Even employees with excellent health insurance would generally prefer to use workers’ compensation coverage for their treatment expenses as opposed to using their private health insurance coverage. After all, workers’ compensation typically does not pass care costs on to an injured employee.
Someone hurt on the job won’t have to worry about paying for a deductible or handing over a co-pay every time they go to an appointment if they use workers’ compensation benefits instead of health insurance. Workers’ compensation will theoretically cover all of an injured Florida worker’s care costs. However, a worker does not necessarily have the right to have any treatment covered nor the right to indefinite care in all circumstances.
When do the medical benefits for workers’ compensation generally end in Florida?
After a worker recovers
The best-case scenario for the end of medical benefits in a workers’ compensation claim would involve the worker responding well to treatment and eventually returning to work full-time without any lingering symptoms. There will no longer be medical benefits available for a worker who has fully recovered and who can now perform the same job responsibilities they once managed before their injury. If their symptoms recur in the future, they may qualify for benefits again.
After a worker reaches maximum medical improvement
Not every injury will lead to a full recovery. Repetitive stress injuries and traumatic back injuries often leave someone with lasting functional limitations. When a patient reaches a point where they no longer respond to treatment, continuing to cover care would be a waste of resources. If a doctor maintains that a patient achieves maximum medical improvement (MMI) given their condition, the coverage for additional treatment will usually end at that point. However, the worker can still receive partial benefits for the management of their lingering symptoms.
After a worker stops following medical instructions
One of the rare cases in which a worker will lose benefits before fully recovering or achieving MMI involves them refusing to follow medical directions. Workers will generally need to follow a doctor’s recommendations or seek a second opinion in a scenario in which they disagree with the doctor’s care plan. Otherwise, their non-compliance might put their future coverage at risk.
Understanding the rules that govern workers’ compensation coverage in Florida can help those recovering from a recent injury get the support they need to return to work and continue supporting their families.