If you are hurt at work, you may know that workers’ compensation should cover your losses. Yet, you may be unsure what type of care will be available to you. Florida’s workers’ compensation medical care could be more extensive than you expect, but it is your responsibility to ensure any care you receive falls within the rules.
At Ara Work Injury Law, our workers’ compensation attorneys will help you determine what your rights are and how to get them. If you were hurt at work, do not wait to contact us for support.
Overview of Medical Benefits Under Florida Workers’ Comp
Under Florida law, most employers are required to maintain workers’ compensation insurance to cover the losses employees incur when they are hurt on the job. Workers’ compensation in Florida covers all medically necessary care related specifically to the workplace injury or illness you suffered.
The employer or the insurance company must authorize the medical care received. If it is not, it may not be covered under workers’ compensation claims.
Types of Medical Care Covered
Because every situation can be a bit different, it is essential to verify that any type of care you plan to receive is covered before proceeding. In most situations, the following types of care will be covered, as long as they meet the previous two elements: being medically necessary and authorized.
- Doctor visits: You must use authorized workers’ comp doctors in Florida for any doctor’s visit for a workplace injury.
- Specialist care: If you have more advanced care needs, an authorized doctor must refer you to a specialist. This is not an automatic process.
- Hospitalization and emergency room treatment: For medically necessary emergencies and care needs, workers’ compensation will cover all costs related to emergency room and hospitalization.
- Diagnostic testing: Necessary tests, such as X-rays, MRIs, blood work, CT scans, and other diagnostic procedures, are covered services.
- Surgery: Surgery is covered by workers’ compensation in Florida if deemed necessary and approved by an authorized physician.
- Prescription medications: Workers’ compensation covers all prescription medications necessary for your medical care.
- Physical therapy or rehabilitation services: When it comes to physical therapy, workers’ compensation in Florida will cover medically necessary care, authorized by a recognized doctor.
- Medical equipment and devices: Workers who require the use of braces, crutches, or other assistive devices for a period of time during recovery can include these costs in their workers’ compensation claim.
It is quite important for an employee to know that any care they receive must be due directly to the workplace injury. If it is treating a previous condition or a new injury not related to the accident, coverage may not apply.
Authorized Treatment Physicians
Another component of this process is ensuring that the person providing treatment is approved. Workers cannot choose just any doctor. Rather, you must go to a provider approved by the insurance company that manages the workers’ compensation coverage for the employer.
In the event of a life-threatening injury, you do not have to verify where to go to get care. Get care as close to your situation as possible. However, in all other situations, employees should ask where to go to get medical care.
Employees may request a change in their treating physician. For example, if the provider is unavailable or there is another type of conflict, an employee can request a change in their treating provider. However, this can be done only once and only under specific conditions.
Second Opinions and Independent Medical Examinations (IMEs)
Injured workers may be eligible to request a one-time change of doctor. A second opinion occurs when an injured employee seeks another doctor’s insight into their diagnosis or treatment plan. You want to confirm that the care the doctor is providing is, in fact, effective and appropriate.
By contrast, an employer or an insurer may request an independent medical examination (IME). This is a way for the employer or insurer to verify the employee’s medical condition and treatment plan. For example, the insurance company may want to ensure that the recommended treatment is the best course of action for the individual and, therefore, seeks a third-party doctor to review the case.
Both are allowable and covered under workers’ compensation under appropriate circumstances. However, this is a one-time occurrence in most situations.
Travel Reimbursement
You can claim compensation for the cost of transportation to and from necessary medical appointments. This is a mileage reimbursement process. It only applies to authorized medical appointments, but may include any type of appointment from the approved services listed above. Be extensive and thorough in this process.
When Medical Treatment Is Denied or Delayed
There are situations where treatment is not approved. In some cases, that is not acceptable, especially if your health and well-being are at risk. Common reasons for denial of treatment or surgery may include:
- Disputes over what happened and where
- Denials of the type of treatment necessary
- Lack of approval for the provider
- Lack of communication over the treatment plan
- Denials related to where care was sought
Delays and denials are not the end of the process. It is very much possible for most situations to receive a full review and appeal. However, this is not an endless process. As a result, it is critical to work with a Florida workers’ comp attorney who will understand why the claim did not succeed and find the evidence to prove your rights to compensation.
Your lawyer will help to dispute medical decisions you do not believe are fair or in your best interest as well. Let a seasoned legal professional be your voice in this process.
Seek Legal Help through a Free Consultation with a Florida Workers’ Compensation Attorney
Set up a free consultation with a workers’ compensation attorney in Florida if your care is delayed, denied, or if you are being pushed back to work too early. Call Ara Work Injury Law at 561.934.3272 or 561.9343.ARA, if you were hurt in a Florida work-related accident.
