When Do I Get My First Workers’ Compensation Check?
All job-related illness and injury victims must wait at least seven days before they receive their first payments. If an injury or illness requires them to miss more than twenty-one days of work, and it probably will, victims receive the first seven days of lost wage replacement benefits retroactively. Unfortunately, in most cases, victims must wait longer than that for their first checks. More on that below.
A Tampa workers’ compensation lawyer works hard to ensure that victims get all the benefits they need and deserve as quickly as possible. These benefits include not only lost wage replacement benefits (usually two-thirds of the victim’s average weekly wage) but also prompt and direct payment of all reasonably necessary medical expenses. This combination of benefits allows job injury and illness victims to return to work as quickly as possible, which is what everyone wants in the end.
Initial Claims Examiner Reviews
Usually about a week after applicants file workers’ compensation matters, a claims examiner reviews the medical bills and other paperwork in the file to determine the amount of compensation the insurance company must pay.
Unfortunately for victims, very few claims settle on favorable terms at this point, mostly due to disputes over the amount of damages.
As mentioned, lost wage replacement benefits are based on the victim’s average weekly wage. The AWW includes cash and non-cash regular and irregular compensation. Additionally, the AWW, unlike a GPA (grade point average), must also account for future wage increases the victim misses because of injury or illness-related inactivity.
Additionally, most insurance companies almost reflexively claim that the medical bills are excessive. Emergency transportation is a good example. Most insurance company lawyers take a “next level down” approach. If the victim was airlifted to a hospital, the insurance company will only pay the cost of surface ambulance transportation. If the victim used a surface ambulance, the insurance company will pay for an Uber. We aren’t sure what happens if the victim Ubered to the hospital.
Note that we said “favorable settlements” are usually unavailable at this time. An unfavorable settlement is almost always an option. Many insurance companies make low-ball offers, hoping the victim will take the money and run (settle the claim for pennies on the dollar).
Subsequent Reviews
Unless an unfair settlement is an option, the claim proceeds to the next level, which is usually another Claims Examiner review.
Sometimes, a senior Claims Examiner basically grades the original Claims Examiner’s paper and determines if the resolution was proper. Senior Claims Examiners usually only overturn decisions in extreme and obvious cases, like a refusal to consider all available medical bills.
Administrative Law Judge Appeals
Since the denial rate is so high at the first two levels, a Tampa workers’ compensation lawyer normally appeals these matters to an administrative law judge. The delay is frustrating for everyone.
The good news is that lost wage benefits are usually retroactive to the date of filing in injury cases. Benefits are usually retroactive to the disability onset date in occupational disease claims. Either way, if victims must wait a long time for their first workers’ compensation checks, those checks are usually substantial.
Work With a Dedicated Hillsborough County Attorney
Injury victims need and deserve substantial compensation. For a confidential consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We routinely handle matters throughout the Sunshine State.
Source:
flsenate.gov/laws/statutes/2019/440.12
