Is Prior Authorization Always Required When Receiving Treatment For A Work-Related Injury In Florida?
Florida’s workers’ compensation system may be confusing and complicated, especially if an injured worker does not understand how the claims process works. If you make mistakes when pursuing a workers’ compensation claim, the insurance company may deny coverage.
Prior authorization, which is often referred to as “pre-authorization,” is one of the most misunderstood aspects of the workers’ compensation claims process. Under Florida law, injured workers must receive medical treatment from healthcare providers approved by their employer’s workers’ compensation insurer.
Failure to seek prior authorization when receiving treatment for a work-related injury could jeopardize your workers’ compensation claim. But is pre-authorization always required when receiving treatment?
What is Prior Authorization in Workers’ Compensation Cases?
The term “prior authorization” in workers’ compensation cases refers to an injured worker’s obligation to get approval for medical services or treatment after a work-related injury or illness.
If you receive medical treatment that was not approved before the procedure, you may not be able to have your employer’s workers’ compensation insurance cover the cost of the treatment. You should consult with a Tampa workers’ compensation attorney if you are not sure whether or not the prior authorization is required in your particular case.
What Are the Rules for Prior Authorization in Florida Workers’ Compensation Cases?
The workers’ compensation system in Florida has the following pre-authorization rules:
- Healthcare providers are legally required to obtain prior authorization from self-insured employers or insurance companies before providing medical care to injured workers. If the authorization was not obtained before the procedure, the insurance company might deny payment.
- Healthcare providers must use the DFS-F5-DWC-25 form when requesting authorization for treatment. The request must be submitted to the employer’s insurer unless the employer is self-insured.
- Pre-authorization is not required when an injured worker needs emergency treatment. Medical treatment meets the definition of “emergency” when the requirements outlined in Fla. Stat. § 395.002 are met.
Consult with a workers’ compensation attorney to find out more rules for prior authorization in your specific case.
Why Do You Need Prior Authorization After a Work-Related Injury?
When you are injured at work or suffer an occupational disease, you may be entitled to workers’ compensation benefits. However, you must follow the required procedures, including those related to pre-authorization, in order to get your claim for workers’ comp benefits approved.
In Florida, workers’ compensation insurance companies have their own network of authorized healthcare providers to provide treatments to injured workers. When a worker is injured at work, they must report their injury to the employer. Their employer will refer them to an authorized healthcare provider.
However, if you have a legitimate reason to see a healthcare provider outside of your employer’s network, you must receive prior authorization from the insurance company before receiving the treatment. If you do not have pre-authorization, the insurance company may refuse to pay for your treatment.
Seeking prior authorization does not necessarily mean that your request will be approved by the insurance company. It is in your best interests to contact a results-driven and dedicated workers’ compensation attorney in Florida to handle your claim and ensure that you get the compensation you are entitled to.
Speak with our Tampa workers’ compensation attorney at Kobal Law to discuss your case. Call 813-873-2440.
Resource:
myfloridacfo.com/division/wc/pdf/DWC-25.pdf
