Jeffrey P. Gale, P.A. // Florida Workers’ Compensation: Creating Compensability of Injuries by Operation of Law (The “120-Day Rule”)

Few provisions in Florida’s workers’ compensation law demand more careful attention from carriers than section 440.20(4), Florida Statutes. Commonly referred to as the “120-Day Rule,” this statute outlines the process for determining compensability of an injury and can create compensability by operation of law when not followed properly. The full statutory language is as follows:

“If the carrier is uncertain of its obligation to provide all benefits or compensation, the carrier shall immediately and in good faith commence investigation of the employee’s entitlement to benefits… [and] shall admit or deny compensability within 120 days after the initial provision of compensation or benefits…. A carrier that fails to deny compensability within 120 days after the initial provision of benefits or payment of compensation … waives the right to do deny compensability, unless the carrier can establish material facts relevant to the issue of compensability that it could not have discovered through reasonable investigation within the 120-day period.”

The provision acknowledges the complexity of determining whether an injury is work-related. To that end, it gives the employer/carrier (E/C) a limited window—120 days—to investigate the claim thoroughly. This includes gathering and reviewing medical records, deposing the injured worker and witnesses, and consulting with physicians.

However, the statute has teeth: if the E/C provides benefits for a particular injury without denying compensability within 120 days, it waives the right to later contest whether the injury arose out of and occurred in the course of employment—unless it can establish that key facts could not reasonably have been discovered during the 120-day period. See North River Ins. Co. v. Wuelling, 683 So. 2d 1090, 1092 (Fla. 1st DCA 1996) (en banc).

To determine if compensability has been established by operation of law, courts apply the test outlined in Sierra v. Metropolitan Protective Services, 188 So. 3d 863 (Fla. 1st DCA 2015). The court will consider:

1. When did the E/C first provide benefits for the disputed condition?
2. Which specific injuries or conditions were covered?
3. Did the E/C deny compensability within 120 days of first providing such benefits?

Real-World Example

Our firm is currently handling a case that illustrates the operation of this rule. The claimant underwent an MRI more than two years post-accident, which revealed injuries not previously diagnosed. This MRI was ordered by a newly authorized physician during his first examination. At the follow-up, the doctor concluded that the accident was the major contributing cause (MCC) of the newly discovered injuries and notified the E/C in writing.

Since then, with the E/C’s full knowledge and authorization, the doctor has continued to treat these injuries for over 18 months—ordering physical therapy, prescribing medication, and issuing medical equipment. Under the governing case law, the E/C had 120 days from the date it received the doctor’s opinion and paid for the condition, not from the date of the accident, to deny compensability. Failing to do so may have resulted in the injury being deemed compensable by operation of law.

Conclusion

The “120-Day Rule” strikes a fair balance. It gives employers and carriers a reasonable opportunity to investigate a claim without penalizing injured workers through endless delays. It also encourages medical providers to offer timely, clear opinions on causation. Most importantly, it prevents E/Cs from passively accepting and treating injuries only to later disavow responsibility.

Proper application of the 120-Day Rule is critical—both as a shield for employers/carriers and a safeguard for injured workers. As always, knowing when the clock starts—and what restarts it—makes all the difference.

********************************

Contact us at 305-758-4900 or by email to learn your legal rights.

Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.