Florida workers who need medical treatment after being injured on the job are almost always entitled to workers’ compensation. Unless they are covered by federal laws that govern specific industries or occupations (including working longshoremen), workers’ compensation coverage must usually be provided by the injured worker’s employer. That coverage entitles employees to medical treatment and possibly to other benefits.
The medical benefit assures that employees who are injured at work do not need to pay a penny for their medical treatment. The co-pay or deductible required by health insurance does not apply to workers’ comp.
Injured employees may not understand how important it is to take advantage of the medical benefit that workers’ compensation offers. Apart from the fact that treatment helps injuries heal, a failure to treat an injury may compromise the ability to collect other workers’ compensation benefits, including disability payments. As long as victims of work injuries need treatment, it is vital for them to keep their doctor’s appointments.
The employer is required to provide medical treatment. In most cases, that process begins when the employee reports the injury to the employer. Employees can protect their rights by reporting the injury as soon as they can after the injury occurs.
Employees jeopardize their claims when they wait more than 30 days to report an injury. When injuries are not reported as soon as they occur, however, the employer’s insurance company might suspect that the employee is making a fraudulent injury report. Reports that are closer in time to the injury are more likely to be accepted as truthful.
When an injury is serious or life-threatening, an employee should get immediate emergency care. The employee is not required to obtain authorization to obtain emergency care, provided that (1) the injury actually requires emergency care, and (2) the injury is work-related. It is important to tell the emergency room physician that the injury occurred at work so that the medical records will reflect that fact.
The emergency room physician’s opinion is an important indicator of whether emergency treatment was required. Still, the fact that an emergency physician treats an injury does not necessarily mean that the injury required emergency care. An injury requires emergency care if the injury is severe and, without emergency care to stabilize the victim’s condition, the injury will likely result in a serious disability or death. If the worker could receive the same treatment at an urgent care center, the injury probably does not require emergency care.
The employer’s workers’ compensation insurance company might refuse to pay an emergency room bill if it believes the injury did not occur while the victim was working, or if it believes that the injury did not require emergency treatment. The insurance company might also require the injured worker to be transferred to an in-network facility after the condition has been stabilized in the emergency room.
When an employee has time to ask an employer for a referral to an in-network hospital or urgent care facility, the employee should ask the employer to authorize prompt medical treatment. The employer should then refer the employee to a treatment provider who is under contract with the employer’s insurance company.
Injured workers in Florida should feel free to call our firm for advice if they are denied a referral to a physician or if an insurance company will not pay for legitimate emergency treatment for a work-related injury.
Continuing Medical Treatment
While an employer will often authorize the first “urgent” medical visit, subsequent visits are usually authorized by the insurance company. That authorization must be provided whenever requested treatment is necessary to promote healing of the injury. However, the insurance company has the right to pick the physician who will provide the treatment.
Workers’ compensation covers a wide range of necessary medical procedures, including:
1. Examinations by the treating physician
2. Referrals for examinations by specialists
3. X-rays, CT scans, and other diagnostic tests that the physician deems necessary
4. Necessary surgery
5. Hospital stays
7. Physical therapy
8. Crutches, wheelchairs, and other medical equipment
9. A limited number of chiropractic treatments if they are medically necessary
In most cases, injured employees must receive prior authorization from the workers’ compensation insurance company before obtaining treatment. The employee may need a new authorization before obtaining treatment that has not been previously authorized.
When a workers’ compensation insurance company disputes the medical necessity of treatment or refuses to pay a bill, injured employees should seek advice from a workers’ compensation lawyer.
Missing an Appointment May Cause Benefits to End
Florida’s workers’ compensation law assumes that when injured workers miss a scheduled medical appointment, their injuries must have healed. In the real world, injury victims miss appointments for many reasons. They might forget the date of the appointment. They might be unable to avoid a childcare crisis. They might not be feeling well enough to visit the doctor.
Injured employees should make every effort to keep appointments. When an employee realizes that it will be impossible to keep an appointment, the employee should call the provider and reschedule the appointment. The employee should also call the insurance company representative to explain why the appointment needs to be rescheduled. Missing an appointment entirely may lead to a loss of benefits.
An employee who is temporarily disabled can receive temporary disability benefits until the injury has either healed completely or healed as much as it is ever likely to heal (up to a maximum of 104 weeks). When an employee misses an appointment, however, the insurer will probably claim that it is entitled to stop paying temporary disability benefits, even if the injury is still healing.
The termination of benefits can be contested but waiting too long will jeopardize the opportunity to force the company to resume the benefit payment. Contacting a Florida workers’ compensation attorney immediately gives the lawyer an opportunity to attempt an informal resolution of the problem. Legal proceedings may be necessary, but those proceedings are more likely to have a favorable outcome when the employee makes a diligent effort to keep every medical appointment.