What do I do if my workers compensation will not cover the full cost of my injury?

The goal of the Florida workers’ compensation system is to provide all of the coverage needed to fully recuperate from your injury. It also should provide for most of the income you lose while you recover.  Unfortunately, thousands of injured workers in Florida are left holding the bill — in part or in full — each year as a result of workers’ compensation coverage limitations or denials.

man with a broken arm from a work injury

When you don’t receive full compensation for the costs of your work injury, you have two main options:

– Appeal the decision of the workers’ compensation carrier

– Explore your legal options for finding compensation from other sources

Injured workers can use both options when trying to find a way to cover the full costs of their work-related injury.

Appealing the decision made by your workers’ compensation carrier

When you feel like you have been unjustly denied coverage for certain damages related to your work injury, the next step is to make an appeal to your insurer. Each insurer will have its own appeals process, although there are many similarities between them. The instructions to file an appeal should be located on the letter telling you what benefits you received — or the reasons for denying certain benefits.

You can also appeal to the conclusions made by the workers’ compensation carrier by filing a Petition for Benefits form with the Florida Division of Workers’ Compensation.

Before appealing, take the time to review the expected benefits provided by workers’ compensation. Again, there may be some differences between carriers, but carriers are also required by Florida law to provide certain types of coverage. Make sure that the losses you intend to claim are covered by the applicable policy. For example, you should know that all workers’ compensation policies in Florida only provide partial wage reimbursement, and the amount provided differs depending on the level of disability.

When appealing the decision made by a workers’ compensation carrier, be prepared to provide specific evidence for why you feel certain benefits should have been provided. This means that you must carefully study the relevant insurance contracts and provide evidence for why you think certain costs should have been covered. These topics can be highly complicated and technical, so it can benefit you to seek out help from an experienced Tampa work injury lawyer when making a workers’ compensation appeal.

Finding alternative means of compensation after a work injury

As described above, workers’ compensation benefits only provide coverage for certain aspects of your injury. A strong example is that, when you have a temporarily total disability, you will only receive 66⅓% of your full wages during the period in which you are completely unable to work. Since there is no way to demand benefits that do not exist, injured workers will have to look elsewhere for forms of compensation.

Personal health insurance coverage

One immediate option is to cover the remaining losses under your own insurance policy. In many cases, private or employer-provided health insurance can cover the remaining losses left over after receiving workers’ compensation.

The one problem is that there are consequences for using this coverage. Deductibles can apply, and it’s possible that your premiums will rise. There may also be exceptions to this coverage, particularly in situations where there is a work-related injury. Your private health insurance provider may say that these costs should be covered by workers’ compensation, so they may expect you to appeal rather than filing a claim on their policy.

Speak to a Tampa work injury lawyer to determine whether it may be appropriate to file under your own insurance or whether other means of obtaining compensation could be available.

Third-party liability insurance coverage

When workers are injured and cannot get losses fully covered by workers’ compensation, they frequently turn to third-party claims. Third-party claims are insurance claims filed against people or companies other than your employer. In order to file such a claim, the injury victim must be prepared to establish that the third party is somehow liable — or legally responsible — for the damages they’ve caused.

Examples of third-party situations relating to a work injury include:

  • An equipment manufacturer has made a defective tool, causing the worker to get injured
  • A building contractor installed faulty safety equipment
  • During a work-related road trip, the injury victim was hit by a negligent driver
  • A maintenance contractor failed to provide warnings about a slippery floor that was just polished
  • A building security contractor failed to protect employee occupants from a violent assault
  • A chemical manufacturer created a substance known to cause harm but provided it for occupational use without reasonable warnings and precautions

In all these situations, the injury could be considered “within the scope of employment”, and work-related circumstances could be considered the “major contributing cause”, making the injury eligible for a workers’ compensation claim. However, because the third party shares responsibility, they could be held liable for their portion of the fault and legally compelled to compensate the injury victim.

A work injury attorney in Tampa can help you explore your options for filing a third-party claim while assisting you with the workers’ compensation process.

A note on subrogation

Claimants are technically not allowed to “double-dip” by seeking coverage for the same type of loss from two different insurance policies. In these situations, the third-party insurance provider or private insurance provider will usually attempt to “subrogate” — or recover — the portion of losses already covered by workers’ compensation.

Put simply: you can only receive benefits once for a specific loss caused by your work injury.

Speak to Tampa work injury lawyers who can help

Getting left with uncovered expenses after your work injury can be devastating — sometimes life-altering. Injured workers may feel scared and anxious about their financial future and the well-being of their families.

Darrigo & Diaz is here to help put your mind at ease. We fight on behalf of injured workers in Tampa and throughout Florida. We help you examine your options for receiving compensation, and we relentlessly pursue any liable parties in order to help you get the money you need to move on with your life.

If you need help with appealing a workers’ compensation claim denial, filing a claim against a third party, or fighting to get compensation for your work injuries in any way, we are here for you. Schedule a free, no-obligation case evaluation when you call (813) 774-3341 or contact us online.


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