Jeffrey P. Gale, P.A. // Gamesmanship Practiced by Florida Workers’ Compensation Doctors

Florida law authorizes employers and their workers’ compensation insurance carriers (“E/C”) to choose every one of an injured worker’s treating doctors. See, sections 440.13(2)(a) & (f), Florida Statutes. They pick medical providers, sometimes called “The Usual Suspects,” from whom they can expect to receive favorable opinions. Because the doctors like the steady and easy income, they play along. So much for honoring the Hippocratic Oath.

To receive workers’ compensation wage loss benefits, also known as indemnity benefits (see, sections 440.13(2)&(4), Florida Statutes), the burden is on the injured worker (a/k/a, Claimant) to establish a connection between the work-related injuries and any wage loss. In 2024, the weekly wage loss benefit can be as much as $1,260.

Medical providers authorized by the E/C are required to complete form DWC-25 after each appointment. Section IV of the form addresses the injured worker’s “Functional Limitations and Restrictions.” It contains three paragraphs (numbers 21, 22, and 23) for this purpose with corresponding boxes for the provider to check. Paragraph 21 indicates that the Claimant does not have any functional limitations. Paragraph 22 provides that the Claimant’s injuries are of such severity he cannot work. Paragraph 23 says that the Claimant can work with restrictions.

Without functional limitations, the Claimant cannot satisfy the burden of showing a connection between the injuries and the wage loss. This is what paragraph 21 accomplishes. Paragraphs 22 and 23 give Claimant a shot at indemnity benefits.

Unfortunately, E/C-selected medical providers commonly check box 21. It is done even when common sense dictates otherwise, such as when the doctor diagnoses a serious medical condition like post-concussion syndrome, herniated discs, or a torn rotator cuff, orders physical therapy, prescribes diagnostic tests (e.g., MRI and CT Scan), or administers epidural injections. What’s going on is that the doctor is managing to make money while saving E/C money.

There are ways to combat these tactics, but it takes time. The workers’ compensation courts are swamped with similar claims, and others, resulting in delays and hardship. It can take months to get contested issues before a judge of compensation claims (JCC).

There was a time when injured workers could select their treating doctors. This ended after the E/C complained to Republican legislators about not having enough influence over the medical providers. The result is the system we have now, handpicked providers who understand the rules for getting E/C referrals. The business model works against the best interests of injured workers.

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