A proposed 14.5% workers’ compensation insurance rate increase will remain in effect unless the First District Court of Appeal rules otherwise, according to a recent decision from that body.
In November of 2016, a district judge struck down the National Council on Compensation Insurance’s proposed increase because the NCCI did not comply with public hearings requirements and held closed-door meetings with state regulators. The appeals court reinstated the increase, which began taking effect in December of 2016, and promised a ruling on an “expedited” basis, which probably means February of 2017 at the earliest. The NCCI originally sought a 19.6% rate increase after the Florida Supreme Court made two victim-friendly decisions in 2016, but later agreed to settle for a 14.5% hike.
Lawmakers will probably be busy with workers’ compensation in 2017 as well, as they look to establish a system that hopefully balances the interests of insurance companies and injured victims.
The New System
Even if the rate increase remains in effect, it will be some time before the amount of money in the system catches up with the increased payouts that will almost certainly come about s a result of Castellanos and Westphal. As discussed in a previous post, these cases increase the amount of attorneys’ fees and more than double the paid recovery period, from two to five years. That is good news in terms of eligibility, but victims need experienced attorneys to take full advantage of these changes.
With the increase in benefits and relatively paltry amount of money in the workers’ compensation system (employer insurance premiums plummeted after 2003), insurance company adjusters and lawyers will be even more aggressive than before when it comes to denying claims and challenging payouts. Since insurance companies cannot argue fault and shift blame onto the victims, they often do the next best thing, which is to challenge the medical treatment.
Many injured workers have physically demanding jobs that require lots of stooping, bending, lifting, and other strenuous activity. As a result, they often need extended and aggressive physical therapy. The courts took care of the “extended” component by reinstating the former paid recovery period, so now, there is very little chance that victims will be cut off mid-therapy with no way to recover from their injuries. However, this therapy must also be aggressive, and insurance companies are not always willing to pay for cutting-edge treatments. Fortunately, an experienced workers’ compensation attorney knows how to present compelling evidence and arguments to the hearing officer.
Whether victims suffer from a sudden trauma injury while at work, such as a fall or a motor vehicle collision, or they are diagnosed with an occupational disease, like hearing loss or repetitive stress disorder, they are normally entitled to all their economic damages.
The first component is lost wages. If victims are temporarily disabled, meaning that they can eventually return to work, they usually receive two-thirds of their average weekly wages for up to 260 weeks (five years). This calculation usually includes both regular cash compensation and irregular compensation, such as bonuses, overtime, and non-cash compensation, like tuition reimbursement. If the victims are totally disabled, they usually either receive a lump-sum payment or a long-term annuity in proportion to the injured area and extent of disability, so a person who is paralyzed from the waist down normally receives a higher award than someone who loses 10% range of motion in a shoulder.
Workers’ compensation also pays all medical bills and related costs, including:
- Emergency care,
- Followup treatment,
- Physical rehabilitation,
- Medical devices,
- Prescription drugs, and
- Related expenses, like mileage to and from the doctor.
Typically, the insurance company pays these costs directly and victims are not responsible for any unpaid charges.
Many victims, especially occupational disease victims, have pre-existing medical conditions. For example, constant physical activity may aggravate existing joint conditions. To receive maximum benefits, the victims must establish that job activity was an MCC (major contributing cause) to the overall injury. Typically, this means that the job injury must be at least 50% responsible for the victim’s condition. A previous workers’ compensation claim usually helps meet the 50% threshold, and an independent review from an outside medical professional is also very persuasive.
To get maximum benefits for your work injury, contact Barnett, Lerner, Karsen & Frankel.