Greetings,  I often get questions about which types of claims need to be reported by an Employer to the Carrier/TPA, and when.   Here is quick synopsis of the categories of claims and reporting, and at the bottom, some caselaw about what can happen if an employer does NOT report a claim..

The administrative rules divide injury severity into four classes: (1) first aid; (2) medical only; (3) lost time; and (4) death.  From a legal standpoint, there is no such thing as a “Report Only”.  That is simply putting the carrier on notice that there is the potential for a claim.  A “report only” would likely avoid any fines for late reporting however.

Here are the 4 categories:

1. First Aid – Employers do not need to report first aid cases to their carrier [Fla. Admin Code R. 69L-3.002(13)

1. “First Aid Case” means a work injury or illness which is treated at the work place, does not require medical treatment for which charges are incurred, and does not cause the employee to miss work for more than one day.
2. If a first aid case later becomes a medical only or lost time case, the employer shall report the injury or illness to the claims-handling entity within 7 days after the employer’s knowledge of the change in status.
3. For a first aid case that is not required to be reported to the claims-handling entity, the employer shall maintain a record of certain information regarding the injury or illness (69L-3.004)  :

2. Medical Only Claims – Employers must report medical only cases to their carrier on a DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) and Fla. Admin Code R. 69L-3.002(20)].

1. “Medical Only Case” means a work-related injury or illness, which requires medical treatment for which charges will be incurred, but which does not cause the employee to be disabled for more than 7 calendar days.
2. Failure to file the DWC-1 form with the carrier within the seven- day time limit subjects the employer to a fine.

3. Lost Time Claims – Employers must report lost time cases to their carriers on the DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) Fla. Admin Code R. 69L-3.002(19)]

1. “Lost Time Case” means a work-related injury or illness, which has caused the employee to be disabled for more than 7 calendar days or for which indemnity benefits have been paid.
2. The 7 calendar days of disability do not have to be consecutive, but are cumulative and can occur over a period of time.
3. Failure to file the DWC-1 form with the carrier within the seven- day time limit subjects the employer to a fine.

4. Death Claims – when an injury results in death, the employer must:

4. The employer must notify the carrier within seven (7) days. [440.185(2)
5.   In addition if an injury or illness results in the employee’s death, the employer shall give notice by telephone or by other means to the Division of Workers’ Compensation within 24 hours of the employer’s knowledge of the death. The mailing address for reporting of death cases is: Department of Financial Services, Division of Workers’ Compensation, Occupational Safety and Health Unit, 200 East Gaines Street, Tallahassee, Florida 32399-4222. The telephone number for reporting death cases is (800) 219-8953, (850) 413-1611 or by facsimile at (850) 922-0024.

And here is a case where an employer refused to report a WC claim.   The DCA ruled the claimant could then file a civil suit against the employer…..

Ocean Reef Club, Inc. v. Wilczewski and Leon, 99 So.3d 1 (Fla. 1st DCA 2012). 

                The Claimants, Wilczewski and Leon, worked in a beauty salon as a nail technician and hair stylist.  They both alleged continual exposure to toxic fumes used in the salon caused them to experience asthma like symptoms.  Both stated they reported their injuries to a supervisor, although the supervisor never advised the Carrier of the complaints.  The Claimant then filed a civil suit for damages against the Employer, who in turn then notified the Carrier of the claims.  The Employer moved for summary judgment in the civil action claiming immunity from tort action due to exclusive remedy of workers’ compensation. The parties agreed the Claimants advised the Employer of their injuries, however the Employer argued the Claimants had a duty to report the injuries to the Carrier as well.  The trial court denied the motion for summary judgment finding immunity did not apply given the facts of the case.

The First DCA agreed and upheld the lower court’s ruling.  The court opined that where an employer fails to satisfy its duty to inform the carrier of potential claims for workers’ compensation benefits, the employer is estopped from raising an immunity defense to a civil claim based upon the same.  Thus, the Claimants were permitted to move forward in their civil negligence claims. 

As always, please let me know if you have any questions!

Sincerely,

Morgan Indek | Managing Partner