Below are Florida workers' comp physician choice requirements and daisyBill resources for treatment authorization and compliance.
Initial Treatment Requests
Injured workers must request their initial medical treatment. Once the request is made, the employer or their claims administrator must arrange the initial care within a reasonable time frame.
Failure to Provide Care
If the employer or their claims administrator fails to provide treatment after the worker’s request, the employee may obtain care independently.
The employer or claims administrator remains responsible for payment if the treatment is:
- Compensable
- Medically necessary
- Consistent with state treatment protocol
Transfer of Care
A claims administrator may transfer an injured worker’s care to a different provider if an Independent Medical Examination (IME) shows that the employee is not making appropriate progress with the current physician.
Change of Physician
An injured employee has the right to request one-time change of physician per accident.
- The request must be submitted in writing.
- Upon approval, the claims administrator must authorize a different physician who is not professionally affiliated with the original provider.
- The claims administrator chooses the alternate physician.
Florida |
Statute/Rule |
Statute |
|
Section |
440.13 Medical Services and Supplies; Penalty for Violations; Limitations |
Subsection Text |
440.13 (2)(c) If the employer fails to provide initial treatment or care required by this section after request by the injured employee, the employee may obtain such initial treatment at the expense of the employer, if the initial treatment or care is compensable and medically necessary and is in accordance with established practice parameters and protocols of treatment as provided for in this chapter. There must be a specific request for the initial treatment or care, and the employer or carrier must be given a reasonable time period within which to provide the initial treatment or care. However, the employee is not entitled to recover any amount personally expended for the initial treatment or care unless he or she has requested the employer to furnish that initial treatment or service and the employer has failed, refused, or neglected to do so within a reasonable time or unless the nature of the injury requires such initial treatment, nursing, and services and the employer or his or her superintendent or foreman, having knowledge of the injury, has neglected to provide the initial treatment or care.
440.13 (2)(d) The carrier has the right to transfer the care of an injured employee from the attending health care provider if an independent medical examination determines that the employee is not making appropriate progress in recuperation.
440.13 (2)(f) Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident. Upon the granting of a change of physician, the originally authorized physician in the same specialty as the changed physician shall become deauthorized upon written notification by the employer or carrier. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary. |
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