Workers’ compensation insurance cover was established following an increased number of personal injury lawsuits against employers for on-the-job injuries to their workers. Employers in Florida agree to offer medical benefits and a specific amount of wage replacement (indemnity) benefits to the workers who get injured while on their official duties. The moment you get workers’ compensation benefits you forfeit the right to sue your employer.
The process and specific medical benefits that coincide with Florida’s workers’ compensation laws are often confusing. While busy seeking medical treatment and focusing on your healing process, it can be very challenging to understand precisely what you are entitled to. This is why you should consult with an experienced workers’ compensation attorney.
Getting medical benefits
Are you eligible for workers’ compensation medical benefits? There is no straight answer to this question. Instead, your attorney should analyze the specific circumstances that led to your injuries. Did you suffer injuries while working within the scope of your employment? Are those injuries the major contributing cause for medical treatment?
If you are getting medical treatment or attention for injuries that are not work-related, you are not eligible for workers’ compensation medical benefits. Even when you’re eligible for medical benefits, it’s in your best interest to understand the extent of your injuries and the specific amount of the related expenses incurred. These details are important during the valuation and review of your workers’ compensation claim.
What do these medical benefits cover?
Most injured workers who pursue workers’ compensation medical benefits often get medical coverage. The coverage pays the expenses of treating an employee for occupational injury or illness. It includes the cost of hospital treatment, doctor visits, nursing care, medical equipment, medication, and more.
Keep in mind that medical coverage isn’t subject to dollar limits, copays, or deductibles. The medical benefits are offered until the injured worker recovers fully. Some restrictions might apply to specific treatments. So, talk to your attorney to understand the specific details of your medical benefits. As part of the medical cover, your employer may provide the following;
Healthcare provider networker
This is a group of doctors, nurses, and other healthcare professionals who have contracted with a specific employer or insurance company to offer medical attention at a discount. These experts should be certified and skilled in occupational medicine. If you got injured while in official duty, your employer might require you to seek medical treatment from a facility within this network.
Utilization management
This is a process designed to make sure the necessary type of medication can be afforded to an employee. That means the healthcare providers may be required to inform your employer about all necessary medical procedures and medications.
Pharmacy benefit manager
This is an administrator of the specific prescription drug program whose main objective is to control expenses. A PBM focuses on establishing formularies, negotiates better discounts with prescription drug manufacturers, and pays prescription drug claims.
Note that most employers have medical care management to oversee the healthcare services offered to injured workers. This ensures that the patient gets appropriate care and ensures he or she returns to work upon recovery.
Know also that workers’ compensation medical benefits are likely to vary depending on the nature and extent of your injuries. For instance, you are likely to incur more medical expenses if you suffered a back injury compared to another employee who suffered minor cuts and bruises.
Contact a Florida Workers Compensation Lawyer if you have any questions about your workplace injury.