Expert medical opinions can cause problems for injured workers

On Behalf of | Jun 24, 2019 | Workers' compensation

When employees suffer injuries in the workplace, they often depend on workers’ compensation benefits to help them cover their expensive medical bills while they recover outside of work. However, the process of securing those benefits is harder than it sounds.

Many injured Florida workers are left without the benefits they need for a smooth and full recovery. And a recent story highlights one of the common challenges that workers face when they apply for workers’ compensation.

Florida woman denied further coverage after challenging the workers’ compensation system

Although Hilado Law, PLLC, was not involved in this case, this situation sheds light on some of the frequent—and unfortunate—challenges that many workers face when pursuing workers’ compensation in our state.

According to WUSF News, Teresita De Jesus Abreu filed a claim to recover workers’ compensation benefits after sustaining a torn rotator-cuff at work in 2015. She received one surgery to repair the tear, but her pain persisted.

However, workers’ compensation insurance would not cover a second surgery that could relieve this pain, even though it stemmed from the original work injury.

The main issue? Expert medical advisors.

Abreu did not receive coverage for the second surgery because when the court had an expert medical advisor (EMA) review her case, the EMA determined the surgery was not necessary.

An expert medical opinion is always necessary when filing a workers’ compensation claim. Usually, the injured worker must visit their own physician and then obtain a second opinion from an approved physician from their employer’s insurance company.

The opinion of an EMA is only necessary if these opinions differ. So, EMAs have a responsibility to:

  • Review medical records or conduct their own examination
  • Resolve conflicting medical opinions in workers’ compensation cases
  • Provide expert testimony at workers’ compensation hearings

The Florida workers’ compensation system and courts rely heavily on the opinions of EMAs. And this is only one of the many reasons that our state’s system creates an imbalance that is often not in favor of injured workers.

Is it possible to challenge an EMA’s opinion?

While it might be possible to dispute an EMA’s medical opinion in court, it can be difficult. It is often beneficial if injured workers obtain an EMA opinion of their own to challenge the other’s.

What might be more helpful is reform. It is no secret that the Florida workers’ compensation system needs reform. The State Supreme Court even ruled that aspects of the system were unconstitutional in 2016. Reform could reduce the influence that EMAs have on these cases, even though they would still be important to help resolve disputes. However, there are almost as many obstacles to workers’ compensation reform as there are in each injured worker’s case.

In the meantime, an experienced workers’ compensation attorney can help guide employees through these challenges to protect their rights and recover the benefits they need.