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  • FLORIDA-HOW DO I GET A SECOND OPINION? Florida

    I was injured on the job in February of 2006. I was sent to the doctor, had the MRI, sent to the neurologist, got facet injections in the 2 herniated discs and have been to physical therapy twice. Now I am seeing a regular MD. The MD says I still need to see a neurologist because the pain isnt any better. The neurologist has said that it is her opinion that I dont need anymore specialized care and that I have reached MMI, but today I got an email from a Spinal Surgery Center that I submitted my MRI results to that states upon looking at my MRI report they feel like I am a candidate for surgery to eleviate the pain. I have been asking the WC company for another neurologist since July and they have denied it everytime saying that the adjuster wont approve it. It is my understanding that their nurse caseworker met with the neurologist that I had and they came up with the conclusions together. I have no clue as to which doctors are in the network and they wont tell me. I do have an attorney who is pretty much worthless, he seems to be just waiting for the money to come to him. I am more concerned with my health than the money and only retained him to help me wade through all of this. I might mention that I have only met with him once since I hired him in June. Only spoke with him three or four times, usually I get the secretary and he will always call me back and seldomly does. I just need to know how to get a second opinion or if I even can get one. I know that Florida has some very strange WC laws but it would seem if I am not any better that I should be able to see another neurologist. I have been instructed by my attorney that the WC company has said they no longet want me to contact them directly. What do I do?
    --this is me

  • #2
    Originally posted by mtj View Post
    I was injured on the job in February of 2006. I was sent to the doctor, had the MRI, sent to the neurologist, got facet injections in the 2 herniated discs and have been to physical therapy twice. Now I am seeing a regular MD. The MD says I still need to see a neurologist because the pain isnt any better. The neurologist has said that it is her opinion that I dont need anymore specialized care and that I have reached MMI, but today I got an email from a Spinal Surgery Center that I submitted my MRI results to that states upon looking at my MRI report they feel like I am a candidate for surgery to eleviate the pain. I have been asking the WC company for another neurologist since July and they have denied it everytime saying that the adjuster wont approve it. It is my understanding that their nurse caseworker met with the neurologist that I had and they came up with the conclusions together. I have no clue as to which doctors are in the network and they wont tell me. I do have an attorney who is pretty much worthless, he seems to be just waiting for the money to come to him. I am more concerned with my health than the money and only retained him to help me wade through all of this. I might mention that I have only met with him once since I hired him in June. Only spoke with him three or four times, usually I get the secretary and he will always call me back and seldomly does. I just need to know how to get a second opinion or if I even can get one. I know that Florida has some very strange WC laws but it would seem if I am not any better that I should be able to see another neurologist. I have been instructed by my attorney that the WC company has said they no longet want me to contact them directly. What do I do?
    Start shopping for another attourney.

    Only someone with intimate knowledge of your case can give advice

    You can get your MD to order a second opinion from a neurologist. Don't go under the knife without it!

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    • #3
      If you are represented by an attorney then the insurance should not ethically be talking to you directly. Communication should be through the attorney. When you hired them and they went on record as your legal rep, that was part of the deal.

      As for the second opinion or different doctor these are straight from the regs http://www.flsenate.gov/Statutes/ind...3eSection%2013

      Title XXXI
      LABOR Chapter 440
      WORKERS' COMPENSATION

      440.13 Medical services and supplies;




      (f) Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident. Upon the granting of a change of physician, the originally authorized physician in the same specialty as the changed physician shall become deauthorized upon written notification by the employer or carrier. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary.

      (c) A health care provider may not refer the employee to another health care provider, diagnostic facility, therapy center, or other facility without prior authorization from the carrier, except when emergency care is rendered. Any referral must be to a health care provider that has been certified by the agency, unless the referral is for emergency treatment, and the referral must be made in accordance with practice parameters and protocols of treatment as provided for in this chapter.

      (d) A carrier must respond, by telephone or in writing, to a request for authorization from an authorized health care provider by the close of the third business day after receipt of the request. A carrier who fails to respond to a written request for authorization for referral for medical treatment by the close of the third business day after receipt of the request consents to the medical necessity for such treatment. All such requests must be made to the carrier. Notice to the carrier does not include notice to the employer.

      (h) The provisions of s. 456.053 are applicable to referrals among health care providers, as defined in subsection (1), treating injured workers.

      (i) Notwithstanding paragraph (d), a claim for specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, X-ray examinations, or special diagnostic laboratory tests that cost more than $1,000 and other specialty services that the agency identifies by rule is not valid and reimbursable unless the services have been expressly authorized by the carrier, or unless the carrier has failed to respond within 10 days to a written request for authorization, or unless emergency care is required. The insurer shall authorize such consultation or procedure unless the health care provider or facility is not authorized or certified, unless such treatment is not in accordance with practice parameters and protocols of treatment established in this chapter, or unless a judge of compensation claims has determined that the consultation or procedure is not medically necessary, not in accordance with the practice parameters and protocols of treatment established in this chapter, or otherwise not compensable under this chapter. Authorization of a treatment plan does not constitute express authorization for purposes of this section, except to the extent the carrier provides otherwise in its authorization procedures. This paragraph does not limit the carrier's obligation to identify and disallow overutilization or billing errors.


      (5) INDEPENDENT MEDICAL EXAMINATIONS.--

      (a) In any dispute concerning overutilization, medical benefits, compensability, or disability under this chapter, the carrier or the employee may select an independent medical examiner. If the parties agree, the examiner may be a health care provider treating or providing other care to the employee. An independent medical examiner may not render an opinion outside his or her area of expertise, as demonstrated by licensure and applicable practice parameters. The employer and employee shall be entitled to only one independent medical examination per accident and not one independent medical examination per medical specialty. The party requesting and selecting the independent medical examination shall be responsible for all expenses associated with said examination, including, but not limited to, medically necessary diagnostic testing performed and physician or medical care provider fees for the evaluation. The party selecting the independent medical examination shall identify the choice of the independent medical examiner to all other parties within 15 days after the date the independent medical examination is to take place. Failure to timely provide such notification shall preclude the requesting party from submitting the findings of such independent medical examiner in a proceeding before a judge of compensation claims. The independent medical examiner may not provide followup care if such recommendation for care is found to be medically necessary. If the employee prevails in a medical dispute as determined in an order by a judge of compensation claims or if benefits are paid or treatment provided after the employee has obtained an independent medical examination based upon the examiner's findings, the costs of such examination shall be paid by the employer or carrier.

      (b) Each party is bound by his or her selection of an independent medical examiner, including the selection of the independent medical examiner in accordance with s. 440.134 and the opinions of such independent medical examiner. Each party is entitled to an alternate examiner only if:

      1. The examiner is not qualified to render an opinion upon an aspect of the employee's illness or injury which is material to the claim or petition for benefits;

      2. The examiner ceases to practice in the specialty relevant to the employee's condition;

      3. The examiner is unavailable due to injury, death, or relocation outside a reasonably accessible geographic area; or

      4. The parties agree to an alternate examiner.
      I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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