The bill makes revisions to criteria for compensation. Significant provisions include:
- Claims of mental injury are not compensible if there is not a physical injury, and the physical injury must be the contributing factor in the mental injury.
- For a claim to be paid, the injured worker must show that a work-related accident was responsible for more than 50 percent of the injury and disability.
- There are several revisions to the compensability of claims and indemnity benefits provided under this bill. Some of the more significant provisions are:
- Injured employees do not qualify for Permanent Total Disability (PTD) if they are physically capable of engaging in employment, including sedentary employment. If the employee is injured catastrophically, then the burden is on the employer/carrier if the employee is catastrophically injured and on the employee if he or she is not catastrophically injured.
- If the accident occurs on or after the employee's 70th birthday, benefits will be paid for no more than five years following a determination of PTD. Cost of living adjustment is revised to 3 percent instead of the current 5 percent.
- PTD supplemental benefits will not be paid after the employee has reached the age of 62 unless the employee is not eligible for Social Security because the injury prevented the employee from working sufficient quarters.
- Permanent Partial Disability (PPD) impairment benefit will be at 75 percent of Temporary total benefits. This benefit is currently 50 percent of TT benefits. This does not apply if the injured worker earns equal or greater pre-injury wage. Funeral benefit for fatal claims will increase from $5,000 to $7,500.
- Maximum aggregate for fatal claims will increase from $100,000 to $150,000.
The bill also includes changes in medical benefits, which include a maximum reimbursement allowance for physicans of 110 percent of Medicare or the reimbursement level of January 2003, whichever is greater; outpatient reimbursement for scheduled surgeries will be reduced to 60 percent of charges from 75 percent of charges; and a reduction in reimbursement for prescription medicine from 1.2 times average wholesale price plus $4.18 dispensing fee to wholesale price plus $4.18 dispensing fee.
The bill also limits attorney fees to a $1,500 per incident fee for attorneys representing injured employees in workers' compensation claims disputes, a measure supported by Republicans, who claim attorney fees are helping drive up workers' compensation costs. Democrats, on the other hand, pointed out that there was no cap on how much the insurance companies could pay attorneys to fight the claims.
Sen. Rod Smith, D-Alachua, said he worries about injured workers "having a fair shot against attorneys that are so good in this area."
The bill does hold employers' feet to the fire when it comes to exemptions from having workers' compensation insurance, and it grants the state more enforcement authority to ensure employers are not only paying into the state workers' compensation fund but are paying the correct amount.
The bill was necessary, say Republicans, to create a climate favorable to businesses thinking about relocating to the Sunshine state. According to the National Council on Compensation Insurance, S.B. 50A is expected to produce 12.5 percent in system savings plus the potential for an additional 4 percent in contractors' rates.
The majority of provisions in this bill are proposed to take effect on October 1.
