Partnering in the Provision of Health Care to Injured Employees
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Role of the Workers' Compensation Insurer
The insurer, acting on behalf of an employer or self-insured
employer is responsible for ensuring that injured employees receive
all medically necessary treatment
required for a compensable injury or illness. The insurer fulfills
this obligation by:
- Reviewing and responding to all requests for authorization of
treatment or referrals for treatment in a timely manner,
s. 440.13(3), F.S.
- Determining if the treatment recommended or provided is
appropriate and consistent with standards of care requirements
in s. 440.13(16), F.S., as
adopted under the FL WC System
- Conducting utilization review pursuant to
s. 440.13(6), F.S., to evaluate the appropriateness of the
level and quality of treatment recommended or rendered to an
injured employee for the compensable condition.
- Determining if the injured employee is making satisfactory
progress in recovery as the result of authorized treatment,
s. 440.13(2)(d)(e), F.S.
- Transferring care to provide alternate treatment and care when
required, s. 440.13(2)(d)(e), F.S.
- Making prompt and accurate reimbursement to a certified
provider for authorized medical treatment and services pursuant
to applicable reimbursement
Frequently Asked Questions (pdf)