Aug 29

Florida Workers’ Compensation – Your Medical Benefits

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One benefit of Florida’s Workers’ Compensation law is that employers are required to furnish medical care to an employee hurt at work for as long as necessary, even if it is for the injured workers’ lifetime. However, the law imposes many restrictions and rules regarding medical care after a work comp injury. A full discussion of all the rules and regulations surrounding Florida’s workers’ compensation medical care would take volumes. However, let me summarize a few things that I believe an injured worker should know about their rights and responsibilities regarding medical care after a work accident.

Obtaining Initial Medical Care Under Florida’s Workers’ Compensation Law

workers compensation doctorIf you are injured at work, do NOT go to your own private doctor for treatment. This could jeopardize your entitlement to medical benefit.

Instead, you should advise your employer that you got hurt at work and ask your employer for medical care — preferably in an email or text message so there is a record of the request.

Your employer is responsible for providing medical treatment, but what happens if they don’t? Florida Statute 440.13(2)(c) states:

(c) If the employer fails to provide initial treatment or care required by this section after request by the injured employee, the employee may obtain such initial treatment at the expense of the employer, if the initial treatment or care is compensable and medically necessary and is in accordance with established practice parameters and protocols of treatment as provided for in this chapter. There must be a specific request for the initial treatment or care, and the employer or carrier must be given a reasonable time period within which to provide the initial treatment or care. However, the employee is not entitled to recover any amount personally expended for the initial treatment or care unless he or she has requested the employer to furnish that initial treatment or service and the employer has failed, refused, or neglected to do so within a reasonable time or unless the nature of the injury requires such initial treatment, nursing, and services and the employer or his or her superintendent or foreman, having knowledge of the injury, has neglected to provide the initial treatment or care.

In laymen’s terms, only after the employer fails, refuses or neglects to furnish initial treatment after a specific request for treatment within a reasonable time, you can go get treatment on your own and have the employer/carrier be responsible for payment. A reasonable time varies on the situations. Most commonly, it is five to ten days.

When you see the work comp doctor, give the doctor a full description of the accident or how you were injured. Be 100% honest about any past or current medical conditions or injuries. Talk to the doctor about whether you can work or not. If you are released to work but can’t return to your same job, you should get instructions from the doctor on what work you can and cannot do.

It is important that you keep and attend all appointments with your doctor, or benefits may be suspended.

After the appointment, you should rely the information the doctor told you to your employer. Tell your employer how much your job means to you, and explain to them what work the doctor said you can and cannot do. Give your employer a copy of the doctor’s note as soon as possible. Keep a copy for you.

You should continue to stay in contact with your employer and the insurance company throughout your treatment and recovery.

Chiropractic Care Under Florida Work Comp

Chiropractic care can be very helpful in the treatment of musculoskeletal injuries caused by work accidents. However, Florida’s law restricts how much chiropractic care can be obtained after a work accident. Under the law, an injured worker is limited to 24 chiropractic treatments or 12 weeks from the date of first chiropractic treatment, whichever occurs first.

Additional chiropractic care can be provided and paid by the workers’ compensation carrier if the adjuster authorized the additional treatment. Unfortunately, many adjusters reject the request for additional chiropractic care which results in paying for orthopedic care, prescriptions and physical therapy – all of which could cost more than the additional chiropractic care.

Prescription Medication Under Florida’s Workers’ Compensation Law

Under the law, an injured worker has an absolute right to choose a pharmacy for filling prescriptions prescribed by authorized doctors. Florida Statute 440.13(3)(j) states that “It is expressly forbidden for the department, an employer, or a carrier, or any agent or representative of the department, an employer, or a carrier, to select the pharmacy or pharmacist which the sick or injured employee must use; condition coverage or payment on the basis of the pharmacy or pharmacist utilized; or to otherwise interfere in the selection by the sick or injured employee of a pharmacy or pharmacist.”

Under the law, generic drugs are authorized. If there is no generic equivalent, than single-course patented drugs are authorized. The authorized doctor could write or state that the brand name drug is medically necessary or is available at a cost lower than its generic equivalent.

Diagnostic Testing After a Florida Work Injury

After getting hurt at work, the carrier is always responsible for payment of diagnostic testing such as x-rays or MRIs prescribed by the authorized doctor. This is true even if the test proves the symptoms are unrelated to the compensable injury.

