Workers’ compensation is a state-regulated form of insurance that most employers must carry for the benefit of their employees. It is a valuable benefit, but there are rules and restrictions that apply to the program. Sometimes, a workers’ compensation insurer might deny a claim on eligibility grounds.
Our attorneys at The Florida Firm represent injured workers in workers’ compensation claim disputes and third-party claims. We are familiar with the rules surrounding workers’ compensation claim eligibility in Orlando and could help you resolve any eligibility questions that arise. Other lawyers recognize our skill and professionalism and often refer their clients with work injury claims to us, knowing that we obtain excellent results.
Employee Coverage
If you work as a W2 employee, you probably have workers’ compensation coverage. State law requires most businesses with at least four employees to provide this benefit.
Construction industry employers are required to provide workers’ compensation insurance, even if they have only one employee. Agricultural employers with at least five regular employees or at least 12 seasonal workers are also required to provide this coverage.
Employees are covered from their first day of work, whether they work full-time, part-time, or seasonally. The coverage provides free medical treatment for work-related injuries and illnesses, as well as disability payments if you are unable to work. If you have trouble accessing your benefits at any point or have questions about claim eligibility, our Orlando-area workers’ compensation attorneys are here to help.
Some Workers May Not Be Covered
Independent contractors are not entitled to workers’ compensation coverage. As a self-employed person, the independent contractor is responsible for providing their own insurance.
Executive officers and some other high-level employees can opt out of workers’ compensation coverage in some cases. However, their decision to opt out has no impact on the business’s obligation to provide workers’ compensation coverage to its other employees.
Injury or Illness Must Be Work-Related
The program covers injuries sustained in work-related accidents, health problems that develop as a result of work, and occupational illnesses. If your injury happened while you were working or developed because of your working conditions, workers’ compensation should cover it.
For example, if you were traveling between locations for work and were involved in a car accident, workers’ compensation should cover your injuries. Workers’ compensation also covers repetitive motion injuries such as carpal tunnel syndrome or back strains. Hearing loss, cancers arising from toxic exposures, and even post-traumatic stress disorder may be covered in some cases.
Sometimes, an employer’s workers’ compensation insurer disputes whether an injury or illness is work-related. You can help prevent problems by reporting any work-related incident or illness to your employer immediately. If the workers’ compensation insurer denies your claim despite a prompt report, contact The Florida Firm to appeal the decision. Our Orlando lawyers are here to help you with any issue you have regarding workers’ compensation, including claim eligibility.
When Is an Injury Not Eligible for Coverage?
You do not need to prove an injury was your employer’s fault to get workers’ compensation benefits—it is a no-fault program and will cover most work-related injuries and conditions. However, there are some situations that disqualify an injury or illness from coverage.
If you were under the influence of alcohol or drugs when an accident occurred, Florida Statute § 440.09(3) says workers’ compensation will not cover you. Your employer may ask you to take a drug test, and if you refuse, coverage will likely be denied. Self-inflicted injuries or injuries that result from horseplay or intentional violations of safety rules are also not eligible for coverage.
If an Orlando employer denies your claim for workers’ compensation, citing eligibility reasons, our experienced attorneys could dispute the denial. For example, a drug test might be administered improperly and its results tainted, and violating a safety rule may not be your fault if your employer did not provide training or proper equipment. We are prepared to fight to obtain coverage for your work-related illness or injury.
Talk to Our Orlando Attorneys About Workers’ Compensation Claim Eligibility
When you get hurt at work or develop a work-related illness, you should be able to rely on the medical care and financial support you receive from the workers’ compensation program. Eligibility issues can derail your benefits and cause hardship for you and your family. If you are involved in a dispute regarding workers’ compensation claim eligibility in Orlando, you should contact us at The Florida Firm. We could investigate the situation and try to resolve eligibility issues in your favor. Call today to discuss your options.