Under the Florida Workers’ Compensation system, an insurance carrier can select to provide benefits under a managed care arrangement. If the carrier has elected to provide benefits under a managed care arrangement (MCA), then this provides the claimant additional rights, but greater duties in order to seek medical care.
Perhaps the most significant duty or obligation of the employee is that they have to exhaust the managed care agreement procedure prior to seeking assistance from the judge compelling medical care. Specifically, under most managed care arrangements, if the insurance carrier does not authorize care, then the employee has to request the medical care from the insurance adjuster, the medical care must be denied, then the employee must file a grievance, and the grievance procedure must be exhausted before the employee can seek help form the Court.
Unfortunately, this causes some delay in getting medical care authorized. On the other side, the MCA does provide additional benefits to an employee, which we feel are very helpful. For example, under most managed care arrangements, the employee is entitled to a change in treating physician, they are entitled to a second opinion, they’re entitled to an employer paid independent medical examiner (the employee actually gets to choose a doctor and have that physician issue an opinion concerning their need for medical care or treatment), and very importantly, the claimant is entitled to their choice of primary care physician.
A primary care physician is usually a general practitioner doctor, or family practitioner, and acts as a gatekeeper for the claimant during the entire course of care. Many insurance carriers imply that this would be the urgent care physician or the first physician that the claimant sees, but this is not necessarily so. Likewise, the claimant gets to choose their primary care physician. This provides the claimant some significant benefit in controlling their medical care.