Medical Benefits

Medical Benefits

Broken arm

Medical Benefits & Florida’s Workers Compensation Laws

Florida’s workers’ compensation laws allow injured workers to receive medical care at no charge to the injured worker. This medical care is to be provided automatically and without the need to prove another party’s fault or negligence. However, in exchange for not having to prove another party’s negligence, in most instances the employer’s workers’ compensation carrier retains the right to select the medical provider.

After being injured, and depending on the severity of the injury, an injured worker will be taken or sent to a walk-in-clinic or hospital. The medical facility should conduct a thorough examination, provide appropriate medical treatment recommend appropriate medical care. Should the clinic refer an injured worker to another physician, such requests must be in writing and submitted to the workers’ compensation carrier. The workers’ compensation adjuster would then select the appropriate specialist or medical provider pursuant to the referring doctor’s request.

An employee who is injured at work does not have the right to select their initial treating medical provider unless the insurance carrier is structured under a managed care arrangement. If a doctor’s request or referral for treatment is being ignored, then after a reasonable period of time has elapsed, the injured worker may select their own medical provider. Following provision of this care, the carrier, or a Judge of Compensation Claims, must then find that the treatment obtained by the injured worker was reasonable, medically necessary and the industrial accident was the major contributing cause of the need for such care. IF the Judge finds in favor of the injured worker, the insurance carrier will be responsible for payment of any medical bills incurred from that provider and for any lost wages owed. However, the insurance company then has the right to select and provide a new doctor for ongoing treatment and the doctor the injured worker selected is no longer allowed to treat. Should the injured worker continue to treat with their own physician after the insurance company has provided a physician, the opinions and recommendations of the injured workers’ doctor will be ignored.

Florida’s Workers Compensation Laws Window for Change

Once during the entirety of the case (depending on the year of the accident) the injured worker may request a one-time change in medical provider. The workers’ compensation insurance company then has a set period of time in which to respond. If the insurance company responds within the time period as required by law they are allowed to select the new doctor. If the workers’ compensation carrier fails to respond in accordance with the law, the injured worker may select the doctor and that physician will be deemed authorized and cannot be replaced by the insurance company. This provision of the law is a, “use it and lose it” provision, meaning once you exercise your right to the change, and actually treat with the new doctor, you cannot select another change for the remainder of the case.

Medical care can continue for the remainder of the injured worker’s life as long as the treatment is medically necessary and the industrial injury remains the major contributing cause of the need for care. The injured worker must also be careful not to exceed the Statute of Limitations which requires the injured worker to treat within a certain period of time following the injury, last date of medical treatment with an authorized provider or payment of indemnity benefits. If the injure worker suffers a new injury (subsequent to the industrial workplace accident) and injures the same body part as injured in the workplace accident, the insurance company has the right to deny further care if the connection between the need for ongoing care and the workplace accident has been severed.

Contact a Florida Workers Compensation Lawyer

Another way to end the right to receive medical care under workers’ compensation law is to settle the claim. If an injured worker agrees to settle their claim, the right to receive future medical care paid for by the workers’ compensation insurance company will be closed forever.

Hurt at Work? We Can Help!
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