have a permanent impairment (PI) if their injury or illness has caused any physical, psychological, or functional loss and the impairment still exists after reaching the maximum medical improvement.
- The physician who treated an employee’s injury must provide an impairment rating indicating how much the injury has affected the employee’s ability to function. This determines the employee’s eligibility for benefits and the number of weeks during which PI benefits can be received.
- PI benefits are generally 75 percent of the employee’s TTD benefit rate. If employees earn income equal to or greater than their previous average weekly wage, PI benefits may be reduced by 50 percent.
- The DWC establishes minimum and maximum benefit amounts, which change yearly. For accidents that occurred in 2021, the maximum TTD benefit was $1,011 per week, and the minimum was $20.
Permanent Total Disability
- Employees who are permanently disabled and unable to earn any wages may be eligible for Permanent Total Disability (PTD) benefits.
- PTD benefits provide 66 and two-thirds percent of the employee’s average weekly wage, payable as long as the employee remains permanently and totally disabled and is unable to earn wages.
- Employees are eligible for PTD benefits if they are physically unable to work within 50 miles of their home, or if they suffered injuries including severe burns, brain damage, spinal cord damage causing paralysis, amputation, or blindness.
- PTD benefits are payable until the employee reaches age 75, unless the employee is not eligible for social security benefits, in which case they are able to receive PTD benefits for life.
- The DWC establishes minimum and maximum benefit amounts, which change yearly. For accidents that occurred in 2021, the maximum PTD benefit was $1,011 per week, and the minimum was $20.
- Employees receiving these benefits may need to take a vocational evaluation once a year to check whether there are any changes in their ability to work.
- Employers are required to pay funeral expenses of up to $7,500 for any employee who dies within one year of a work-accident or within five years after a continuous disability resulting from a work-related accident.
- A worker’s dependents may be eligible to receive up to 66 and two-thirds percent of the worker’s average weekly wage, up to the maximum amount allowed by the DWC. The aggregate maximum of these benefits is $150,000.
- Death benefits can be paid to a surviving spouse for life but will be terminated upon remarriage. Upon remarriage, a surviving spouse may be entitled to receive a single payment equal to 26 weeks of compensation at the rate of 50 percent of the average weekly wage. If this sum would exceed the maximum amount of benefits, the payment will provide the remaining amount of benefits available. Dependent children can receive benefits until they are 18, or until they are 22 if they are full-time students and are not married.
- For a surviving spouse, up to 1,800 hours of instruction at a community college may be covered in addition to death benefits.
What are the penalties for breaking Florida Workers’ Compensation laws?
Failure to adhere to the Workers’ Compensation laws set out by the WCL can result in significant fines and even imprisonment. In order to avoid any costly penalties, it’s important to consult the WCL or your insurer to ensure you are in compliance. Below are the major ways in which companies can be penalized:
Failure to Maintain Coverage
- Employers that fail to comply with coverage requirements may be ordered by the DWC to cease all business operations.
- Fines include $1,000 per day for each day the company operated without required coverage, plus an additional fine of $1,000 or twice the amount the employer would have paid in insurance premiums during the period of noncompliance (whichever is greater).
- If an employer is given a stop-work order for failing to maintain coverage, information about the order will be published on the DWC’s website for at least five years.
- Employers that fail to comply with a stop-work order or violate DWC coverage requirements more than once within a five-year period may face felony charges.
- There may be an additional fine of $5,000 for employers that failed to provide coverage for an employee because the employee was misclassified as an independent contractor.
- Employers that fail to maintain coverage may be sued in court for damages by employees who were injured during the period of noncompliance.
Failure to Report
- Employers that fail to file appropriate forms, documents, and reports within the specified time periods may be subject to penalties including a $100 fine for items that were one to 14 days late, $500 for items that were 15 to 30 days late, $1,000 for items that were 31 to 60 days late, and $50 per day for items that were more than 60 days late.
Failure to Pay Benefits
- Employers that fail to obtain prompt medical care for injured employees may face a fine of $2,500 per violation, to a maximum of $100,000.
- Failure to pay benefits will result in a fine of 20 percent of the unpaid benefit installment plus 12 percent interest.
- Failure to pay uncontested medical bills within 45 days of receiving an invoice will result in a fine of $25 to $50 for each unpaid bill plus 12 percent interest.
- Failure to pay compensation due under a DWC award with seven days of the due date will result in fines of $50 to $100 plus 12 percent interest
- Employers who fail to meet any other requirements stated in the WCL may face fines of $2,500 per violation to a maximum of $100,000.
- Penalties for fraud are decided based on the monetary value of the fraud.
- Fraud with a monetary value of less than $20,000 could result in a maximum fine of $5,000, a third-degree felony conviction, and up to five years imprisonment.
- Fraud with a monetary value of $20,000 to $100,000 could result in a second-degree felony conviction, a maximum fine of $10,000, and up to 15 years imprisonment.
- Fraud with a monetary value of more than $100,000 could result in a first-degree felony conviction, a maximum fine of $10,000, and up to 30 years imprisonment.
How much does Workers’ Compensation Insurance cost in Florida?
According to the National Academy of Social Insurance Workers’ Compensation Report (November 2020), the average employer cost for Workers’ Compensation in Florida was $1.30 per $100 of covered wages. This figure is estimated across all insurers and all industries, so the cost to your particular business may vary.
How does the Workers’ Compensation claims process work in Florida?
Employees should report any work-related injuries to their employer within 30 days of the injury occurring or within 30 days of a doctor determining that they are suffering from a work-related injury. Any delay in reporting may result in delays in the claims process or denial of the claim.
Employers must report incidents to their insurance carrier within seven days of it being reported. In the case of serious injuries or fatalities, the reporting period may be reduced to 24 hours. A claims adjuster will determine benefits due to the employee.
In the case of disputed claims, employees and their attorneys are expected to try to resolve their grievances with their insurer. If they cannot reach an agreement, employers can file a petition with the Office of the Judges of Compensation Claims. Insurers must pay benefits within 14 days or contest the claim. If the insurer has paid the benefits, it may still dispute the claim within 120 days after it received the petition.