An injured worker needs the workers’ compensation carrier’s approval before a provider treats the injury, except in an emergency. Florida sets rules for that approval, including a deadline for the carrier’s reply. The rules appear in section 440.13 of the Florida Statutes.
Authorization Comes Before Non-Emergency Treatment
A provider who treats a worker must get the carrier’s authorization before treatment as a condition of payment. The requirement doesn’t apply to emergency care. A provider who gives emergency care must notify the carrier by the close of the third business day, and must also notify the carrier by telephone within 24 hours of initial treatment if the worker is admitted.
Florida Statutes section 440.13 sets these rules in subsection (3), and the full section is available on the legislature’s website. Subsection (3) is the part that governs authorization.
The Carrier Must Answer Within Three Business Days
When an authorized provider asks for authorization, the carrier must respond by the close of the third business day after it receives the request. The response can be given by telephone or in writing. A request must go to the carrier, because the statute requires all such requests to be made to the carrier.
Workers in West Palm Beach and the surrounding communities who are waiting on a reply can ask a Palm Beach County work injury lawyer to track the date the request was received. A request received on a Friday is due by the close of the following Wednesday if no holiday intervenes. Weekends are not business days.
Silence on a Written Referral Counts as Consent
The statute adds a consequence for written referral requests. A carrier that doesn’t respond to a written request for a referral by the close of the third business day consents to the medical necessity for that treatment. The text doesn’t state the same consequence for a telephone request.
A carrier that does respond can still deny the request by relying on a doctor who never examined the worker, which is the situation behind a peer review denial. The deadline governs the reply and not the answer itself.
Paperwork That Supports a Request
Records that help support an authorization request include the following:
- The treating provider’s written request describing the proposed treatment.
- The date and method used to send the request to the carrier.
- Any written reply from the carrier or adjuster.
- Medical records linking the condition to the workplace accident.
Section 440.13 lets the carrier or the worker select an independent medical examiner when treatment is disputed, so an independent medical examination may add a date to the sequence. The worker’s records should show the date the examiner was selected and the date of the examination.
Different Injuries Follow the Same Process
Authorization questions can arise with any workplace injury, whatever part of the body is involved. A lifting injury, a repetitive motion condition, and a fall each lead to the same request-and-response process.
A worker with a back injury may need imaging, therapy, and a referral to another doctor in sequence, and each request starts its own three-business-day count in back injury claims. Each approved step also needs its own date in the worker’s records, along with the provider’s written request for the next step.
Conditions that develop over time and require repeated visits to a provider, such as repetitive trauma claims, need ongoing treatment, so authorization comes up again at each stage of care and at each change in the treatment plan. The provider’s progress notes should be kept with each request, since they show why further treatment was sought.
Whether the injury happened in an office or at a job site, the three-business-day deadline in Palm Beach County workers’ compensation claims runs from the carrier’s receipt of the request. The place of the injury does not change that starting point.
Judd Koenig’s Background
Our managing partner Judd Koenig began his career representing employers and insurance companies and has represented only injured workers since 2004. He also belongs to the Palm Beach County Bar Association’s Workers’ Compensation Law Practice group.
Law Offices of Franks, Koenig & Neuwelt represents injured workers in workers’ compensation matters throughout Florida. Its attorneys focus on workplace injuries ranging from back injuries to construction accidents.
Counting the Third Business Day
Write down the date a request was sent and the date it was received. A carrier’s deadline runs from receipt, so that date anchors every later step.
If the carrier answers after the deadline, the written dates show whether the reply was timely. A worker who wants the dates confirmed can schedule a review with a Palm Beach County work injury lawyer and learn what to do if three business days pass without a reply.
