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Who pays for unauthorized treatments?

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in Human Resources

Q. We have an employee who has had several work-related injuries. Our workers’ compensation insurance carrier, after reviewing the circumstances of the employee’s injuries, has denied her any treatment for a back injury. Even so, she has gone to a chiropractor for treatment 60 times. Her attorney has now filed a petition for benefits with the Judge of Compensation Claims. It seeks authorization for the visits and asks our company and the carrier to pay for all 60 chiropractor visits. If the judge determines that these visits are authorized, are we going to have to pay for all of them?

A. If the judge determines that the chiropractor visits should have been authorized, payment can be ordered only for a maximum of 24 visits, in the absence of any evidence that the insurance carrier authorized any extended treatment.

Florida’s 1st District Court of Appeal recently ruled that Section 440.13(2)(a), Florida Statutes, means exactly what it says: “Medically necessary treatment, care, and attendance do not include chiropractic services in excess of twenty-four treatments or rendered twelve weeks beyond the date of the initial chiropractic treatment, whichever comes first, unless the carrier authorizes additional treatment.”

Thus, because the carrier has not authorized the additional treatment, if the judge otherwise authorizes the treatment, payment can be required only for the first 24 visits.

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