Second Opinions Under Work Comp

There is no statutory right for a second opinion under Florida’s workers’ compensation law. However, despite the lack of any statutory provision for a second opinion, you may be entitled to a second opinion as part of your medically necessary care. Although the Court was unable to rule when a second opinion would be medically necessary, the Court did conclude that a request for a second opinion presents a question of fact that must be resolved after an evidentiary hearing.

In most situations, the carrier will refuse to authorize a second opinion. If you feel that a second opinion is medically necessary, you should talk with an attorney who understands Florida’s workers’ compensation law to discuss your options.

Change of Doctor Under Workers’ Compensation

As an injured worker, you are entitled to one change of doctors during the entire course of treatment for any accident. In almost all situations, the workers’ compensation carrier picks the doctor. If the new doctor is not satisfactory, you essentially are stuck with that doctor. Therefore, it is important that you use this right strategically.

The law states that that the employee/carrier must provide an alternative physician upon written request from the employee or the employee’s attorney. Upon the granting of the change of doctor, the original doctor is deauthorized and cannot provide future care.

The carrier must respond to a written request for a change of doctor within five days after receiving the request. If the carrier fails to response within five days, you may choose the physician and the law deems that physicians to be authorized. However, note that the carrier just has to authorize a new doctor within five days. In some situations, the carrier will authorize a new doctor, but not have an appointment scheduled for months after the authorization. The carrier will argue they followed the law while you will have to fight that no treatment for months does not follow the spirit of the law.

Independent Medical Examination (IME) After a Work Injury

What happens if the first doctor didn’t address your injuries and then the change of doctor resulted in the same conclusion? Since you cannot request another change of doctor, an alternative would be an Independent Medical Examination.

Pursuant to Florida Statute section 440.13(1)(k), independent medical examinations (“IME”) are “an objective evaluation of an injured worker’s medical condition, including, but not limited to, impairment or work status, performed by a physician or an expert medical advisor at the request of a party, a judge of compensation claims, or the division to assist in the resolution of a dispute arising under this chapter.”

The Workers’ Compensation law allows both you and the carrier the right to an IME. However, you are limited to only one IME per accident. In addition, the party requesting the examination and choosing the examiner is responsible for all costs associated with the examination – meaning you have to pay for your IME. The IME doctor cannot be a treating physician unless the parties agree, and the independent medical examiner is prohibited from providing follow-up care.

An independent medical examination is crucial if a dispute arises relating to a medical issue in your case. Since only worker’ compensation authorized doctors, IME doctors and EMA doctors (see below) are allowed to testify at a workers’ compensation hearing, it is important that there is supportive medical testimony for your position.

Expert Medical Advisor (EMA) in Florida’s Workers’ Compensation Law

What if the workers’ compensation doctor says you don’t need certain treatment and your Independent Medical Examination says you do? Who decides? An Expert Medical Advisor (EMA).

Florida Statute 440.13(9)(c) states “if there is disagreement in the opinions of the health care providers, if two health care providers disagree on medical evidence supporting the employee’s complaints or the need for additional medical treatment, or if two health care providers disagree that the employee is able to return to work,” the Judge of Compensation Claims shall, order the injured employee to be evaluated by an expert medical advisor (EMA).

You and the carrier may agree on the health care provider to serve as an expert medical advisor, but if there is no agreement, the judge of compensation claims shall select an expert medical advisor.

The Judge most often must follow the EMA’s opinions because the law states that the opinion of the expert medical advisor is presumed to be correct unless there is clear and convincing evidence to the contrary.

The involvement of an EMA is risky for both sides. Because the EMA’s opinion ultimately resolves the disputed issue, it is important that the Expert Medical Advisor is not biased for or against one party.

Conclusion

As previously discussed, volumes of books can be written about medical treatment and care in a Florida’s workers’ compensation claim. I hope this general information has been helpful. It is important that you don’t try to navigate issues relating to the medical treatment after a work injury be yourself. Talk to an attorney who understands Florida work comp law so you fully understand your rights and responsibilities.

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workers compensation attorney matthew noyesAttorneys Matthew Noyes and Lorrie Robinson help workers who are injured at work and fighting for Florida workers’ compensation benefits. If you have questions after a work injury, call Personal Injury Attorney Matthew Noyes at 727-796-8282 or simply click here to schedule a free case consultation.

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