Your

Medical Care

Typically, the insurance company gets to select all of the doctors who provide authorized medical treatment if you’ve been injured.  There is one exception, which will be discussed below. There are only three types of doctors who are able to provide medical opinions in Florida workers’ compensation cases:  an authorized treating physician, an independent medical evaluator and an expert medical advisor.

Independent

Medical Evaluators

An authorized treating physician is easy enough to understand, but what is an independent medical evaluator (IME)?  The Florida Workers’ Compensation Law provides that one time during the course of litigation, each party can select and pay for evaluation with a physician when there is a “dispute concerning overutilization, medical benefits, compensability, or disability.”  Importantly, even if there are multiple different injuries involved, each party is only entitled to a single IME. This is important because an IME is unable to render opinions outside his/her area of expertise. Additionally, each party is bound by the opinions of their IME. If a case has been denied completely from the outset, you will have to obtain an IME in order to establish entitlement to any benefits. This is because if the case has been denied, there are no authorized treating physicians to provide opinions on your appropriate work status, what medical treatment, if any, is reasonable and medically necessary and whether the industrial accident is greater than 50% the cause of your condition, need for treatment, and resulting disability.

One-Time Change

In Treating Physicians

As mentioned above, there is an exception to the insurance company being able to select all of your authorized treating physicians. One time during the course of a claim, you can provide written notice to the insurance company, advising that you would like to request a one-time change in authorized treating physician. If the insurance company fails to select a physician and notify you of that selection within 5 calendar days, you can then select the one-time change physician who then becomes your current authorized treating physician.

Expert

Medical Advisors

Ok, so what is an expert medical advisor? An expert medical advisor (EMA) is a doctor appointed by the Judge of Compensation Claims presiding over the existing case. Rather than being either party’s expert, the EMA is the Judge’s expert. His/her role in the case is to essentially serve as a tie breaker, deciding which doctor’s opinions are correct. In fact, in a situation where there is a dispute between doctors, for example, regarding whether you need to have a surgery performed, a Judge of Compensation Claims does not have the authority to resolve that dispute. Instead, the Judge must appoint an EMA to evaluate you, review any pertinent medical records and/or deposition testimony, and render an opinion as to the ultimate resolution of the issue in dispute.