Every adjuster has received that e-mail or fax from a claimant’s attorney with a whopping emergency room bill. Had the claimant waited a few more days and simply gone to their authorized provider, the carrier would only be on the hook for a simple follow-up visit, as opposed to the hospital bill which often multiplies…

The problematic request for a one-time change in treating physician can severely impact a case if not handled properly. As new case law continues to modify the acceptable manner of appropriately and timely responding to these requests, adjusters have greater burdens in appropriately responding. Below are some tips to help preserve the EC’s right to…

With the Thanksgiving holiday approaching, beware of claimant lawyers using the Hinzman case to secure authorization of undesirable physicians. In February 2013, the First DCA issued its opinion in Hinzman v. Winter Haven Facility Operations. This case holds that the 5 day rule pertaining to the claimant’s one-time change in treating physicians is 5 consecutive…

Changes in the Florida Workers’ Compensation Law implemented in 1994 provide employer/carriers with a powerful investigative tool. Section 440.13(4)(c), Florida Statutes, was amended as follows: [U]pon the request of the employer, the carrier, an authorized qualified rehabilitation provider, or the attorney for the employer or carrier, the medical records, reports, and information of an injured…

The First DCA entered an opinion on October 16, 2013 that will likely result in appointment of Expert Medical Advisors (EMAs) in many more claims. Banuchi v. Dep’t. of Corrections, (Fla. 1st DCA, Oct. 16, 2013). Prior to Final Hearing, the claimant filed her “Notice of Conflict” wherein she pointed out a conflict in the…

In a recent court decision in the case of Bustamante v. Amber Construction Co. and American Interstate Insurance Co., the First DCA held that mere authorization of a change in physician is not enough to avoid the claimant partaking in the self-help nature of Florida Statute 440.13. Specifically, in this case, the claimant requested a…

Believe it or not, the idea of providing medical and wage benefits to employees who are injured on the job dates back to Sumeria, 2050 B.C.[1] Back then, benefits provided to the injured worker depended on the ruler’s whim and there was little or no recourse for those that felt they were unfairly treated. In…

Some attorneys who represent injured workers have been engaging in a tactic designed to generate attorney’s fees without the employer/carrier becoming aware of this exposure. The process is initiated by the claimant’s attorney sending a Petition for Benefits (PFB) via certified mail to the employer/carrier (EC) without ever filing the PFB with DOAH. Even though…

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