Terms to be Familiar with

Accident: In workers’ compensation, accident means only an unexpected or unusual event or result that happens suddenly. Disability or death due to the accidental acceleration or aggravation of a venereal disease or of a disease due to the habitual use of alcohol or controlled substances or narcotic drugs, or a disease that manifests itself in the fear of or dislike for an individual because of the individual's race, color, religion, sex, national origin, age, or handicap is not an injury by accident arising out of the employment. Subject to s. 440.15(5), if a preexisting disease or anomaly is accelerated or aggravated by an accident arising out of and in the course of employment, only acceleration of death or acceleration or aggravation of the preexisting condition reasonably attributable to the accident is compensable, with respect to any compensation otherwise payable under this chapter. An injury or disease caused by exposure to a toxic substance, including, but not limited to, fungus or mold, is not an injury by accident arising out of the employment unless there is clear and convincing evidence establishing that exposure to the specific substance involved, at the levels to which the employee was exposed, can cause the injury or disease sustained by the employee.

Agency: In workers’ compensation, Agency means the Agency for Health Care Administration.
Average Weekly Wage (AWW): Average weekly wage is the injured workers average earnings. This is calculated by adding the wages earned during the 13 weeks immediately preceding the injury and dividing that number by 13. This number is then used to calculate temporary and permanent indemnity benefits.

Carrier: In workers’ compensation, “carrier” means any person or fund authorized under s. 440.38 to insure under this chapter and includes a self-insurer, and a commercial self-insurance fund authorized under s. 624.462. In simple terms, the carrier is the company or person who will act as your insurance carrier and handle the disbursement of benefits.

Compensation: The money allowance payable to an employee or to his or her dependents as provided for in this chapter.
Employee Earnings Report: These are forms that are usually sent out by the Carrier. It is very important that you read the Employee Earnings Report and report any income from any source on these. Failure to do so could subject you to fraud charges. If you have any questions, contact an attorney before signing these forms.

Injury: In workers’ compensation, injury means personal injury or death by accident arising out of and in the course of employment, and such diseases or infection as naturally or unavoidably result from such injury. Damage to dentures, eyeglasses, prosthetic devices, and artificial limbs may be included in this definition only when the damage is shown to be part of, or in conjunction with, an accident. This damage must specifically occur as the result of an accident in the normal course of employment.

Major Contributing Cause: This is a threshold legal standard by which the compensability of a benefit sought is evaluated. In order for a benefit such as indemnity or medical treatment to be compensable, the work place injury must be the major contributing cause of the need for the benefit or treatment.
Maximum Medical Improvement (MMI): MMI is a treatment plateau in each person’s healing process. It can mean that the patient has recovered from the injury or that the patient’s medical condition has stabilized to the point that no major medical change can be expected in the injured workers’ condition. Once you reach MMI the doctor will assign a permanent impairment rating and temporary benefits will stop.

Maximum Medical Improvement, Date of: Means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Misconduct: Includes, but is not limited to, the following, which shall not be construed in pari materia with each other:

1. Conduct evincing such willful or wanton disregard of an employer's interests as is found in deliberate violation or disregard of standards of behavior which the employer has the right to expect of the employee; or
2. Carelessness or negligence of such a degree or recurrence as to manifest culpability, wrongful intent, or evil design, or to show an intentional and substantial disregard of an employer's interests or of the employee's duties and obligations to the employer.

Permanent Total Disability (PTD): If you have reached maximum medical improvement and you are unable to work you may be permanently and totally disabled. A claimant deemed to PTD could be allowed to collect indemnity benefits for the rest of his or her life. The legal standard to be applied by the court in determining whether or not a claimant qualifies for permanent total disability benefits will depend on the date of accident. An injured worker should seek the advice of an attorney in order to determine what legal standard applies to his or her date of accident.

Petition for Benefits (PFB): A Petition for Benefits is a claim for a benefit which is filed with the Division of Administrative Hearings Office of Judge of Compensation. The filing of a petition will result in the case being designated a case number and the matter being set for a mediation. Under Florida law, mediation must be held within 120 days after the filing of a Petition for Benefits. If necessary, a final hearing will be scheduled within 90 days of the mediation.

Temporary Partial Disability Benefits (TPD): If a doctor has released you back to work with some restrictions, then you are entitled to collect temporary partial disability benefits, once you are eligible. This amount will be about sixty-four percent (64%) of your average weekly earnings. However, if you are working, the insurance company gets a dollar for dollar credit on this amount.

Temporary Total Disability Benefits ( TTD): If a doctor has directed you not to return to work, then you can collect temporary disability benefits once you are eligible. This amount will be two thirds (2/3) of your average weekly wages.

Time of injury: The time of the occurrence of the accident resulting in the injury.

Total Controvert: A claim that is totally controverted means that the employer/carrier have rejected your claim in its entirety and do not believe that your accident is compensable. This could be because the Carrier does not believe that it was reported on time or they simply do not believe that you sustained an accident while in the course and scope of employment.

Wages: The money rate at which the service rendered is recompensed under the contract of hiring in force at the time of the injury and includes only the wages earned and reported for federal income tax purposes on the job where the employee is injured and any other concurrent employment where he or she is also subject to workers' compensation coverage and benefits, together with the reasonable value of housing furnished to the employee by the employer which is the permanent year-round residence of the employee, and gratuities to the extent reported to the employer in writing as taxable income received in the course of employment from others than the employer and employer contributions for health insurance for the employee or the employee's dependents.

Weekly Compensation Rate: Means and refers to the amount of compensation payable for a period of 7 consecutive calendar days, including any Saturdays, Sundays, holidays and other nonworking days which fall within such period of 7 consecutive calendar days. When Saturdays, Sundays, holidays, or other nonworking days immediately follow the first 7 calendar days of disability or occur at the end of a period of disability as the last day or days of such period, such nonworking days constitute a part of the period of disability with respect to which compensation is payable.

The above is not legal advice. That can only come from a qualified attorney who is familiar with all the facts and circumstances of a particular, specific case and the relevant law. See Terms of Use.