Workers who sustain an on-the-job injury may require ongoing medical treatment, including surgery. Ideally, medical care under workers’ compensation is covered if they follow the guidelines. These treatments are managed through a combination of processes involving the injured worker, employer, medical providers, and the Florida Division of Workers’ Compensation.
However, it’s rarely straightforward to get the benefits you are entitled to receive. If you need a skilled workers’ compensation law firm to handle your claim, you can be sure that Berlin Law Firm will work tirelessly on your behalf.
Long-Term Workers’ Compensation in Florida
In Florida, injured workers can receive a total of 104 weeks, or approximately two years, of temporary permanent disability or temporary partial disability.
When the doctor decides the injured employee has reached Maximum Medical Improvement (MMI), they are not expected to improve further. The doctor then evaluates the employee for permanent work restrictions or impairment. When an employee is rated permanently impaired, it determines their future bi-weekly payment. The rating is based on the percentage of the workers’ bodily disability.
Treatments Covered by Workers’ Compensation
The treatments covered by workers’ compensation include:
- Prescription medications
- Medical tests
- Hospitalization
- Doctor’s visits
- Physical therapy
- Prostheses
- Attendant care
Note that injured workers do not have the right to choose their physicians. That choice lies within the purview of the employer’s insurance company. You can change your doctor, which is permitted once by written request.
Additionally, it’s important not miss any medical appointments or treatments. Failure to attend these appointments can indicate your injury has been resolved, as far as the insurance carrier is concerned. If you cannot attend an appointment, notify the healthcare provider and schedule a new one. Notify the insurer and explain the situation as well. Otherwise, you are in danger of losing your benefits.
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Ongoing Treatment Authorization
Generally, injured workers must receive authorization from their workers’ compensation insurer before receiving ongoing treatment beyond the initial injury, but this is not required in emergencies. However, it is possible that the employer’s insurer will not recognize specific injuries as emergencies and refuse to pay the bill. At that point, it is wise to seek the help of an experienced workers’ compensation attorney if you have not done so already.
Healthcare providers must also obtain authorization from the employer’s insurance company before providing medical care to injured workers. Failure to obtain authorization may result in payment denials.
As per §440.13 Fla. Stat, healthcare providers cannot refer injured workers to another “healthcare provider, diagnostic facility, therapy center, or other facility” without prior authorization from the carrier. Again, there are exceptions for emergency care.
Utilization Review
According to §440.13 Fla. Stat, a utilization review refers to “the evaluation of the appropriateness of both the level and the quality of healthcare and health services provided to a patient, including, but not limited to, evaluation of the appropriateness of treatment, hospitalization, or office visits based on medically accepted standards.”
Other than emergencies, the insurer evaluates the proposed course of treatment to determine whether this treatment is “reasonably prudent.” If the insurer has specific objections, they must notify the physician by the end of the tenth business day.
Dispute Resolutions
When a dispute arises with the insurance carrier regarding the payment of benefits or the type of treatment you need, it is a good time to consider hiring a workers compensation attorney who can advocate on your behalf. You are more likely to receive the benefits, treatments and coverage you need with legal counsel on your side. If the dispute is not resolved to your and your attorneys’s satisfaction, the case must go to mediation within 130 days.
Mediation does not require you to settle your claim, although this is often the case. Your lawyer will discuss the extent of your injury and the treatment that it requires. The defense attorney working for the insurance carrier also makes a presentation.
The two parties then convene in separate rooms, and the mediator discusses the strengths and weaknesses of the case with each, as well as possible settlement offers. While the mediator goes back and forth between the parties, conversations are confidential unless one party grants permission to share information with the other party.
It’s important to note that workers’ compensation insurance carriers are incentivized to deny or minimize claims to protect their bottom line. At Berlin Law Firm, our attorneys are very familiar with these strategies and know how to present your claim, emphasizing the critical facts insurers use in case evaluations. We can help you receive the compensation you deserve after a long-term job-related injury.
Schedule a Free Consultation with a Florida Workers’ Compensation Attorney
When you’ve been hurt on the job, you need an advocate with extensive experience to get positive results. At Berlin Law Firm, our attorneys specialize in Florida workers’ compensation law. Our practice focuses strictly on workers’ comp claims, and our goal is to protect your rights.
If you believe you are not getting the treatment you need for ongoing medical treatment or surgeries, you need an experienced Florida workers’ compensation attorney. Schedule a free, no-obligation consultation today.
Discuss Your Work Injury Claim for Free
Learn the types of compensation you may be eligible for and have your questions answered. Call today.
