If you’ve had a work-related injury or illness in Florida, your employer must provide you with any needed medical treatment. But how do you get that treatment through the state’s workers’ comp system? And who gets to pick your doctor?
Florida has strict rules on the choice of treating doctors, switching doctors, getting referrals to specialists or other health care providers, and getting an objective outside opinion when there are disputes about medical treatment. Read on for details.
Obviously, your doctor will play an important role in your recovery, from diagnosing your medical condition to deciding on the appropriate care you need—from medicines to surgery or rehabilitation. But the treating doctor will also make a number of important decisions that will affect how much you might receive in Florida workers’ comp benefits, including:
In Florida, your employer’s insurance company generally has the right to select your treating doctor—except for emergency care. However, there are two situations when you have at least some right to choose your doctor:
If you’re not happy with the doctor that the insurance company picked for you, you have the right to request another doctor after you’ve seen the initial physician at least once. But Florida allows you to switch doctors only one time during your entire workers’ comp case.
The insurer will pick a replacement physician who is in the same medical specialty but is not professionally affiliated with the initial doctor. However, if the insurance company doesn’t authorize an alternative physician within five days after your written request, you may then choose a new doctor.
Some injuries need more specialized care than the treating doctor can provide, like an orthopedic surgeon or physical therapist. But the insurance company must authorize any medical referrals, except in emergency situations.
A referral is considered authorized if the insurer doesn’t respond to your treating doctor’s request for authorization in time. Normally, the required response time is within three business days, but it’s 10 days when the referral is for specialty services like surgery, occupational therapy, x-rays or special diagnostic laboratory tests that cost more than $1,000.
You may have disagreements with the insurance company and/or your doctor about the medical care in your workers’ comp case, including:
In order to get another doctor’s opinion on the issue, both you and the insurer may request an independent medical examination (IME). The examiner must be a doctor in the medical specialty that’s appropriate for your condition. If the examiner finds that you aren’t making enough progress toward recovery, the insurance company may transfer you to another treating doctor.
If you’re the one who requests the IME, you have to pay for it—unless you win the dispute or the independent examiner is a doctor from the insurer’s managed care provider network. You’re entitled to only one IME during your workers’ comp case, even if you run into another dispute that involves a different medical specialty. The same rule applies to the insurance company.
You and the insurance company may decide to agree on the same independent examiner to resolve your dispute. In that case, both sides will have to follow the results of the “consensus” IME.
If you’re having trouble with your medical treatment or doctor in your workers’ comp case, you should speak with a lawyer. Workers’ compensation rules are notoriously complicated, and insurance companies often do whatever they can to save money on medical treatment for injured workers. A qualified workers’ comp attorney can help you through the system to get the medical care and benefits you deserve.