What medical services are covered by workers’ comp insurance in Florida?

An individual who suffered an on-the-job injury in Miami, FL that is receiving workers’ compensation is entitled to receive the following:

 

  • Emergency services and care (e.g. hospitalization). For example, if an injured worker required immediate medical attention after suffering an injury in a work-related accident, workers’ comp should cover the costs associated with the care provided to him/her.
  • Medical treatment provided by an authorized health care professional
  • Medicine such as prescription drugs
  • Medical tests
  • Medical supplies
  • Durable medical equipment
  • Orthoses
  • Prostheses
  • Other medically necessary equipment
  • A workers’ comp recipient can also obtain remedial treatment and care and can attend work-hardening or pain management programs only when “such care is given based on a referral by an [authorized] physician,” according to Florida Statute §440.13.

 

Workers who suffer on-the-job injuries are usually limited to receiving care that is considered medically necessary. In other words, workers’ comp isn’t going to pay for care for an injury or condition that is not associated with the injuries suffered in the work accident. However, if an employee had a pre-existing condition that was made worse as a result of the work accident, he/she may then seek treatment for it as it is related to the work injury.

 

What does medically necessary mean?

 

Medically necessary refers to “any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to the patient’s diagnosis and status of recovery, and is consistent with the location of service, the level of care provided, and applicable practice parameters.” Florida Statute §440.13 does stipulate that chiropractic visits are not considered medically necessary when they have exceeded 24 treatments or rendered 12 weeks beyond the date when chiropractic care was first provided, whichever comes first. The only time an injured employee would be entitled to receive additional treatment from a chiropractor is if the insurance carrier authorizes the treatment or the worker has suffered a catastrophic injury.

 

What happens after an injured worker recovers from their injury?

 

Once a worker’s physician has determined that they have recovered or reached a point where they can return to work, the doctor will release them from care. In some cases, once a worker is released back to work, they may be placed on light duty or they may be limited to only performing certain tasks for a specified period of time.

 

What if an employee loses medical benefits or is released too soon?

 

Workers who lose medical benefits or are released by their physician sooner than expected can discuss the matter with their employer/insurer. If a worker feels as though their claim isn’t being handled fairly, they can always contact a Miami, FL workers’ compensation attorney who can help them understand their rights. Mario Trespalacios P.A. offers legal services to injured workers in Miami and would be happy to assist any employee who is experiencing an issue with their workers’ comp benefits.

 

Mario Trespalacios P.A. can be contacted at:

 

9495 SW 72 Street, Suite B-275

Miami, FL 33173

Phone: 305-261-5800

Website: www.mtpalegal.com