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Medical Benefits – Workers’ Compensation

When a worker is injured in the course and scope of his/her employment, it is essential that prompt medical benefits are provided by the workers’ compensation insurance company. In Florida, most employers are required to carry workers’ compensation insurance to cover on the job injuries. Depending upon the severity of the injury, this might require immediate transport to an emergency room or, if not life-threatening, simply an appointment with a clinic or other physician. In a typical workers’ compensation case, the employer carrier will refer the claimant to an occupational or walk-in-clinic, for the purpose of assessing the individual’s need for medical services.

Regularly, at such a clinic, the individual’s condition is evaluated, testing is performed, and the individual might be prescribed some type of medication or physical therapy. Depending upon the individual’s test results, or his/her response to therapy or other preliminary treatment, a referral to a specialist of some type is often made. Depending upon the injury, that specialist might be an orthopedic surgeon, a neurologist, a neurosurgeon, or another type of physician.

Medical Benefits - Workers’ CompensationOnce the individual reaches the specialist level, it is often appropriate for more advanced diagnostic testing to be performed. The purpose of these diagnostic tests is to help the physician in a better understanding of the individual’s injury and need for additional treatment. If these tests demonstrate the need for surgery, the carrier would be obligated to authorize the surgery. If something less than surgery is required, such as additional physical therapy, that would also be ordered.

It is always the claimant’s burden to demonstrate that the industrial accident represents the major contributing cause of an individual’s current disability and/or need for treatment. A major contributing cause has been defined, since 2003, as the single greatest cause of the disability or need for treatment. In other words, the accident must be the major contributing cause/ at least 51% responsible for the disability or need for treatment.

Medical Benefits – What To Expect After Reaching Maximum Medical Improvement

Eventually, whether surgery is required or not, the injured worker will reach a level of maximum medical improvement. Maximum medical improvement is the point at which no additional medical treatment is likely to bring about improvement in the individual’s condition. This does not mean the individual is necessarily 100%, or as good as they were before the accident. It simply means that no additional treatment is likely to bring about improvement in the condition. At that point, the injury changes from being temporary in nature to permanent in nature. The treating physician will assign a permanent impairment rating, if applicable, by consulting the Florida Impairment Rating Guides. The Florida Impairment Rating Guides cover a multitude of injuries that could be expected to be sustained in the course of employment.

Additionally, once maximum medical improvement has been assigned, the physician is required to determine whether any permanent restrictions are appropriate for the injury. A restriction is a limitation assigned by the doctor, such as no lifting greater than 10 pounds, no bending, no kneeling, etc. The purpose of assigning restrictions in general, and permanent restrictions in particular, is to give the claimant some understanding as to the nature of the injury, and the risks associated with exceeding certain physical demands. The goal, of course, would be to make certain the claimant is working and living in a safe manner, and thereby reduce the likelihood of re-injury.

Once an individual reaches maximum medical improvement, very little changes in terms of their right to ongoing medical treatment (keeping in mind the statute of limitations; the obligation to never allow a year or more to pass without receiving authorized treatment). An individual is entitled to medical treatment after maximum medical improvement has been assigned, as long as the treatment remains reasonable, necessary and related to the injuries sustained in the accident. The only difference is that once MMI has been assigned, the individual is required to make a $10 co-payment to their physician for office visits.

Workers’ Compensation Attorney

Our workers’ compensation attorney in Tampa has extensive experience dealing with injured workers – and the various issues that arise in workers’ compensation cases. We help ensure your claim is filed correctly and you receive the help you need to get back on your feet and back to work. Schedule a consult today at our website here.