Injured workers are often shocked at the amount of underpaid benefits I am able to identify and collect on their behalf. This often occurs even in cases where the adjuster feels that the adjuster was actually being “fair” in the adjuster’s handling of the claim.
Why do I see this so often? A primary reason is that injured workers are not familiar enough with workers' compensation benefits to recognize when they are being cheated, intentionally or unintentionally, by an insurance company. Injured workers are also not aware how the pressure on adjusters to get claims closed often leads adjusters to deny benefits inappropriately.
Let me give you an example. In Florida, the starting point for all workers' compensation lost wage benefits is the calculation of average weekly wage (AWW). The calculation of AWW is controlled by specific guidelines in the law. Routinely, though, adjusters make an incorrect AWW calculation at the start of the case that results in an improperly low AWW.
An adjuster’s AWW calculation error might lead to an underpayment of $50.00 per week. Multiply that by 20 weeks and you have $1,000.00. Sometimes adjusters use an incorrectly low AWW on purpose. Sometimes adjusters use an incorrectly low AWW because of a mistake, or because the adjuster does not know how to properly calculate the AWW! No matter the cause, injured workers can’t afford to give away thousands of dollars in underpaid workers' compensation lost wage benefits, but injured workers lose thousands of dollars routinely because of improper AWW figures.
AWW is also impacted if the employer stops paying toward fringe benefits at some point of a case. When that happens, the adjuster is supposed to increase the AWW by the weekly amount that the employer contributed to the fringes benefits before the work accident. How often does this happen in reality? In my experience, rarely is such an adjustment made until an attorney identifies the fringe benefits issue and makes a claim for an increase in AWW and underpaid benefits. This is because once a worker is hurt, adjusters rarely follow-up to see if fringe benefits stop at any point.
Further, workers' compensation adjusters face a lot of internal pressure from their managers to get claims closed. To push injured workers to close their claims, adjusters often take positions on benefits payments that are not consistent with the law, both in terms of lost wage benefits and medical benefits.
For example, “voluntary limitation of income” is a valid reason to deny payment of benefits if an injured worker refuses to perform work that the employer makes available within assigned work restrictions. Yet, I see this defense asserted with alarming frequency even in cases where the injured worker never refused any offered work. Such improper assertion of defenses routinely cost injured workers thousands of dollars that they should be paid and discourages injured workers from pursuing their claims.
The same situation happens with improper medical defenses. Adjuster’s often deny provision of medical care on improper grounds. For example, an adjuster will deny authorization of a surgery on the grounds that the work accident did not cause the need for surgery, or that the surgery is not medically necessary, even though doctor requesting the surgery already told the insurance company that the work accident caused the need for surgery and that the surgery is medically necessary. Injured workers often give up in the face of such denials and pursue the care outside of the workers' compensation system, not realizing the denial can be challenged.
The bottom line is that the Florida workers' compensation system is complicated. It is nearly impossible for an unrepresented injured worker to know if benefits are being paid properly. All too often, workers' compensation benefits are underpaid, increasing the hardship on an injured worker and that workers’ family.
If you suspect that your benefits have been underpaid or denied inappropriately, trust your instincts and let us provide a free consultation (941) 365-7575, or contact us online to go over the facts of your case.