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 manuals
Frequently Asked Questions
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