Greetings, thought it would be a good day to reflect on the things that scare me most these days in handling a FL WC claim:
- Missing a 1-time change: Unfortunately, the DCA has allowed this provision of the statute to really be a matter of gamesmanship….the claimant attorneys still try and be vague in their requests for 1-time change and/or send the request when it is most likely to be missed so they get to pick their doctor. We only have 5 calendar days to respond to a request for a 1-time change with the name of the doctor, and we should probably contact the doctor’s office to provide authorization. Do not wait for an appointment, notify the claimant and/or claimant’s atty of the name of who you will pick. If ultimately your pick refuses to see the claimant you get to pick again.
Watch out for the claimant to just cite the statute, “a doctor per 440.13(2)(f)”. The request can be in a fax, email, PFB, etc. but you still only have 5 days.
- 120 day arguments regarding preexisting conditions: The Churchill case (see Tip dated 6/5/23) says the E/C must send the 120 day letter within a reasonable time after initially treating any condition or you accept the compensability of the condition. This requires a lot of fortune-telling by the adjusters as to whether a knee strain will eventually become a request for a total knee and at what point is it the arthritis being treated versus the strain. Be clear in your authorizations to the doctor’s offices and pay attention to the diagnosis in every visit to see if it changes. Partial denials of pre-ex conditions are needed to avoid this situation (The E/C accepts the compensability of the knee strain but denies any treatment for the preexisting arthritis)
- Clowns (scary ones):
- Employers authorizing care on their own and not reporting the claim to the carrier: This can now handcuff us in denying any conditions or the claim if it goes far beyond 14 days (see 120 day rule above). If the ER paid for it, that IS authorized treatment. Plus we may get stuck with treatment from doctors we would never use, which leads me to…..
- Using unknown or unfamiliar doctors: One of the best advantages we have in Florida is the E/C gets to select all of the doctors in case (unless the 1-time change is missed). I sometimes see a new case referred to me where the doctors selected by the E/C are unfamiliar or ones we should not be using. Our firm has 8 offices throughout Florida (as well as GA and TN), so please reach out if you need to find a doctor or a specialist and we can point you in the right direction!
Have a safe and happy Halloween! Hope to see you at our Holiday parties (11/30 Tampa, 12/1 Orlando , 12/9 Atlanta)
Morgan Indek | Managing Partner