Below are the Florida workers' compensation requirements for physician choice, provider authorization, and eligibility, including procedures for initial treatment, changing physicians, and exceptions for emergency care.
Initial Medical Treatment
In Florida, the employer or their claims administrator selects the initial treating provider.
Injured workers must request their initial medical treatment from their employer, who must arrange the care within a reasonable timeframe.
If the employer or claims administrator fails to provide treatment after the injured worker’s request, the worker may obtain care independently. In this case, the employer or its claims administrator remains responsible for payment if the treatment is compensable, medically necessary, and consistent with state treatment protocols.
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 a 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.
Provider Authorization
Florida providers must obtain prior authorization from the employer’s workers’ compensation insurance carrier before treating injured workers to be eligible for payment.
- Emergency Care Exception: Providers do not need to obtain prior authorization before furnishing emergency care to injured workers.
Provider Eligibility
To become an authorized provider under the Florida workers’ compensation law:
- Providers must obtain authorization from the carrier before providing treatment.
- Only authorized providers are eligible for payment for treating injured workers.
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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