Our cover story and several companion articles this month focus on Florida's workers' compensation system. By unhappy coincidence, a family member and a good friend (I will call them “Able” and “Baker”) have had recent firsthand experiences of that process. Some background: Able is a first responder, located in one of our state's largest cities. Baker is an hourly employee with a major Florida school district.

In both cases, there was never any question that the injuries were job-related (Baker was actually walking with his boss when his injury occurred). However, the individual experiences following the compensability determinations were quite different.

First-responder Able's injury required surgery and several months of physical therapy. The doctors and physical therapists assigned to him were skilled and responsive; the case manager was not. Repeated phone calls to her by all parties seeking authorizations and answers to questions went straight to voice mail; messages left there were not returned. Able spoke to her only once during his entire seven months of injury/surgery/rehabilitation.

The morning of the surgery, the case manager still had not sent in all of the necessary forms to the doctor. To his credit, the doctor — a veteran of the workers' compensation system and familiar with the employer — said, “Don't worry, we'll take care of it,” and went ahead with the surgery despite the missing paperwork.

The procedure went well, and the doctor prescribed several months of physical therapy. When Able arrived at the therapist's office for his first appointment, the case manager once again had not sent the paperwork. As with the doctor, the physical therapist performed the treatment anyway. Repeated phone calls and faxes by the doctor, the patient, and the therapist to the case manager eventually resulted in receipt of the required forms, albeit several days late.

As healing progressed, Able's employer assigned light-duty work: answering phone calls in a windowless room, not the most stimulating work for a type-A, first-responder personality. Able dutifully did phone-duty for a few weeks, then decided to whittle down his stockpiled vacation time in lieu of more hours in the windowless room.

My grade for Able's experience? Medical and health-care providers = A+. Employer = C (no supervisor called during recovery; light-duty work was mind-numbing). Case manager = F.

Hourly employee Baker is retired military special forces, now employed in a county school system. If there is a type A+ personality, this is it. Malingering is not in his vocabulary. Pain? Please.

He suffered a foot/ankle injury while walking the school grounds with his boss. His employer sent him to a physician who, it was later determined, misdiagnosed the injury. A change of doctors, another diagnosis, and subsequent treatment did not bring relief.

After eight months of increasingly contentious communications with the insurance company, case manager, and medical providers, Baker hired an attorney. It took another year-and-a-half of depositions and hearings before authorization was issued for what hopefully is Baker's last surgery. The surgery was performed just before Christmas. The prognosis for recovery at this point is good.

Grade: Medical and health-care providers = F, F, A (the first doctor erroneously diagnosed a sprained foot; the second doctor erroneously diagnosed a broken foot; the third doctor — secured through Baker's attorney — diagnosed ligament damage and recommended surgery). Employer = F. Case manager = F.

Taking these two cases as “teachable moments,” as our president would say, they prove once again that you can have all the rules and regulations in the world, but a successful workers' compensation program ultimately comes down to how well people in the system perform their jobs.

Special Reports /

This Time, It's Personal

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