You are injured on the job. Your employer files a workers’ compensation claim. The workers’ compensation insurance carrier sends you to an Urgent Care. The doctor at the Urgent Care refers you to an orthopedic surgeon. The orthopedic surgeon says you are fine, but sends you to physical therapy. Therapy causes you more pain. You go back to the orthopedic who really isn’t listening to you. Can you you have a second opinion? The adjuster chuckles when you ask. Sorry. No second opinion for you! Welcome to Florida Workers’ Compensation.
Receiving a correct diagnosis for an injury is one of the most important components to recovering after an accident. Yet, workers’ comp doctors are often on the side of your employer and their insurance company, so what rights do you have in finding and acquiring a second opinion for your injury? How can you be sure you’ve received all the benefits you’re entitled to under Workers Comp insurance?
In Florida, if you lose faith in your doctor, you have two options: ask for a “one-time change” in physicians, or pay between $1,000 and $2,500 for an independent medical exam with the doctor of your choice.
Pursuant to F.S. 440.13(2)(f), a Claimant can change doctors once. A “one-time change” means just that: you may change physicians once during the life of your claim. Once you’ve used it, you are stuck. To add insult to injury, you do not get to choose your new doctor, the insurance company does. This means that many times you can go from the frying pan to fire. If you don’t like your new doctor, you are most likely stuck. There are ways to avoid this at times, but those ways are not obvious and are not always in your control. You should be careful before using your one time change. It’s not always a good idea, especially for primary care. Most times, if you use your one time change and are still unhappy, your last resort is an Independent Medical Exam.
INDEPENDENT MEDICAL EXAM
Injured workers are allowed to select one physician to perform an independent medical exam at their expense. That means you can pick a doctor of your choice, but you have to pay for it. The doctor will not be your treating physician, but can give you a fair and independent diagnosis of your condition and make a recommendation for treatment. You can use this to get the Judge of Compensation Claims to order the treatment.
WHY CAN’T I JUST USE MY HEALTH INSURANCE?
Most health insurance policies contain a exclusion for work-related injuries or at least say that they are secondary and have a right of subrogation if they pay for work-related injuries (this means that can seek reimbursement from your settlement, if you get one, or from the workers’ compensation carrier). If your case has been denied in its entirety, then you should be able to put your care through your health insurance. The catch? The doctors you see are not allowed to offer opinions or testify in your workers’ compensation case, even if they say you can’t work, the workers’ compensation carrier does not have to pay you disability benefits.
CAVEAT: MANAGED CARE
There are some carriers that still use a Managed Care Arrangement to administer workers’ compensation claims. For most of this, you can get a second opinion, and you may even be able to select your physician from a list of providers. Most MCAs also pay for the Claimant’s IME. While these cases do allow the claimant to be more involved in their care, they have pitfalls, like a mandatory Grievance Procedure that can delay treatment and drag out the dispute resolution process.
WHY?? ANOTHER WAY CARRIERS CONTROL THE CASE
The Florida Workers’ Compensation System is definitely not user friendly for injured workers. The Florida Legislature has given most of the control to insurance companies. Insurance companies choose conservative doctors because those types of doctors do less and cost less, leaving injured workers’ at best unsatisfied and at worst in need of medical care If you are lucky, you’ll get a doctor you like. If not, you’ll need to be clever and spend some money, or find a lawyer who can help.
Fighting for injured workers and their families since 1997. Scott R Marshall has dedicated his career to helping injured people in their battle with big insurance, by leveling the playing field between families and corporations. The greatest balancing factor in the fight against inequality and oppression is the Rule of Law.