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Non-Compliance in Florida Workers’ Compensation Claims

Non-Compliance in Florida Workers’ Compensation Claims

Non-Compliance in Florida Workers’ Compensation Claims

I have heard this phrased several ways from clients:

‘the adjuster said if I didn’t make the doctor appointment, my benefits would be cut off”

“I had to reschedule an appointment, and the adjuster suspended my benefits”

“I missed an appointment, and my case was denied”

What this describes is the concept of medical non-compliance that an employer/carrier uses in order to suspend benefits – and the trickier issue of what does and what does not constitute medical non-compliance.

In my experience, this issue comes about when an injured worker is receiving indemnity benefits – temporary partial or temporary total disability benefits – and an issue comes up with missed or cancelled appointments, rescheduled surgeries, etc.

In the case of Gil v. Cargo Force, Inc., 141 So.3d 253 (1st DCA 2014), the court applied several prior cases to address this question. The court reaffirmed prior precedent that compensation will not be due for a period when a claimant absented herself from available medical treatment which could have ameliorated a compensable condition. In other words, the claimant cannot sit on his or her hands and not seek treatment. Now, what goes “beyond the line” is always a fact specific issue and is best answered by the age old legal advice of: IT DEPENDS.

In this Gil case, the court found that “The doctrine of medical noncompliance does not result in the permanent forfeiture of benefits and will only apply during the period Claimant failed to take reasonable steps to secure medical care.” See Davis v. Marion County, 667 So. 2d 297 (Fla. 1st DCA 1995) (stating Lobnitz does not support denial of medical benefits or forfeiture of future benefits after claimant makes herself available for medical examination).

I would always recommend that an injured worker make diligent efforts to keep all scheduled appointments. However, life comes up: sick child, car breaks down, sick relative, etc. My best advice is to document any missed appointments and take active measures to correct and reschedule as soon as practical, and to document the attempts, in writing, if possible. These are all factors that could come up to answer the question did the injured worker “take reasonable steps to secure medical care”.

If you have questions regarding non-compliance, or other workers’ compensation questions, feel free to reach out for a free consultation. You can call our office or schedule a consult here.

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