This diagram is not intended to be a conclusive timeline of every case, but is illustrative of a general timeline of workers’ compensation disputes following the filing of a Petition for Benefits. If you have questions about your specific facts and circumstances, please call our office to speak with one of our Tampa workers compensation attorneys. We offer free consultations.
What is a benefit that is not being provided?
A common benefit not being provided would be a surgery recommended by the authorized treating physician, which is not being authorized by the workers’ compensation carrier. This can also be a variety of medical benefits: physical therapy, diagnostic testing, medications, etc. If the case is denied in its entirety, then no benefits are being provided. Additionally, there may be entitlement to indemnity benefits that are not being provided.
If your attorney feels there is a benefit you are entitled to that is not being provided, he/she will make a good-faith attempt to resolve the matter with the workers’ compensation insurance carrier. If the good-faith attempt is unsuccessful in resolving the dispute, a Petition for Benefits will be necessary.
Filing a Petition for Benefits
Most Petitions are filed by an attorney, although an injured worker can file one pro se. Petition for Benefits must meet certain specificity requirements and must contain certain information. See. F.S. 440.192 (2014) here.
We have a long summary of information regarding claimant depositions in Florida workers’ compensation cases. A claimant’s deposition typically occurs within two months of filing the initial Petition for Benefits, but does not have to occur at any specific time. Depositions are scheduled on a case-by-case basis, so your case may differ. However, as a general rule, many cases will involve the claimant’s deposition being taken between the filing of a Petition for Benefits and the state mediation.
A state mediation is a meeting of the parties (the injured worker/their attorney and the insurance company/their attorney) in which a mediator acts to encourage and facilitate the resolution of issues/disputes prior to those disputes being decided by a judge. Mediation is required in order to have your case eventually heard by a Judge of Compensation Claims. The mediation is an informal discussion and there is no formal questioning [such as in the deposition]. The judge is not allowed to know the substance of any of the discussions that occurred during mediation.
If the parties resolve the outstanding issues (the benefits contained in the PFB, or the case in its entirety), the pending benefits claimed in the Petition for Benefits are essentially resolved. At this point, the mediator sends a form to the judge noting that all issues have been resolved and therefore no final hearing will be needed. If any issues are left unresolved, the mediator sends a form to the judge stating that the parties did not resolve all the pending issues so that the judge knows to schedule a final hearing on the unresolved issues. If some outstanding issues remain for the judge to resolve a final hearing is scheduled.
While not required to take place at this specific time, this time period (between mediation and final hearing) is when litigation/discovery typically heats up. If a surgery is being denied, it is common to take the treating physician’s deposition or the deposition of the independent medical examiner.
The final hearing is a trial without a jury. The judge hears evidence and witnesses from the claimant and then from the employer/carrier. Within thirty (30) days after the final hearing, the judge of compensation claims issues a written decision regarding the entitlement to the benefits claimed.
Workers’ compensation cases can be straight forward, or extremely complex based upon each injured worker’s specific facts and circumstances. If you have questions about how this timeline applies to your Florida work comp injury, please contact our office for individualized legal advice.