Injured on the Job in Florida, What Rights Do You Have? - Part 2

If the Worker's Comp Ins. carrier agrees to provide medical care, they generally have the right to send you to the primary care physician of their choice (there are exceptions to that rule such as the situation where the medical care is provided through a managed care arrangement that provides that the injured worker may select the doctor from a list of providers in the network). Usually, the primary care doctor determines the course of treatment, including referrals to other specialists if necessary. All medical care which is necessary to treat the work related injury must be provided free of charge to the injured worker until he or she has reached the point of maximum medical improvement (referred to as MMI) based upon the opinions of each and every treating doctor. MMI is defined in the law as the point at which the doctor does not anticipate that any further treatment will provide a lasting improvement in your condition (see F.S. 440.02(10), "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability). Once you reach that point of MMI, if you want to return to one of your authorized doctors because of a flare-up, exacerbation, medication refill, or simply to see what else can be done, you are responsible for a small co-payment of $10 for each doctor visit (the $10 is not applicable to therapy, testing, or treatment costs).

In addition to paying for your medical care, the insurance company is responsible to pay you for mileage to and from your doctors office for treatment, follow-ups, examinations, testing (ie. MRI, X-ray, EMG etc.), therapy appointments, and arguably anything medical related including going to and from the pharmacy to pick up prescriptions. You are entitled to 44 cents per mile, which you may claim by keeping track of the mileage and submitting it to your insurance company on a form they should provide (caution: be clear not to guess or overstate on the reimbursement form - use MapQuest or clock the mileage on a reliable odometer. If you are not able to transport yourself to your medical care, the insurance company must provide transportation for you, but make sure to arrange this well in advance of the date and time of your appointment.

Some injuries are so severe that the injured worker may not be able to perform some or all of their activities of daily living like dressing, bathing and other personal hygiene issues, getting up, taking medicine, etc. There are times when a severely injured person can not be left alone for their personal safety. In these cases, the insurance company is required to provide the injured worker with an attendant. The law requires that your doctor provide a prescription to the insurance company for this attendant care before the insurance company is required to pay for it. The prescription must describe both the type of help required and the number of hours per day it is needed. If a family member provides the care, they would be entitled to compensation from the insurance carrier (often the insurance company will agree to pay a family member to provide the care as that is usually a much cheaper option than hiring a professional home care company).

Injured workers are frequently provided with some attendant care after surgery to assist them for a limited time period. Some injuries require an attendant for 24 hours per day for the rest of one's lifetime (ie. brain damage, dementia, quadriplegia, etc.). Even in these situations, where the cost of providing care may be in the millions of dollars, the workers' compensation insurance company (or the employer if they are self-insured) is responsible to pay for this expense.

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