Newsletter
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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