Background
Employees are faced with numerous risks in the course of executing their duties. Some of these risks relate to injuries and diseases. To minimize loss arising from compensating employees, the insurance industry has developed the Workmen’s Compensation Policy. The state of Florida has developed comprehensive workers’ compensation scheme with the objective of ensuring effective workers’ compensation. Workers’ compensation which includes four parties namely the injured employee, employer, insurer and health provider (Sink, 2008, para. 3).
The Injured Employee
The injured party is expected to report the job-related injury within a period of 30 days upon the occurrence of the accident to the employer. On the other hand, the employer should inform the insurer within seven days. The insurer contacts the patient and explains rights and obligations for better treatment. The Employee Assistance Office of the Division of Workers’ Compensation (EAODWC) sends notification letters and forms containing the injury details, fraud statement, medical records and medical mileage reimbursement forms.
The patient should comply with the doctor’s instructions and notify the employer of any special recommendations regarding job attendance. Depending on the severity of the injury, the insurer will provide compensation for the regular wages for a given period which also depends on the type of injury. The patient will be liable to prosecution if a false claim of an on-the-job injury or exaggerated injuries is filed.
The Employer
The Bureau of Compliance ensures compliance of employers to Chapter 440 of Florida Statutes by obtaining appropriate workers’ compensation insurance coverage for their employees (Florida Division of Workers Compensation, 2010,para.1-5). The employer is required to report the occurrence of injury within the workplace to the insurer and keep in contact with both patient and the doctor. In addition, the employer should get the doctor’s recommendations about the patient’s ability to work. In conjunction with the patient, he should make the necessary arrangement for the new job description and wage and notify the insurer. It is a criminal offence for an employer to be working without worker’s compensation coverage, submitting fraudulent certificates of coverage, misclassifying employees to pay lower premiums and violating stop-work order.
Health Care Provider
A health care provider or a physician must be certified by the Division of Worker’s Compensation in order to comply with worker’s compensation statutes, rules and reimbursement manuals (Leibowitz, 2007, para. 5).It is the responsibility of the certified health provider to offer the care authorized by the insurer, provide medical documentations of the patient to the insurer, recommend work limitations of the patient and filing of medical bills for compensation. It is a criminal violation of worker’s compensation laws for any physician to conspire violation or the owner of the hospital to allow use of facility in conspiracy.
Insurance Company
The functions of the insurer are to adjust claims, investigate claims, filing of policy information to the Division, respond to medical treatment requests from doctors, contact the patient within 3 days of injury, obtain a fraud statement and pay compensation depending on the degree of impairment. The insurer is expected by the Division to make compensation in time failure to which penalties will be imposed depending on the time taken for compensations to be effected. It is unlawful for any insurance to revoke compensation when an employee returns to work or when the hired employee has filed compensation claim (Sink, 2008, para. 4).
References
Florida Division of Workers Compensation. (2010). Department of Financial Services. Web.
Leibowitz, M.L. (2007). Bylaws of Workers’ Compensation. Florida Workers Compensation Section. Web.
Sink, A. (2008). Workers’ Compensation System Guide. Florida Division of Worker’s Compensation 5-30. Web.