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Can I go to my own Doctor if I am in need of Treatment and the Workers’ Compensation Insurance Carrier has not provided me with any Treatment or denied my Treatment?

Workers’ Compensation Insurance Carrier

What if you get injured on the job and cannot return to work? You tell your supervisor about your injury right after it happens.   He/she does not give you any instruction. You seek treatment at the local emergency room or urgent care center.  But then you do not hear anything at all from your employer about whether you will get compensated or whether your treatment will be paid for.  You are stuck paying the medical bills and your employer still is not returning your calls.  You know this is a work-related accident and think you should be covered by workers’ compensation.

Under Florida’s workers’ compensation law, you must report your injury to your employer within 30 days from when the injury occurred. If you fail to report the injury; then you could lose your right to benefits.   It is always a good idea to report the injury in writing so that there is a record of it.  Even if it is just in an e-mail or text message to your employer; there will be proof that you informed them.  It is harder to prove that you reported it if was just reported verbally.  Many employers end up denying claims claiming lack of notice. Even if you did not report your injury to your supervisor, if your supervisor had actual notice, then this could still satisfy the notice requirement.  Actual notice involves situations where your supervisor was present at or around the scene of the accident and may have witnessed or heard about it through others.  This is harder to prove.

If the employer is denying notice, the Worker’s Compensation Insurance Carrier, (“carrier”), will not know about your injury and be able to send you to an authorized provider.  In Florida, the carrier chooses which doctors are authorized to provide your care.  If you go to your doctor, this is an unauthorized doctor.  The carrier will not have to pay for this treatment, and your doctor’s opnion as to whether you suffered a work-related accident and or whether you have a disability, among other things, will not be evidence in your trial and will not be considered by a Judge unless certain conditions are met.

The carrier has a duty to promptly provide treatment unless it is denying your claim.  If the carrier simply does not know about your claim because the employer has failed to report it, then this is another situation where you may be without treatment.  In such situations, the law has what is referred to as a “self-help” provision.  Fl. St. 440.13(2)(c) allows you to obtain treatment with your doctor of choice.  The “self-help” provision also makes the carrier liable to pay for your treatment even though it is with an unauthorized doctor, your doctor of choice.  But, it only applies in a very narrow set of circumstances.  So, it is very important to understand what those circumstances and facts are and requires a close look at the statute.

Fl St. 440.13(2)( c) reads as follows:

If the employer fails to provide initial treatment or care required by this section after a 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 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, knowing the injury, has neglected to provide the initial treatment or care.

The most important points to take away from this is that it applies to “initial treatment” and comes after you have requested it from the employer. At the very least, you would have to inform your employer of your specific injury and or complaints so that they are aware of the problem and have a chance to provide you with appropriate treatment.  If you never give them that chance, and just go and treat them on your own; then the “self-help” provision will likely not apply.  The request has to be specific enough so that your employer knows what body parts are problematic so that they know what type of treatment you need.  If you just say that you are in pain, but nothing further, this probably will not be enough to put your employer on notice that you are requesting or in need of treatment for a specific condition.  You also have to give them a reasonable period to provide the treatment.   So, requesting it today and then going out and getting it on your own tomorrow, will likely not be found to be a reasonable period to allow them to provide the treatment.

Let’s assume that you meet the requirements for the “self-help” provision to apply.  How long do you get to continue to treat with your own doctor?  The “self-help” provision is limited to only that time frame where the employer wrongfully failed to provide you treatment.  So, as soon as they authorize a provider for you, then you must go to their provider and will no longer be able to treat with your provider under “self-help”.

The “self-help” provision also applies to situations where the carrier is denying treatment.  The carrier may deny treatment for one of several reasons.  For example, they may allege that the treatment is unrelated to the accident, or not medically necessary.  In such instances, you would need to utilize the “self-help” provision and obtain treatment from your doctor while your attorney litigates the issue and a Judge eventually makes a decision.

As demonstrated in this article, if you suffer a work-related injury, your employer may dispute that you gave them notice, and you may be without treatment.  In addition, even if notice to your employer is not an issue, the carrier may fail to provide treatment or may deny treatment.  An experienced workers’ compensation attorney can help you navigate the system and ensure that you not only obtain the benefits that you are entitled but help you maximize your benefits.  If you have suffered a work-related injury, contact us at the LaBovick Law Group to see what benefits you may be entitled to.  We provide free consultations where we will review the facts of your case to determine the right course for you.  Call us today at (561) 625-8400 for your free evaluation.


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