Greetings, the FL WC statute states that when a claimant reaches overall Maximum Medical Improvement (MMI), they are responsible for a $10 co-payment for medical visits.
This is an important tool to use to make sure the claimants are bearing some responsibility/burden for their continued post-MMI treatment. Most carriers have a template “MMI letter” to be sent to claimant’s advising of this change after MMI. If the Statute of Limitations runs because the claimant did not want to go to the doctor because of the co-payment, that is a valid denial.
440.13 (13)(c) Notwithstanding any other provision of this chapter, following overall maximum medical improvement from an injury compensable under this chapter, the employee is obligated to pay a copayment of $10 per visit for medical services. The copayment shall not apply to emergency care provided to the employee.
Some key points:
- The claimant must be overall MMI from all conditions/injuries.
- The physician’s office should collect the $10 and deduct that from the fee schedule billed to the carrier.
- The MMI Co-payment was challenged but upheld as constitutional by the 1st DCA in Stahl v. Hialeah Hosp., 160 So.3d 519 (Fla. 1st DCA 2015)
- What do you do if MMI is later rescinded by the doctor? There is no caselaw addressing whether you have to reimburse the claimant or not for their prior co-payments.
As always please let me know if you have any questions.
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Sincerely,
Morgan Indek | Managing Partner