A recent blog post regarding workplace injury caught my attention. It was titled Florida's Workers' Compensation Laws Fail Workers (originally published on prweb.com. This headline was followed by the assertion that
"According to the United States Department of Labor, workers in Florida have filed 7,792 workers' compensation claims so far this year. More than 50% of those claims -- 3,967 -- have been denied, according to the Department's Office of Workers' Compensation Programs."
The link in that quote leads to the Florida Division of Workers' Compensation home page, not to any specific Florida data or reporting. There is no link provided to the U.S. Department of Labor, the purported source of the volume of "claims" at 7,792. The post was published on July 24, 2018. It struck me initially that is not clear whether the post's reference to "this year" is to the fiscal year 2019, which began July 1, 2018, or calendar year 2018, which began January 1, 2018.
ABC7 republished the blog, labeling it a "press release," with the same headline. It appears that republication did not involve any editorial review or checking of the facts or headline asserted.
A search of the Florida Division of Workers' Compensation Claims Database, reached through the link provided by the blog post, revealed that 21,324 "total cases" have been documented in Florida since January 1, 2018. The Division's search tool does not afford an opportunity to search date ranges except using the January 1 start date and December 31 end date (calendar years).
A similar query of the Florida Division database yielded "total cases" totals between 56,000 and 63,000 in each of the ten years before January 1, 2018. It is difficult to understand how the total volume as of July 2018 could be 7,792 as reportedly stated by the U.S. Department of Labor. And, that led me to investigate further.
As a side note, the represented Florida case figure for 2018 thus far (21,324) is seemingly not consistent with the annual volumes over those ten previous years. If the 21,234 figure for 2018 were "annualized," upon the premise of this total being gleaned with seven months of the calendar year now concluded, then the "total cases" for 2018, the total for "this year," might be anticipated to be something less than 37,000 (21,234/7 months = 3,046; 3,046 x 12 months = 36,556).
The Florida Division database does not provide a search function for gleaning the volume of "claims" (that) have been denied. The figure for this "denied" represented by the cited blog post for 2018 claims is 3,967. The absence of any database for that on the Florida Division page also caused me curiosity.
I reached out to the author of the blog and was provided a link to the data relied upon in the post regarding "claims," and was provided a link to the U.S. Department of Labor. This DOL page explains that last year the DEEOIC (Division of Energy Employees Occupational Illness Compensation) implemented new case management tools, and provides data REGARDING ITS CLAIMS. This is related to a federal program that was enacted in two parts noted, "Part B" and "Part E."
Part B was enacted in 2000 and is for employees of the Department of Energy and specified others:
"who were diagnosed with a radiogenic cancer, chronic beryllium disease, beryllium sensitivity, or chronic silicosis, as a result of exposure to radiation, beryllium, or silica while employed at covered facilities"
Part E was enacted in 2004 and compensates Department of Energy contractors, miners, millers, and specified others:
"for any occupational illnesses that are causally linked to toxic exposures in the DOE or mining work environment"
The statistics regarding the volume of claims "in Florida" as stated in the blog quote:
"According to the United States Department of Labor, workers in Florida have filed 7,792 workers' compensation claims so far this year. More than 50% of those claims -- 3,967 -- have been denied, according to the Department's Office of Workers' Compensation Programs."
are related to the "combined Part B and E." In short, the quoted statistics are related to people engaged in work covered by two federal programs. The quoted data regarding these claims is related to Florida only in that these federally employed, federally insured, employees are in, or filed their federal claims in, Florida. The cited Department of Labor data has nothing to do with Florida workers' compensation.
The blog post's headline Florida's Workers' Compensation Laws Fail Workers is thus inaccurate, misleading, and unsupported. This indictment headline impugns the Florida workers' compensation law and its workers' compensation system and provides no relevant data in support. And, despite the implications of the headline, it might be impractical to even determine a rate of "denial" for Florida "claims."
It is possible that one might calculate the volume of "claims" in Florida. However, before any Florida statistics were quoted, I would suggest that definition(s) would be of assistance. That is the point in the initial question titling this post: "What is a claim?"
"Claim" could mean that an accident/injury is reported to the Florida Division of Workers' Compensation, see section 440.185, Florida Statutes. That is the "case" data from the Florida Division.
Or, one might only count those instances in which benefits are not voluntarily provided for such injury, that is when litigation is filed, which is referred to as a "new case" in the Office of Judges of Compensation Claims (OJCC) vernacular. That filing would be a "petition." Back when the Florida Supreme Court was creating rules for Florida workers' compensation, it enacted a rule that defined "claim" as "any element of a petition for benefits (PFB) or other entitlement," see former Rule 4.020; see also Amendments to the Florida Rules of Workers' Compensation Procedure, 829 So.2d 791 (Fla. 2002).
As of August 6, 2018, there had been 18,934 "new cases" filed with the OJCC thus far in calendar year 2018. Some of those "new cases" were established because an employee or employer wants a procedural decision made by a judge (motion determined, settlement considered, etc.). Others were established because an employee feels she/he is entitled to some benefit that is not being provided and they seek a hearing to prove entitlement.
Moreover, when the situation is one of seeking benefits (filing a PFB), that PFB might seek one benefit (and thus perhaps be described as containing one "claim"). Or, that PFB might seek several benefits and thus be described as containing some other number of "claims."
Thus, depending upon the definition of "claim," there could be a variety of answers: accidents reported, petitions filed, new cases filed, or all the individual requests in those various petitions. Each definition of "claim" would likely yield a different answer.
When the employer or its insurance carrier receives that PFB, it might acquiesce in some claim(s) and deny others. It notifies the injured worker of that decision(s) through filing a "response to petition, or "RP"). And, if the employer or carrier changes its mind about something in the RP, it may file another RP describing that change. The number of RP might be readily determined, but determining how many "claims" or issues were "denied" would likely be a bit more elusive. One might have to read each RP to determine if it could be accurately termed a "denial."
Thus, there is a published headline that impugns Florida, and it is unsupported by Florida data. The post provides federal data, while inaccurately implying that data is somehow related to Florida workers' compensation. The result is misleading. The effect is unfortunate.