In Florida, the workers’ compensation system gives the insurance carrier, not the injured worker, the authority to select the treating physician. Treatment outside that authorized network is generally not covered, though the law does give you a limited right to request a change under specific circumstances.
Why the Insurance Company Controls Medical Treatment
Florida’s workers’ compensation system is structured to manage medical care through authorized providers. Under section 440.13, Florida Statutes, the employer or insurance carrier has the right to select the treating physician. Even if you already have a primary care doctor, you are generally required to see the provider assigned to your claim. Medical bills from providers outside the authorized network are typically not covered.
When You May Be Able to Change Doctors
Although you cannot initially choose your doctor, Florida law does give you a one-time opportunity to request a different authorized physician.
Circumstances that may support a change request include:
- Dissatisfaction with current care: You have concerns about the quality or appropriateness of the treatment you are receiving.
- Communication breakdown: Your doctor is not adequately addressing your symptoms or explaining your treatment plan.
- Inappropriate treatment plan: You believe the prescribed course of treatment does not match the severity of your injury.
Emergency Situations Are Different
Emergency medical situations are an exception to the general rule. If you are seriously injured and require immediate care, you can go to the nearest emergency room or seek urgent treatment.
In these cases:
- Emergency treatment covered: Care received at the nearest emergency room for a serious injury is covered regardless of prior authorization.
- Transition to authorized care required: Once the emergency is stabilized, ongoing treatment must shift to a provider authorized by the insurance carrier.
Seeing a doctor who is not authorized by the workers’ compensation insurance carrier can create challenges for your claim. Even if the treatment is necessary, it may not be reimbursed.
Potential risks include:
- Denied medical bills
- Disputes over the necessity of treatment
- Delays in receiving benefits
- Difficulty connecting the injury to your workplace accident
How Doctor Choice Affects Your Workers’ Comp Case
The authorized physician assigned to your case has direct influence over the direction of your claim. Medical opinions influence your work restrictions, treatment plan, and eligibility for benefits.
Important factors include:
- Work status decisions: Whether you can return to work or need restrictions.
- Impairment ratings: Evaluations that affect long-term benefits.
- Treatment recommendations: Ongoing care and recovery plans.
If you have concerns about your assigned physician’s assessments, addressing them through the proper channels, including your one-time change right, is the most effective path forward.
What to Do If You Disagree With Your Doctor
Disagreements with your assigned physician can happen. If you believe your condition is not being properly evaluated or treated, there are steps you can take, including:
- Request a one-time change of physician through the insurance carrier
- Keep detailed records of symptoms and treatment concerns
- Follow all medical advice while addressing the issue
- Seek legal guidance if the dispute continues
Talk With Our Workers’ Compensation Lawyer About Your Options
Insurance companies select doctors for a reason, and it is not always in your best interest. At Smith, Feddeler & Smith, P.A., we are prepared to fight for the full story of what happened to you, including at trial when that is what it takes.
If your claim has stalled or you are unhappy with your assigned physician, call us at (863) 355-4204 or reach out online to schedule a free case evaluation.
