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Workers Compensation In Florida - Why Hire a Lawyer?
You May Need Help with Workers Compensation rights.

by Lesa Miller, Attorney at Law , Of counsel

The Florida workers' compensation system is supposed to be "self-executing." This means that it's designed to allow injured workers and insurance companies to interact without the need for lawyers. Indeed, insurance adjusters are ethically bound by their state licenses to put the interest of the injured workers first, even before the interest of their insurance company. Meanwhile, they are supposed to timely pay out all claims, thoroughly apprise injured workers of their rights and remedies and work with injured workers to ensure their complete recovery and return to work, if possible.

In reality, though... does this happen? Too much of the time, the answer is simply "NO." Insurance adjusters, even good ones, are overworked. They make mistakes, Sometimes they under calculate the average weekly wage, shorting you on benefits you may not even realize you are entitled to.

Sometimes you have a right to another medical opinion and don't know it. Sometimes the adjuster fails to send out the lengthy written information that apprises you of your rights. Even when they do send it out, the information is long and can be difficult to understand. The adjuster also too seldom has time to explain your rights to you, even when you ask directly. Even then, the adjuster can't explain all of the rights and remedies that are available as the process progresses. There are too many. And all of that assumes that the adjuster whom you/ve been assigned isn't unscrupulous and automatically doubting your legitimate complaints.

The system is complex. Much can depend on whether the employer and insurance carrier operate under a managed care plan, which is optional in Florida. Managed care plans offer options for doctor selection that non-managed care plans do not. The substantive and procedural rights and obligations of both the employer/carrier and the injured worker also vary depending on the date of the accident. Finally, Florida workers compensation law is law in flux because the legislature can change it at any time.. and they do.

Can an injured worker navigate the intricacies of the system without a lawyer? Yes. Do we recommend that? Almost never! This not only because of the ever-changing and relatively complex nature of the workers compensation law, but also because of the nature of the insurance business. Insurance adjusters are faced with competing interests: the best interest of the injured worker and the insurance companies' bottom line. One obligation demands that they spend money and the other demands that they save money. The hard truth is that no adjuster can serve all of those interests simultaneously and serving one will advance their careers and secure their jobs, while the other will not. Even the most well intentioned adjuster faces this paradox. That is why they must always chose the shortest and least expensive route to closing a case. If no one is watching, they will almost never supply more medical care than they absolutely have to. If no is watching, they will almost always choose the most affordable doctors who will give them the most favorable opinions.

How do they do that? Well... they are professionals who deal with injured workers all day long. They already know who the doctors are, who will send an injured worker back to work in practically any circumstance and who will not. So do we. They know all the defenses they can exploit to cut off benefits, even to otherwise deserving injured workers. So do we. They know whether the temporary benefits are calculated correctly. So do we.

The difference between us and them is that they ply their knowledge in service of their employer and carrier and with the avowed goal to move you as quickly and inexpensively through the system as possible. On the other hand, we stand guard for you, watching to ensure that they are tendering every benefit to which you are entitled. They will prey upon your toughness and exploit your desire not to make waves. We stand ready to take the fight to them, placing the adjuster under oath to answer for their actions in deposition. They will inquire of your health, hoping that you say you are feeling okay.... then if you do, they will document it in their notes and use it as a binding statement. We will listen to your complaints with an attentive ear, make formal claims for you and prosecute them, even through trial where necessary.

We put our year of experience, our in-depth knowledge of the system and the doctors and our expertise at negotiation to work for you. We know your rights and we know how to fight for them. We use our power as Officers of the Court to demand the full story from them. We compel them to explain their claims decisions before a Court of law. We use the force of law to obtain all of your medical records and we independently review them. We know how to obtain changes in doctors where possible, who and how to choose from doctor lists where they exist and how to question doctors who aren't appropriately addressing your needs.

The bottom line is that we fight for you. You deserve representation that understands the intricacies of the law, where your advantage lies and how to press that advantage to make sure that the insurance company fulfills the obligations that it has under the law. We assist you in accomplishing your goals and advise your along the way. If you want to get back to work, then we facilitate that. If you want to settle your case, then we work toward the best possible settlement for you. We work for you. It;s all that we do at the Work Comp Group. We represent injured workers. It's all that we do.
 

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