Florida workers’ compensation law requires medical providers to obtain prior authorization for all non-emergency treatment.
Below are key authorization requirements and resources to help Florida providers know when to request prior authorization.
General Rule: Authorization Before Treatment
Florida providers must obtain authorization before delivering any non-emergency services to injured workers.
- Required: All non-emergency services must receive prior authorization from carriers.
- Do not provide non-emergency treatment until the carrier approves the authorization request.
- Track the response deadline: The carrier must respond within three business days by phone or in writing.
Per 440.13 (3) (d), non-emergency treatment is automatically authorized if the carrier does not respond within three business days.
How to Request Prior Treatment Authorization
Providers must complete and submit the Florida Workers’ Compensation Uniform Medical Treatment/Status Reporting Form (DFS-F5-DWC-25) to request authorization before treating injured workers, except in emergencies.
To request treatment authorization, providers must do all of the following:
- Complete the DFS-F5-DWC-25 Form: Clearly indicate the treatment plan, referral, or medical service requested.
- Submit the form directly to the carrier: Do not route the request through the employer or the injured employee.
- Keep proof of submission: Save a fax confirmation, email receipt, or electronic receipt to document the date sent.
- Track the response deadline: The carrier must respond within three business days by phone or in writing.
Note: The treatment is automatically authorized if the carrier does not respond within three business days.
Emergency Care
Florida workers’ comp allows providers to render emergency care immediately, but strict notification rules apply.
When administering emergency care, providers must adhere to the following notification deadlines:
- Notify the carrier by the close of the 3rd business day after providing emergency care.
- If the emergency results in hospital admission, notify the claims administrator by phone within 24 hours after the initial treatment.
Important: Emergency care is compensable only if the injury arose from a work-related accident.
Treatment Referrals
When treating Florida injured workers, providers must obtain prior authorization for all referrals to other providers or facilities, except when referrals are made during emergency care, which do not require prior approval.
Specialty Services ($1,000+) Authorization
Services costing $1,000 or more are not reimbursable unless one of the following applies:
- The carrier expressly authorizes the services, or
- The carrier fails to respond ot the authorization request within 10 days, or
- The services are provided as emergency care.
Note: A Specialty Service is automatically authorized if the carrier does not respond within ten days.
Treatment Plan Authorization
In Florida workers’ comp, authorization of a treatment plan does not guarantee approval of individual services.
- Unless otherwise stated, individual services or treatment must be specifically authorized by the carrier.
Florida |
Statute/Rule |
Statute |
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Section |
440.20 Time for Payment of Compensation and Medical Bills; Penalties for Late Payment |
Subsection Text |
440.20 (2) (a) As a condition to eligibility for payment under this chapter, a health care provider who renders services must receive authorization from the carrier before providing treatment. This paragraph does not apply to emergency care.
440.20 (2) (d) A carrier must respond, by telephone or in writing, to a request for authorization from an authorized health care provider by the close of the third business day after receipt of the request. A carrier who fails to respond to a written request for authorization for referral for medical treatment by the close of the third business day after receipt of the request consents to the medical necessity for such treatment. All such requests must be made to the carrier. Notice to the carrier does not include notice to the employer.
440.20 (2) (e) Carriers shall adopt procedures for receiving, reviewing, documenting, and responding to requests for authorization.
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Section |
440.13 Medical Services and Supplies; Penalty for Violations; Limitations |
Subsection Text |
440.13 (3) (a) As a condition to eligibility for payment under this chapter, a health care provider who renders services must receive authorization from the carrier before providing treatment. This paragraph does not apply to emergency care.
440.13 (3) (b) A health care provider who renders emergency care must notify the carrier by the close of the third business day after it has rendered such care. If the emergency care results in admission of the employee to a health care facility, the health care provider must notify the carrier by telephone within 24 hours after initial treatment. Emergency care is not compensable under this chapter unless the injury requiring emergency care arose as a result of a work-related accident. Pursuant to chapter 395, all licensed physicians and health care providers in this state shall be required to make their services available for emergency treatment of any employee eligible for workers’ compensation benefits. To refuse to make such treatment available is cause for revocation of a license.
440.13 (3) (c) A health care provider may not refer the employee to another health care provider, diagnostic facility, therapy center, or other facility without prior authorization from the carrier, except when emergency care is rendered. Any referral must be to a health care provider, unless the referral is for emergency treatment, and must be made in accordance with practice parameters and protocols of treatment as provided for in this chapter.
440.13 (3) (d) A carrier must respond, by telephone or in writing, to a request for authorization from an authorized health care provider by the close of the third business day after receipt of the request. A carrier who fails to respond to a written request for authorization for referral for medical treatment by the close of the third business day after receipt of the request consents to the medical necessity for such treatment. All such requests must be made to the carrier. Notice to the carrier does not include notice to the employer.
440.13 (3) (i) Notwithstanding paragraph (d), a claim for specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, X-ray examinations, or special diagnostic laboratory tests that cost more than $1,000 and other specialty services that the department identifies by rule is not valid and reimbursable unless the services have been expressly authorized by the carrier, unless the carrier has failed to respond within 10 days to a written request for authorization, or unless emergency care is required. The insurer shall authorize such consultation or procedure unless the health care provider or facility is not authorized, unless such treatment is not in accordance with practice parameters and protocols of treatment established in this chapter, or unless a judge of compensation claims has determined that the consultation or procedure is not medically necessary, not in accordance with the practice parameters and protocols of treatment established in this chapter, or otherwise not compensable under this chapter. Authorization of a treatment plan does not constitute express authorization for purposes of this section, except to the extent the carrier provides otherwise in its authorization procedures. This paragraph does not limit the carrier’s obligation to identify and disallow overutilization or billing errors. |
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