Who Decides Medical Care in My Florida Workers' Comp Claim? Authorized Doctors vs. Unauthorized Doctors

authorized doctor medical care workers comp compensation attorney lawyerA few years ago, while communicating with the workers’ comp insurance company in one of my client’s cases, I had an adjuster tell me she could decide whether an injured worker could get aspirin paid for by workers’ comp.

While unfortunate, it is true that in Florida, the workers’ comp insurance company can micromanage every aspect of an injured worker’s medical care, including:

  1. The doctor you will see and when you will see him or her
  2. The type of medical care you will receive
  3. The medical tests you will undergo
  4. The procedures the doctor will provide
  5. The prescriptions you will receive
  6. When you’ll go for therapy (if needed)
  7. Whether the doctor will continue to treat you, regardless of whether you continue to suffer from injuries or not

Authorized Doctors vs. Unauthorized Doctors

The doctor that the insurance company selects for you is called an authorized workers’ comp doctor. A doctor that you see on your own is defined by the workers’ comp insurance company as an unauthorized doctor.

Authorized medical care means that a claims adjuster employed by the workers’ comp insurance company has notified the doctor that your bills will be covered and paid for by workers’ comp.

Most additional workers’ comp benefits are received only because of the opinion of the authorized doctor.

For instance, if an authorized doctor says that an injured worker cannot work, then the workers’ comp insurance company will begin to pay wage loss benefits to the injured worker. But, if an unauthorized doctor says an injured worker cannot work, the workers’ comp insurance company does not have to pay wage loss benefits.

Can an Unauthorized Doctor Become an Authorized Workers' Comp Doctor?

It is possible for an unauthorized medical doctor to become authorized.

To authorize an unauthorized doctor, you can seek an “after-the-fact determination” by the judge of compensation claims.

In order to seek an after-the-fact determination, you must hire a new doctor with whom you do not have a treating relationship as an “independent medical examiner."

This new doctor will review the records of your unauthorized doctor and provide testimony. The judge of compensation claims will then consider whether an after-the-fact authorization is warranted.

What to Do in Emergency Situations

In emergency situations that require an ambulance or immediate visit to an urgent care clinic, there may not be time for the workers’ comp insurance company to provide an authorized doctor.

If you have a medical emergency after work hours or on the weekend, please do not make your first call to the insurance company or an attorney; instead, call 911 or go directly to the emergency room.

Some workers’ comp insurance companies maintain a 24-hour hotline for reporting claims and authorizing medical care, but your health is far more important than the nuances of the workers’ comp insurance system and the Florida legal system.

Worry about your health first and go to the emergency room. You can sort out the legalities later.

Did you know? If you don't like the authorized doctor that workers' comp has selected for you, you can switch doctors using a "one-time change." Learn more with a free download of my workers' comp book, Sharing the Secrets, Learning the Lies: A Guide to Florida Workers' Compensation

Wade Coye
Attorney/Author Wade Coye - serving consumers legal needs for over 27 years