How Florida Workers' Compensation Works-Medical Care in the Florida Workers’ Compensation System

Posted over 3 years ago. Applies to Florida, 1 helpful vote

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Chapter 3

Getting Better: Medical Care in the Florida Workers’ Compensation System

The other major category of benefits that you are entitled to under Florida’s workers’ compensation law is medical benefits. When you’re injured at work, your employer or its insurance carrier is required to pay for all medical treatment that is reasonably necessary, related to your injury, and prescribed by your authorized treating doctor.

First Steps

Once you have reported your injury, your employer and its insurance carrier will begin the process of providing for your medical care. Unless you have suffered an injury that requires immediate emergency care, an appointment will be scheduled for you with a primary care doctor that the employer/insurance company chooses. If you have to get emergency treatment first, the employer/insurance company will assign you a primary care doctor after that. In either case, the primary care doctor will become your authorized treating doctor.

The first time you go to your authorized doctor’s office, you may be required to submit to a drug test. Your workers’ compensation claim could be denied if you refuse to submit to the test or if you test positive for a banned substance. You have the right to challenge the results of a positive test. If you test positive, you should contact your attorney immediately.

Authorized Treating Doctor

“Authorized treating physician" means the doctor(s) that your employer or its insurance carrier has chosen to treat you. The employer/insurance company is not required to pay for any medical care performed or prescribed by a doctor who has not been authorized to see you. You risk paying for your medical treatment out of your own pocket if you seek treatment from someone other than an authorized doctor. The only exception is emergency treatment; generally this is covered.

The course of your medical treatment depends on the severity of your injury and the medical opinion of your doctor. Your primary care doctor will recommend a course of treatment for you after your initial visit. This course of treatment could include physical therapy, medication, testing, or other options. The prescribed medical treatment and any prescriptions should be paid for by the employer or its insurance company. It’s important for you to provide your attorney with copies of prescriptions for treatment or medications right away so that you can be treated in a timely manner.

Primary care doctors often provide the initial treatment and then refer the patient to a specialist. If you’re referred to a specialist, the employer/insurance company is required to set an appointment with a doctor of its choosing in the appropriate specialty. You will only be authorized to see a specialist on the referral of your authorized treating doctor. You should provide a copy of the referral to your attorney immediately.

After you reach MMI, the employer/carrier will continue to pay for your treatment, but you will be required to pay a $10 co-pay.

Change of Doctor

If you become dissatisfied with your authorized doctor, Florida law allows you to make a one-time change. However, the employer/insurance company can choose the new doctor as long as your request is honored within 5 days. If your request is not honored within 5 days, you will be allowed to choose your own doctor, but you must still choose a doctor who has agreed to accept payment under the workers’ compensation fee schedule. Once you change doctors, you can’t change back, so you should make this decision carefully and only after talking to your attorney.

Attendant Care

While you’re recovering, you may need the help of professional or non-professional “attendant care." Attendant care is defined by the Florida workers’ compensation law as care given by a trained professional attendant that is beyond the scope of household duties. Family members may provide attendant care, but they can’t be compensated for care that falls within the scope of household duties or other services normally provided by family members for free. The law defines “family member" as a spouse, parent, sibling, child, grandchild, father-in-law, mother-in-law, aunt, or uncle.

Your authorized doctor must provide a written prescription for attendant care. The prescription must specify the times you need care as well as the type and level of care required. Your attendant care benefit will probably be delayed if the prescription doesn’t specify all of these things. You should give your attorney a copy of the prescription so that if the benefit is denied, the attorney can file a petition asking the court to require the employer/insurance company to provide it.

After you get the prescription, you have to decide who will provide the attendant care. If your doctor recommends a professional, you should follow the doctor’s orders. But sometimes a family member or other non-professional can provide the necessary care.

A family member who provides attendant care is entitled to reimbursement for his or her services. An unemployed family member or one who provides services during times that he or she is not working is entitled to be paid the federal minimum wage. A family member who quits a job to provide care is entitled to be paid at the per-hour value of the job he or she quit to provide the care. However, the per-hour value cannot exceed the per-hour value of such care that is available in the community. The family member or combination of family members providing nonprofessional attendant care cannot be compensated for more than a total of 12 hours per day.

Medical Bills

Covered Expenses

The employer or its insurance company must pay all medical bills for treatment prescribed or recommended by your authorized treating doctor. The employer/insurance company is not obligated to pay for medical services that you obtain on your own without prior authorization (except for emergency services). You should send any medical bills that you receive from authorized treating doctors to your lawyer to ensure proper payment.

The employer/insurance company is required to pay for all medications prescribed by your authorized treating doctors. Ordinarily, you will receive a prescription card that you should take to the pharmacy indicating that you are covered under a workers’ compensation plan. By presenting this card at the pharmacy, you will not be required to pay anything out of pocket for your prescription medications. You may go to any pharmacy that accepts your employer/insurance company’s insurance plan.

The employer/insurance company is also required to pay for the cost of your transportation to and from appointments for medical treatment. If you drive your own vehicle, you are entitled to mileage reimbursement. The current rate is .44.5¢ per mile. You should get a mileage log from your employer or its insurance carrier, and you should maintain the log regularly and accurately. You should submit the log periodically for reimbursement. Insurance adjusters will use Mapquest, Google Maps, or another computer program to verify the accuracy of your mileage requests. If you don’t have transportation or if you can’t drive because of your injury, the employer/insurance company is required to provide suitable transportation for you to and from your appointments.

Mental or Psychological Disorder

A mental or psychological disorder that manifests itself independent of a physical injury is not covered under Florida’s workers’ compensation law. However, you can be compensated for a mental or psychological disorder that is brought on by a physical injury. For example, many people with chronic pain develop clinical depression. If you are diagnosed with a compensable mental or psychological injury, you are only entitled to receive temporary benefits for the disorder (for a maximum of 6 months after reaching MMI for the physical injury).

Additional Resources

To learn more about Workers' Compensation claims please go to our website at www.sullivanandhepler.com or call us at 1800-295-4193 to discuss your case.

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