In addition to a drug formulary that would theoretically control costs, a legislative panel recommended that the Florida workers’ compensation system adopts new medical treatment and authorization guidelines.
A special three-member panel (which actually only has two members at present) of the Insurance Commission mulled a number of changes to the system during a recent meeting. The body’s chief responsibility is setting medical reimbursement levels and making associated policy decisions. Assistant DWC Director Andrew Sabolic called medical authorization “the elephant in the room. . .that needs to be examined.” During a recent review, almost all worker complaints mentioned medical authorization, he added. The problem, according to some, is that while Florida law requires carriers to respond to treatment requests, there is no timetable, so requests sometimes languish for several weeks without action. “We can do better,” Mr. Sabolic surmised.
On the subject of drug formularies, some witnesses noted that other states successfully use these devices mostly since some drug mixtures and combinations used to treat injured workers are not Food and Drug Administration-approved. Although Florida sets a few allowances, they do not cover all treatment protocols. Price is an issue as well, since providers are normally unaware of what their competitors charge.
The panel made some recommendations, which it will forward to the House and Senate. If legislators fail to act, executive regulations may be an option.
Covered Injuries
In addition to the severe medical problems, workplace injuries create considerable stress because there is no money to pay everyday expenses, let alone the growing number of medical bills. Fortunately, workers’ compensation takes care of both unpaid wages and all medical expenses, whether the injury occurred because of a:
- Trauma, like a motor vehicle collision or a fall, or an
- Occupational disease, such as hearing loss or joint pain.
Largely because of a legal doctrine called the eggshell skull rule, which basically states that negligence defendants are liable for all damages, even those related to a preexisting medical condition, aggravating occupational disease or trauma injuries are normally treated the same as new injuries.
Workers’ compensation is no-fault insurance, so rather than proving how the injury occurred, which is sometimes difficult, victims must only establish that the injury occurred during work hours, which may be as simple as looking at a clock.
Benefits Available
In terms of lost wages, workers’ compensation normally pays two-thirds of the victim’s average weekly wage for the duration of any temporary disability. Thanks to a recent Florida Supreme Court case, these benefits have been extended from a maximum 104 weeks (two years) to 260 weeks (five years).
There are basically two types of permanent disabilities. If victims recover to the point that they can go back to work but can no longer pursue their previous careers, workers’ compensation may both provide job retraining services and/or pay benefits that help erase the difference between the old salary and the new salary. If the disability precludes future employment, a larger payout is usually in order. These victims may also be eligible for Social Security Disability, although a cap may apply.
Medical providers are normally compensated according to a predetermined payment schedule. In most cases, personal injury attorneys send letters of protection to their clients’ medical providers. These letters guarantee payment once the cases are resolved, so victims do not need to pay upfront for:
- Emergency care,
- Followup visits,
- Physical therapy, and
- Medical devices.
In some situations, attorneys can negotiate with medical providers and obtain lower rates, increasing the amount of settlement money that the victims retain.
Additional Compensation
In most cases, workers’ compensation is a reasonable alternative to a traditional tort system, because although victims cannot receive noneconomic damages, such as pain and suffering, the claims procedure is simplified (as explained above) and the overall process is at least somewhat streamlined. However, in some cases, workers’ compensation is not a reasonable alternative and victims may sue outside the system to obtain noneconomic damages. Some situations include:
- Defective Products: If a non-working safety device or other dangerous product was partially responsible for the workplace injury, a negligence lawsuit against the product manufacturer may provide a proper remedy.
- Negligent Co-Workers: Roughly the same theory applies if the victim’s injury was caused, at least in part, by a non-employer’s negligence.
- Recklessness: Workers’ compensation provides employers immunity from negligence (carelessness) lawsuits, but if the employer knowingly or recklessly put the victim in a dangerous position, this immunity may not apply and a tort suit may be in order.
In addition to noneconomic damages, punitive damages may also be available in tort cases.
To get the benefits you deserve, contact Barnett, Lerner, Karsen & Frankel.