THE DIVISION OF WORKERS’ COMPENSATION Presents §AN OVERVIEW OF THE FLORIDA WORKERS’ COMPENSATION SYSTEM FOR EMPLOYERS Chapter 440 Florida Statutes Lloyd Harger, Phone (850)

TOPICS §What is Workers’ Compensation? §What’s the Purpose? §Who Are the Major Parties in the System? §Why Do We Have “Workers’ Compensation?” §What Role Does the Division Play?

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.

SELF-EXECUTING Timely Benefits Accident Return to Work

GOVERNOR’S COMMISSION ON WORKERS COMPENSATION REFORM §The Relative Availability and Affordability of Workers’ Compensation Insurance in Florida As Compared to Other States With Similar Relevant Characteristics. §Impediments to Quick Resolution of Disputes and Statutory Changes Necessary to Facilitate Quicker Resolution of Workers’ Compensation Cases.

GOVERNOR’S COMMISSION ON WORKERS’ COMPENSATION REFORM §Major Cost Drivers in the Workers’ Compensation System and Statutory Changes Necessary to Reduce the Cost of Workers’ Compensation Insurance in Florida. §The Adequacy of Compensatory Benefits for Injured Workers and Statutory Changes Necessary to Equitably Compensate Injured Workers in the Workers’ Compensation System.

MAJOR PARTIES IN THE FLORIDA SYSTEM §EMPLOYEES §EMPLOYERS §Health Care Providers §Rehabilitation Providers §Insurance Carriers/Agents §Attorneys/Judges §Government Agencies §General Public

EMPLOYER MUST HAVE COVERAGE IF Employer Has Four (4) Or More Employees 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 OF COMPLIANCE Phone (850)

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

HOW MUCH DOES IT COST? §Type of Industry §Amount of Payroll §Experience Modification

INSURANCE PREMIUM DETERMINATION §Employers l Manual Rate = Payroll/100 Times Class Code Rate l Experience Rating l Drug Free Workplace Program Credit l Safety Credit l Other Debits and Credits

INSURANCE PREMIUM DETERMINATION §Overall Rate Level Change §Industry Group Changes l Manufacturing l Contracting l Goods & Services l Office & Clerical l Miscellaneous

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

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

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 DOI--Department of Insurance AHCA--Agency for Health Care Administration FIRG--Florida Impairment Rating Guide

WHAT IF...? §What If It’s His/Her Fault? §What If It’s Due to the Employer’s Negligence? §If the Employer has Coverage, Can They Still be Sued?

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

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

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 “Welcome Back to the Team” Phone (850)

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

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 , (1), F.S.

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

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 AVOID FINES AND PENALTIES

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

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

PENALTIES FOR EMPLOYER’S LATE FILING §DWC-1 First Report of Injury or Illness up to $ §DWC-1a Wage Statement $10 Per Day Up To $100 §Delays in Filing Forms Delays Benefits to Injured Employees Phone (850) Bureau of Monitoring and Audit and Audit

ADDITIONAL FORMS TO BE COMPLETED BY EMPLOYER 1. DWC-1a Wage Statement* 2. Complete and Send to Carrier Within 14 Days of Knowledge Of Lost Time Case 3. Give Employee Copy * Average Weekly Wage is a Highly Litigated Issue

EMPLOYER MAY FURNISH NECESSARY MEDICAL CARE THROUGH A MANAGED CARE ARRANGEMENT* §Agency for Healthcare Administration §Not Mandatory for Employers After October 1, 2002 §Carrier Submits Plan of Operation Agency for Healthcare Admin. (850) or (850) * Employer’s Choice

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

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

INDEMNITY BENEFIT TYPES §Temporary Total §Temporary Total at 80% §Temporary Total Rehabilitation §Temporary Partial §Impairment Income Benefits §Supplemental Income §Permanent Total §Death Benefits §104 Weeks Maximum for “Temporary Benefits”(Excluding Temporary Total Rehab) §401 Weeks From Date of Accident for All Indemnity Benefits Excluding Permanent Total

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 7. Deviation from Employment

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

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

POP QUIZ (TRUE OR FALSE) 1. 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.

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. POP QUIZ (TRUE OR FALSE) cont..

QUESTIONS?