Can I see my own doctor for a work injury?
The short answer to this question is: no, you cannot see your own preferred doctor if you wish to have all of your treatment costs and other damages covered by workers’ compensation. Florida is one of the few states that gives workers’ compensation insurance companies full control to authorize which physicians and other care providers give medical treatment.
There are four main areas where the requirement to see an insurer-authorized doctor comes into play:
- Receiving emergency or urgent medical treatment
- Getting a diagnosis
- Providing key medical details that affect your claim
- Seeking a second opinion
You are expected to see an authorized doctor, even for emergency medical treatment or urgent care
Some work injuries aren’t obvious, falling into the “let’s wait and see” category. But other times, prompt treatment is needed. This scenario can apply immediately after you get hurt in a catastrophic work injury, such as a deep cut or a bad fall. It can also apply when you think you aren’t significantly hurt at first — only to realize later that, yes, you need to see a doctor as soon as possible. This second scenario is common with internal injuries like slipped discs that, at first, may not hurt or cause physical limitations, only to reveal themselves as serious sometime later.
Unfortunately, in both scenarios, you would ideally see an authorized emergency medical care provider or go to an approved clinic for urgent treatment. In the hectic moments of realizing you are injured and deciding to seek prompt care, it can be easy to overlook the importance of going to an authorized provider. However, your treatment at these facilities may not be covered. Further, you will need to start the official process of receiving treatment over again by seeking a medical diagnosis from an authorized care provider (more on that in the next section).
If you were unaware of this policy and sought treatment from a care provider who is not authorized, it may be possible to get your treatment costs at this facility covered — especially if the event was an emergency. Inform the care provider that your injury was work-related, and give them the name and contact information of your insurance carrier and/or employer. But, when possible, ask your employer or your current workers’ compensation insurance carrier which providers are authorized before receiving treatment.
If you have already received treatment at an unapproved facility, read the next section to learn what to do next, and then speak to an experienced work injury lawyer in Tampa as soon as possible.
Only an authorized doctor can provide a legitimate diagnosis for workers’ compensation claims
The workers’ compensation claims process is supposed to start by you notifying your employer within 30 days of the accident/incident or within 30 days of you first noticing a work-related illness, injury, or condition. Your insurance carrier will then inform you of your options for seeing a care provider, who will formally diagnose your condition and form a treatment plan.
Your claims process cannot begin until you receive a diagnosis from an authorized physician. If you have already gone elsewhere to receive emergency diagnosis and treatment, you will now need to visit an authorized doctor to get what is considered your “official” diagnosis.
Your authorized care provider will determine key details, such as recommended treatments and a timetable for recovery
One major aspect that can leave hurt workers dissatisfied with their authorized care provider is that they may disagree with the provider’s assessment of the injury and its implications for their work duties.
When you visit an authorized physician, they will not only determine a diagnosis but will also make the following recommendations to your employer and your insurance carrier:
- What treatments you should receive, which can include prescriptions, therapies, medical devices, surgery, etc. Only these recommended treatments will be covered by workers’ comp.
- What work duties you can perform. The physician may indicate that you are ready to return to work for regular duties, or they may indicate that you should perform light duties or receive accommodations. They may also say you are completely unable to work for an estimated “X” amount of days.
- How long until you recover, in part or in full. Your recovery window dictates the number of replacement wages you receive. If you are recommended to return for light-duty work, your replacement wages will only provide you with the difference between your new wages and your old wages.
The authorized physician will file their assessment report with the insurer, who will then have to approve the treatment plan and provide appropriate benefits.
What do I do if I disagree with the authorized doctor’s medical opinion? Can I get a second opinion?
It can be very frustrating if you disagree with the authorized care provider’s assessment. They may deny you certain treatments you feel you need. They may say you can return to work your regular duties when you know you cannot. They may give an aggressive timetable for recovery, pressuring you to return to work earlier than you feel is reasonable.
With all of these types of disagreements, there is really only one remedy in Florida: appealing the decision through your insurance carrier’s recommended appeals process. When you receive a description of benefits letter or a denial letter, the decision should be justified in reference to the medical opinion of the authorized care provider. The letter will also provide you with instructions for the next steps to take to appeal the decision.
In all cases, you can only seek a second opinion from an authorized care provider. If you decide to see your own doctor anyways, it’s very likely you will not be covered in full for the costs of the visits and the treatments you receive — especially if they’re different from the authorized provider’s recommendations. The secondary provider’s assessment will also likely be disregarded by the insurance carrier.
You may even be unable to choose which alternative provider you want to see from the list of authorized providers! As said above, workers’ compensation insurance carriers in Florida have near-total control over the process.
Fight for your rights with assistance from experienced work injury lawyers in Tampa
Insurance carriers may wield lots of power in the Florida workers’ compensation system, but you still have legal rights. If you disagree with any assessments, want to appeal a denial of coverage, or want to explore your options for getting other treatments covered, you can turn to work injury attorneys in your area.
Darrigo & Diaz fights for the rights of injured workers in Tampa, Florida, and we keep them informed of their options. Whether you’ve just gotten hurt or are trying to appeal a decision for a recent injury, we can be here for you.
Find out what strategies you could be using and how we can help you fight for coverage during a free, confidential, no-obligation case review. Call (813) 774-3341 or contact us online to schedule a free case evaluation now.