What if you get injured on the job and cannot return to work? You tell your supervisor about your injury right after it happens. 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 isn’t returning your calls. You know this is a work-related accident and think you should be covered by workers’ compensation. But, you don’t know who else to call or where you should be going for treatment, or what you are supposed to do.
Under Florida’s workers’ compensation law, you must report your injury to your employer within 30 days from when the injury occurred. There are some exceptions to this rule.
- The employer or the employer’s agent had actual knowledge of the injury;
- The cause of the injury could not be identified without a medical opinion and the employee advised the employer within 30 days after obtaining a medical opinion indicating that the injury arose out of and in the course of employment;
- The employer did not put its employees on notice of the requirements of this section by posting notice; or
- exceptional circumstances, outside the scope of the above exceptions, justify such failure.
Failure to timely report the injury could bar your claim for benefits. It is always a good idea to report the injury in writing so that there is a record of it. It is harder to prove that you reported it if was just reported verbally.
Your employer is required to report the injury to its workers’ compensation insurance carrier within 7 days. The employer reports the injury on a form called “the first report of injury”, and provides you with a copy. At that point, there are a series of steps that are supposed to occur. You should be provided with informational brochures about Florida’s workers’ compensation law and procedures directly from the insurance carrier, along with information about treatment and which doctors you are authorized to see. The carrier should be scheduling an appointment for you to go and see the provider authorized to treat you.
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 own doctor of choice. You will later be reimbursed for such treatment by the carrier, assuming your claim is compensable and the treatment was medically necessary. This section also applies if the carrier is aware of your claim but is denying your claim and not authorizing treatment because your claim is in denial status. If your claim is later found to be compensable, the carrier would be liable to reimburse you for treatment. This includes not only medical bills but reimbursement for prescriptions and other medically necessary apparatus’s as well as mileage to and from your doctor’s visits, among other things.
In order for the “self-help” provision to apply, the injured worker must make a request for care and allow the carrier a reasonable time to respond. If there is no timely response from the carrier, the injured worker can obtain treatment on his or her own but must show that the treatment was compensable, reasonable, and medically necessary.
Medically necessary and compensable treatment simply means that the treatment is related to the work-related injury and not to unrelated or pre-existing conditions, and is due to medical necessity. So, a benefit that would not improve a worker’s condition or aid in recovery would be invalid. Treatments that are experimental or investigative are not compensable. Treatments that are not recognized or are illegal, such as medical marijuana, are not compensable. Also, keep in mind that just because a doctor says that a treatment is “medically necessary” does not automatically make it so. The carrier can challenge that designation and then a Judge would need to decide. For example, there has been litigation over whether a carrier needs to pay for a swimming pool if a doctor says that it is medically necessary for an injured worker to swim in order to aid in his or her recovery. Depending on the circumstances, the carrier has had to pay for the cost of installing a pool at an injured workers’ home.
So, again it is your burden to request treatment after an injury, and allow the employer/carrier a reasonable time to respond. However, even if you do not request treatment from the employer; you still can be compensated for treatment you obtain on your own if the nature of the injury requires such initial treatment and the employer having knowledge of the injury, has neglected to provide the initial treatment or care.
Under the workers’ compensation law, the employer/carrier has the right to choose the doctor who will treat you for your work-related injury. That is, the carrier’s doctor is going to be the person determining whether your injury is related to the accident, and the necessity and type, and frequency of treatment. Thus, the employer/carrier ordinarily has a lot of control over your medical care. It is only when the employer/carrier fails to fulfill its obligations under the workers’ compensation law that it loses that control.
As long as the employer/carrier fulfills its duty to provide appropriate care in a timely manner, it will retain the right to select and authorize the physicians to treat an injured worker. When an employer abandons its obligation to provide appropriate care, however, it surrenders to the injured worker the right to select a physician and obtain treatment. Thus, the carrier has an incentive to act appropriately and in accordance with the law in promptly providing you with treatment.
Besides medical treatment, you may be entitled to indemnity benefits to compensate you for lost earnings. If these benefits are withheld by the carrier because it is denying the compensability of your claim; then once the claim is found compensable, the carrier will not only be responsible for paying your appropriate past due to indemnity benefits but also interest and penalties on top of that. In the event that the employer never reported the injury to the carrier and you are out of work and losing wages, then you should eventually get the lost wage benefits that you are entitled to, plus interest and penalties, as well.
As demonstrated in this article, sometimes the system does not quite work the way that it should. An experienced West Palm Beach workers’ compensation attorney can help you navigate the system and ensure that you are obtaining the benefits that you are entitled to. 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.