Florida Workers’ Compensation and Emergency Medical Treatment
One of the most common area of questions we receive from our workers’ compensation clients at Harris Guidi Rosner, P.A. concerns going to the emergency room. The two most common questions are:
“Can I go to the Emergency Room?”
“Will the insurance company pay the bill if I go to the emergency room?”
Both are very important and valid questions. First, it depends on if the insurance carrier has accepted the claim as compensable. Often in the beginning of a claim, a claim is in its initial investigation period and the insurance company involved may or may not have decided if it is providing benefits regarding the claim. Secondly, the bill will only get paid if the need for the visit is determined by the emergency room physician to truly be an emergency and the need for the visit must be related to your work injury. Practically speaking, if going to an urgent care center will suffice for your initial evaluation by a doctor, it is commonly a good first start for an evaluation, however, no two injuries are the same.
According to Florida case law, an injured worker has no responsibility, duty or obligation to get prior authorization for emergency medical treatment from an insurance carrier. As mentioned above, the test is if the treatment was a true and genuine emergency. See Teimer v. Pixie Playmates, 532 So. 2d 37, 40 (Fla. 1st DCA 1988). In our practical experience at Harris Guidi Rosner, P.A., the request for prior authorization often gets ignored or rejected by the average insurance Carrier, in most situations. The issue of whether it gets paid for afterwards will depend on what the examining physicians think at the emergency room visit (this becomes a medical question for the doctor who sees you) and how your records are documented regarding the emergency room visit.
Florida case law states that when it is an emergency, an injured worker can get emergency medical care wherever he or she chooses. It is not a reasonableness standard. See Sieracki v. Pizza Hut, 599 So. 2d 678, 679 (Fla. 1st DCA 1992). It will not matter, if it is truly an emergency, if the injured worker could have obtained care closer to his or her home or from an authorized treating physician. However, all emergency room care, is not compensable (meaning an insurance carrier will not pay for it) unless the need for the emergency room care results from a work-related accident [§ 440.13(3)(b), Fla. Stat. (1/1/94)
If you do receive medical treatment at an emergency room regarding your injury, it is very important you keep all your related paperwork from the discharge paperwork to any bills you may receive. If the carrier involved in your claim will not pay the bills after you submit them, please speak with us to see if we can help you.
If you have questions regarding emergency medical care and your Florida work injury, please contact us at Harris Guidi Rosner, P.A. for a free consultation regarding your case at (904) 777-7777. If you prefer email, you can also email us at firstname.lastname@example.org to schedule a consultation.