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Florida workers’ compensation claims: Who chooses the doctor?

On Behalf of | Oct 26, 2023 | Workers' Compensation

The workers’ compensation program in Florida helps to protect those who get injured on the job. Employees who get struck by falling merchandise in a warehouse or who develop carpal tunnel syndrome after years of repetitive job functions can receive benefits. There are disability benefits to replace lost wages when people have to take time off of work or change professions. They can potentially receive up to two-thirds of their average weekly wages until they return to work. There are also medical benefits that provide full coverage for necessary treatment costs. Workers need to carefully abide by program rules to file a claim and maintain their eligibility for this compensation.

Even those with health insurance are often eager to utilize workers’ compensation medical coverage, as such policies do not pass care costs back to the patient the way that health insurance usually does. However, there are far more rules regulating those medical benefits than other forms of health coverage. For example, patients don’t necessarily get to choose their own doctor when workers’ comp is footing the bill. Who makes the decision about which physician gets to provide healthcare for an injured worker?

Employers or insurance companies choose the physician

Every business in Florida with workers has to invest in a workers’ compensation insurance policy. The insurance provider that they select will have a network of approved healthcare professionals and facilities. Specific organizations and physicians can cooperate with workers’ compensation insurance when they have negotiated specific terms, such as reimbursement rates for different types of treatment. Therefore, either the employer or their insurance company will be the party that selects the physician providing someone’s treatment.

There are a few exceptions to this rule. The most commonly utilized one is when a worker requires emergency medical treatment. When it is not possible to communicate with the business before seeking care due to the urgency of the situation, workers can still expect that the medical benefits will cover the cost of their treatment. However, after medical stabilization, they will typically need to seek continued treatment through the physician or facilities selected by the insurance company. Workers have the right to ask to switch doctors once during a claim, but the new physician will also be someone selected by their employer or the insurance company.

It can be difficult to understand the rules that govern workers’ compensation benefits. Seeking legal guidance while pursuing a claim can help workers avoid the chances of making a mistake that could cost them the full value of the benefits that they’re rightfully owed.