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Whether the workers' compensation insurance carrier has the right to select the treating physician is one of the primary worries of numerous injured workers in Florida. This blog post seeks to shed light on the matter and offer an overview of an individual’s right to receive medically necessary care following an accident occurring during the course and scope of his/her employment.
Shortly after reporting your work accident to your employer, they typically will report the incident to the workers compensation insurance carrier for this company. The workers compensation insurance primary responsibilities should be to secure as much information concerning the extent of the injuries so the company can refer you to the appropriate medical providers to evaluate the injuries, recommend the medical care and if necessary, refer you to a medical specialist for further assessment and treatment. Often the injured worker can express displeasure with the doctor provided by the insurance company.
For example, the injured worker may be Spanish speaking and he/she would feel more comfortable with a Spanish speaking doctor. Another issue that may arise relates to the location of the physician’s office. The worker may feel the doctor is too far from his/her house. This begs the question…who selects the physician that will provide you with medical care after a workers compensation accident?
Insurance Company Chooses Medical Provider:
In Florida, while filing a workers' compensation claim, the insurance company practically controls who the doctor(s) will be.
Initial Choice of Doctor: According to Florida law, the workers' compensation insurance carrier has the legal right to select the medical provider who will initially treat you for the work-related injury.
Subsequent Care: Should you require the services of a specialist, like an orthopedic surgeon, your insurance provider will designate the qualified specialist to attend to your needs.
One Time Change: You have the right to ask for a one-time change of medical providers if you are dissatisfied with the care you received from the first physician or specialist. But again, the insurance company has the right to select the change of provider. However, it is important to note that after a change is requested, the insurance company must provide an alternative physician in a timely manner. If the insurance fails to provide the alternative care in a timely manner, you may be able to select the physician to provide continued medical care for your workers compensation injury.
Independent Medical Examination (IME)**: The injured worker has the right to request an Independent Medical Examination (IME) if they are dissatisfied with the care they received from medical professionals provided by the workers compensation insurance. The injured worker can select an IME if there is disagreement about the severity of the injuries, or if they believe they need more medical attention. In this instance, the physician performing the IME can be chosen by the injured worker. Note however that the insurance company will not pay for the IME. The injured worker will need to pay for any costs associated with the IME.
As an Injured Worker, You Have Rights:
While the insurance carrier does have major authority over the selection of your healthcare provider, you still have rights that can empower you in the process:
Right to Medical Treatment: In connection with your work-related injuries, you are entitled to reasonable and required medical care. This covers all medical appointments, prescription drugs, procedures, physical therapy, and any other therapies that are thought to be essential to your recovery.
Right to Request a Change of Physicians: You have the right to ask for a new physician if you feel that the one you now see is not giving you the care you require.
Right to Request an Independent Medical Examination: You have the right to request an independent medical examination from the medical expert of your choosing if you are unsure about the diagnosis or the recommended course of treatment. However, all expenses related to the independent examination will be borne by the injured worker.
Right to Appeal Decisions: If the insurance company denies specific treatments prescribed by an authorized medical provider or an IME, you have the right to file a Petition for Benefits with the Office of the Judge of Compensation to ensure that the Judge issues a compensation Order, instructing the insurance company to provide the required medical care.
There are a few things to consider regarding the selection of your doctor and its implications on your treatment:
Firstly, it's important to note that not all doctors provide the same level of care. The quality of treatment you receive may vary depending on factors such as the doctor's experience, specialization, and treatment approach. If the insurance carrier selects a doctor who lacks experience or doesn't meet your specific needs, it could potentially affect your recovery process.
Additionally, if you are dissatisfied with the doctor chosen by the insurance carrier and wish to change, you may have to go through an approval process, which could result in delays in receiving the necessary treatment. These delays can prolong your recovery time and impact your ability to return to work.
Effective therapy depends on you and your doctor having open lines of communication and trust. It may be difficult for you to communicate honestly about your symptoms and progress toward healing if you are forced to see a physician chosen by the insurance company and do not feel comfortable with them.
Here are some suggestions to help you handle your medical care within the context of your workers' compensation claim:
Take thorough notes on everything: Maintain thorough records of all doctor appointments, prescription drugs, and correspondence with the insurance company. This paperwork can be quite helpful in the event that disagreements do occur.
Keep lines of communication open: It's critical to keep lines of communication open and honest with your physician. This will help ensure that your treatment is effective and tailored to your specific needs.
Seek Legal Advice: If you encounter difficulties with the insurance carrier or feel your rights are being violated, consider consulting with Juan Lucas Alvarez, P.A.. We can provide guidance tailored to your situation.
Be Proactive: Stay informed about your rights and responsibilities in the workers' compensation system. The more you know, the better equipped you will be to advocate for yourself.
Conclusion
In Florida, while the workers' compensation insurance carrier does have a say in selecting the doctor who treats you, it’s essential to understand your rights as an injured worker. You have the right to request a change in medical provider, and if necessary, you can select an independent medical examiner to evaluate and make recommendations concerning additional care. The IME can serve as an expert medical witness if you need to go before the Judge of Compensation Claims in an effort to secure additional workers compensation disability benefits and/or medical care. By being proactive and informed, you can navigate the complexities of your workers' compensation claim more effectively and ensure that you receive the care you need for a successful recovery.
But always keep in mind that the workers compensation insurance company always has their attorneys behind the scenes to counsel them on how they should handle your claim. Their interests may not always be aligned with yours. So don’t try to handle this legal claim on your own.
Contact Juan Lucas Alvarez, P.A. for a free consultation so you can have a better understanding of your legal rights and how to protect your benefits. We are here to help you advocate for your rights.
