Greetings,

After a claimant has reached Maximum Medical Improvement (MMI), they can continue to treat in Florida until or unless one of a few things happens:

1. The authorized doctor states the accident does not remain the major contributing cause (MCC) of the need for treatment; or
2. The authorized doctor states no further care is medically necessary; or
3. The statute of limitations (SOL)  expires; or
4. The case settles; or
5. the claimant dies.

The applicable statutes are below.

The first two above require an opinion from the treater.   And it is always a balance, the cost of possibly causing litigation versus paying for annual follow up visits by a claimant simply to keep the SOL from running.  

As far as medical necessity is concerned, it is sometimes difficult to get a doctor to state that an annual follow up is not medically necessary.   Usually the claimant is discharged PRN (which is an abbreviation for a Latin term “pro re nata,” which means “as the situation demands,” or simply, “as needed.”)  I have had doctors tell me they cannot tell me if its medically necessary until they see the claimant and know what is going on, kind of a circular Groucho Marx argument.   (I can’t say if I need to see ‘em until I see ‘em.)

Absent any of the above 1-5 or some other one-off reason such as they commit fraud, we do have to authorize the annual visits unfortunately.  As always, let me know if you have any questions and be sure to sign up for our firm’s upcoming webinars:   https://eraclides.com/events/

MCC

440.09(1)( b) If an injury arising out of and in the course of employment combines with a preexisting disease or condition to cause or prolong disability or need for treatment, the employer must pay compensation or benefits required by this chapter only to the extent that the injury arising out of and in the course of employment is and remains more than 50 percent responsible for the injury as compared to all other causes combined and thereafter remains the major contributing cause of the disability or need for treatment. Major contributing cause must be demonstrated by medical evidence only.

Medical necessity

440.13(1)(k) “Medically necessary” or “medical necessity” means any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to the patient’s diagnosis and status of recovery, and is consistent with the location of service, the level of care provided, and applicable practice parameters. The service should be widely accepted among practicing health care providers, based on scientific criteria, and determined to be reasonably safe. The service must not be of an experimental, investigative, or research nature.

SOL

440.19 Time bars to filing petitions for benefits.—

(1) Except to the extent provided elsewhere in this section, all employee petitions for benefits under this chapter shall be barred unless the employee, or the employee’s estate if the employee is deceased, has advised the employer of the injury or death pursuant to s. 440.185(1) and the petition is filed within 2 years after the date on which the employee knew or should have known that the injury or death arose out of work performed in the course and scope of employment.

(2) Payment of any indemnity benefit or the furnishing of remedial treatment, care, or attendance pursuant to either a notice of injury or a petition for benefits shall toll the limitations period set forth above for 1 year from the date of such payment. This tolling period does not apply to the issues of compensability, date of maximum medical improvement, or permanent impairment.

Sincerely,

Morgan Indek | Managing Partner