The first thing that is needed after an employee has been injured in a Florida workers compensation claim is obtaining medical treatment.
In emergency situations the employee can obtain care immediately and then report the accident to his employer as soon as reasonably possible. Common senses dictates that a worker with a compound fracture of his femur will go straight to the hospital, probably by ambulance.
Emergency care and treatment means treatment needed to address a condition that will cause death or that substantial risk of serious bodily injury will occur if the condition is not immediately addressed. A pulled muscle in the back will not qualify for a medical emergency. If the employee seeks out care for an injury that he or she believes is an emergency situation, the workers compensation carrier may dispute payment of the medical bills if the condition is not serious.
When the injuries do not require emergency care and treatment, the injured worker must report the accident and injury to the employer before seeking medical care. (Failure to report the accident and injury within thirty days may result in the loss of all benefits). Also, the employee must give the workers compensation insurance carrier a reasonable opportunity to provide treatment.
Also, an injured worker should not follow an employer’s suggestion to get his care through the employer’s group health insurance. When the employee reports to the doctor he will be asked whether the condition is the result of an accident at work. If the employee states that his condition is not the result of an accident at work, this statement will be used against him when he pursues the workers compensation claim.
Problems usually develop with obtaining non-emergency care if the employer will not report the accident to their workers compensation insurance company. Florida law requires the employer to post the name, and address of the workers compensation insurance carrier in an obvious place (if the employer is required to carry workers compensation insurance). Contacting the insurance company directly and reporting the claim may be useful.
If the injured worker cannot get authorization for treatment after giving the employer and workers compensation carrier a reasonable opportunity to provide treatment, the employee may seek out care on his own and the judge of compensation claims can order the employer and carrier to pay for the treatment.
When the injured worker is having difficulty obtaining care they should make their requests in writing and the employee should keep a diary of their efforts to get authorization for treatment. This will be useful evidence if the workers compensation insurance company disputes that reasonable efforts were made to obtain authorization for care before the employee seeks out care on their own.
If you are having difficulty obtaining medical care call us for a free consultation. Compensation you deserve…it’s what we work for.