The 120-day rule for Florida workers’ compensation governs how long your employer’s workers’ compensation insurance carrier must approve or deny your claim after the initial payment of benefits.
Workers’ compensation claims have numerous deadlines and rules that could affect how your claim works and your right to benefits. If you have questions or concerns about your workplace injury claim in Central Florida, an Orlando workers’ compensation lawyer can help you.
How the Florida Workers’ Compensation System Works
Workers’ compensation insurance policies offer benefits to injured or ill workers if their medical condition occurred because of their job. Most companies in Florida with four or more employees must carry this insurance for their full- and part-time workers.
Workers generally cannot sue their employers in Florida, so this system allows employees who are injured on the job to get medical care and support, regardless of who caused their injuries.
What Workers’ Compensation Benefits Are Available in Florida?
In Florida, the primary benefits of workers’ comp insurance include:
- Medical benefits: All necessary medical care expenses resulting from treating the employee’s injuries or illness are covered. The workers’ compensation carrier usually pays the health care provider(s) directly instead of reimbursing the employee. This means you should not see any medical bills during or after your treatment.
- Partial wage replacement: Injured workers also receive workers’ compensation payments to make up for some of their lost wages while they recover from their injuries. Most workers will receive payments covering two-thirds of their pre-injury average weekly wage, up to a certain limit. If you can perform light-duty work while recovering, your payments may be lower.
Is There a Waiting Period for Workers’ Comp Benefits in Florida?
When a worker reports an injury, there is no waiting period for medical treatment benefits. If you file a claim promptly, your medical bills should be covered immediately.
There is a seven-day waiting period for wage loss benefits, meaning you must be out of work for more than seven days to receive payments, and you will not receive payment for the first seven days unless you are out of work for more than 21 days.
You should receive your first wage loss payment from the workers’ compensation insurer within 21 days.
If I Started Receiving Benefits, Doesn’t That Mean My Claim Is Approved?
Just because you started receiving benefits does not necessarily mean your claim is officially approved. To ensure injured employees can start getting benefits immediately, workers’ comp generally uses a “pay now, investigate later” process.
While the insurance carrier is obligated to begin issuing benefits as soon as possible, an adjuster will begin an investigation and determine whether to accept or deny the claim, and they must do so within a 120-day period after providing initial workers’ compensation benefits.
If the insurance adjuster ultimately sends you a notice of denial, they may ask you to re-pay the benefits you previously received. If this happens to you, an experienced workers’ comp attorney can help you file an appeal and hopefully prevent the insurer from forcing you to pay back your benefits.
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When Does the 120-Day Rule Come into Effect?
Under Florida’s workers’ compensation law (Florida Statutes § 440.20), the 120-day rule gives an insurance carrier 120 days from the date it begins providing benefits to:
- Accept compensability, meaning they approve the claim; or
- Deny compensability, meaning they reject the claim
What Happens If The Insurer Misses the 120-Day Deadline?
If the insurer does not deny the claim within 120 days, the claim is considered approved by default. After that point, the insurance company waives the right to dispute compensability, even if it discovers additional evidence to support a denial.
What Is the Purpose of the 120-Day Rule for Florida Workers’ Compensation?
The 120-day rule protects injured workers from unreasonable delays in full claim approval. Without this rule, some employers or insurers might purposely drag their feet until a worker heals and returns to the workforce, potentially releasing them from responsibility.
This rule encourages timely investigations and quick decisions about eligibility. It also ensures that injured workers do not face a claim denial several months after an injury, after they have already racked up a large pile of medical bills and received several wage loss payments that they may have to pay back.
Without this rule, injured workers could face indefinite uncertainty about their benefits and major financial challenges.
Are There Exceptions to the 120-Day Rule?
An insurer may be able to request an exception or deny a claim after 120 days in some rare instances. Some of these circumstances could include:
- More information required: The insurance company can request an extension of the deadline if it requires more information to investigate the claim that it could not obtain within 120 days.
- Fraud: If the insurance carrier later uncovers substantial evidence or proof that the injured worker committed fraud, such as lying about their injury, the carrier might be able to deny the claim after the 120-day deadline has passed.
How the 120-Day Rule Affects Injured Workers
For injured workers, Florida’s 120-day rule is a safeguard, but it is also something you should be aware of for strategic reasons. This is especially true if your employer or their insurance company has been paying for your medical care and lost wages, but your claim has not officially been approved, and the deadline is approaching.
If 120 days have passed since you first received benefits, you have a strong argument that the insurer has accepted compensability by default. If the insurance company attempts to deny your claim or stop your benefits at this point, you should contact a workers’ compensation lawyer as soon as possible.
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Talk to Our Workplace Injury Team About Your Claim Today
If you were hurt at work in Central Florida and your employer or their workers’ compensation insurance company denies or delays your initial claim, you have rights. You can talk to our team for free and learn how our Florida workers’ compensation attorneys will protect your claim and ensure you have the legal guidance and advocacy you deserve.
Bogin, Munns & Munns has served injured workers in Central Florida since 1979. We have offices across the region to ensure you have access to an experienced attorney. Contact us today for a free consultation.
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