HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 637 Treatment by a Medical Specialist
SPONSOR(S): Commerce Committee, Insurance & Banking Subcommittee, Yeager and others
TIED BILLS: IDEN./SIM. BILLS: CS/SB 808
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Insurance & Banking Subcommittee 17 Y, 0 N, As CS Herrera Lloyd
2) Appropriations Committee 27 Y, 0 N Perez Pridgeon
3) Commerce Committee 18 Y, 0 N, As CS Herrera Hamon
SUMMARY ANALYSIS
Florida’s Workers’ Compensation Law requires employers to provide injured employees all medically
necessary remedial treatment, care, and attendance for such period as the nature of the injury or the process
of recovery may require. The Department of Financial Services (DFS), Division of Workers’ Compensation
(DWC), provides regulatory oversight of Florida’s workers’ compensation system, including the Workers’
Compensation health care delivery system. The law specifies certain reimbursement formulas and
methodologies to compensate Workers’ Compensation health care providers that provide medical services to
injured employees.
If a firefighter, law enforcement officer, correctional officer, or correctional probation officer becomes disabled
by tuberculosis, heart disease, or hypertension, Florida law presumes that the disease has been contracted in
the line of duty, subject to certain limitations, and is therefore compensable under workers compensation law,
unless the contrary can be shown by competent evidence.
To be eligible for this legal presumption, the officer or firefighter must have taken a pre-employment physical
exam that failed to reveal any evidence of tuberculosis, heart disease, or hypertension.
The bill permits firefighters, law enforcement officers, correctional officers, or correctional probation officers in
need of medical treatment for a compensable, presumptive condition to file a written notice with their
employer/carrier to obtain authorization of treatment from the selected medical specialist. The employer/carrier
may approve the selected medical specialist or authorize an alternative specialist with equal or greater
qualifications. The authorization must be resolved within 5 business days and the appointment date must be
within 30 business days of the written notice. If the authorization is not timely, the firefighter’s or officer’s
selected medical specialist is automatically authorized.
Also, the bill allows a maximum reimbursement to selected medical specialists to 200 percent of the
reimbursement allowed by Medicare, rather than 110 percent (non-surgeons) and 140 percent (surgeons).
The bill will likely have an indeterminate, but significant fiscal impact on the State Risk Management Trust
Fund. Local governments may experience increased costs. See Fiscal Analysis.
The bill has an effective date of October 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Qualifications for Employment as a Firefighter, Law Enforcement, Correctional, or Probation Officer
Florida law sets forth the minimum requirements for any person to be employed or appointed in a full-
or part-time capacity, or in an auxiliary capacity, as a law enforcement officer, correctional officer, or
correctional probation officer; or to be appointed as an auxiliary correctional officer by a private entity
contracting with the Department of Corrections.
To become a law enforcement, correctional, or correctional probation officer, an applicant must satisfy
age, education, and citizenship requirements; complete a training course; pass a certification exam;
pass a criminal background check; and pass a physical examination. 1
The physical examination requires screening for evidence of tuberculosis, heart disease, or
hypertension.2
In addition to law enforcement, correctional, and correctional probation officers, the presumption
applies to firefighters working for any unit of Florida government. 3
Workers’ Compensation Presumption
A legal presumption makes it easier for an employee to obtain Workers’ Compensation benefits by
shifting the burden of proof in a disability determination from the employee to the employer. 4
In general, occupational diseases are compensable if:
 A condition peculiar to the occupation causes the disease;
 The employee contracts the disease on the job;
 The job is associated with a particular hazard of the disease;
 The incidence of the disease is substantially higher in the occupation than in the public;
 The nature of the employment was a major contributing cause of the disease; and
 Epidemiological studies show that exposure to the specific substance involved, at the levels
to which the employee was exposed, may cause the precise disease sustained by the
employee.5
Florida law includes a presumption that treats tuberculosis, heart disease, or hypertension as an
occupational disease associated with firefighters, law enforcement officers, correctional officers, and
correctional probation officers. If these employees become temporarily or partially disabled by
tuberculosis, heart disease, or hypertension, the law presumes that the employee contracted the
disease in the line of duty unless the contrary can be shown by competent evidence. 6
However, firefighters, law enforcement officers, correctional officers, and correctional probation officers
are entitled to the presumption only if the officer passed a pre-employment physical exam that failed to
reveal any evidence of tuberculosis, heart disease, or hypertension. 7
1 S. 943.13, F.S.
2 S. 943.13(6), F.S.
3 Ss. 112.18(1)(a) and 175.231, F.S.
4 Caldwell v. Division of Retirement, Florida Dept. of Administration , 372 So. 2d 438, (Fla. 1979).
5 S. 440.151(2), F.S.
6 Ss. 112.18(1)(a) and 175.231, F.S.
7 S. 112.18(1)(a), F.S.
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 If the employee’s pre-employment physical failed to reveal any evidence of disease, the employee must
demonstrate the he or she suffers from tuberculosis, heart disease, or hypertension, but does not have
to present evidence of causation that is typically required to demonstrate that an occupational disease
is compensable.8
To overcome the statutory presumption, the employer must present clear and convincing evidence that
the disease was caused by a non-work-related event or exposure.9
Pre-Employment Physicals
To be employed as a law enforcement, correctional, or correctional probation officer, an applicant must
pass a physical exam.10 The law that establishes minimum employment standards states that such
officers are eligible for the presumption of s. 112.18, F.S., only if the physical exam fails to reveal any
evidence of tuberculosis, heart disease, or hypertension.11
To enroll in firefighting training courses and be certified as a firefighter, an applicant must be in good
physical condition, as determined by a doctor or nurse practitioner.12 The law does not mention specific
screening for tuberculosis, heart disease, or hypertension. The medical professional must certify that
the applicant is medically fit to engage in firefighting training and does not have any pre-existing or
current condition, illness, injury, or deficiency.13
Division of Workers’ Compensation
Florida’s Workers’ Compensation Law 14 requires employers to provide injured employees all medically
necessary remedial treatment, care, and attendance for such period as the nature of the injury or the
process of recovery may require.15 The Department of Financial Services (DFS) provides regulatory
oversight of Florida’s Workers’ Compensation system, including the Workers’ Compensation health
care delivery system. The law specifies certain reimbursement formulas and methodologies to
compensate workers’ compensation health care providers 16 that provide medical services to injured
employees. Where a reimbursement amount or methodology is not specifically included in statute, the
Three-Member Panel is authorized to annually adopt statewide schedules of maximum reimbursement
allowances (MRAs) to provide uniform fee schedules for the reimbursement of various medical
services.17 DFS incorporates the MRAs approved by the Three-Member Panel in reimbursement
manuals 18 through the rulemaking process provided by the Administrative Procedures Act. 19 In 2023,
CS/CS/HB 487 eliminated the authority of the Three-Member Panel to adopt MRA’s for individually
licensed health care providers, work-hardening programs, pain programs, and durable medical
equipment providers.20 Instead, it mandates DFS to annually publish the maximum reimbursement
allowance for physician and non-hospital reimbursements on its website by July 1st , effective the
following January 1st .21
8
McDonald v. City of Jacksonville, 286 So. 3d 792 (Fla. 1st DCA 2019), citing Walters v. State, DOC/Div. of Risk Management, 100 So.
3d 1173 (Fla. 1st DCA 2019), rehearing denied, review denied 108 So. 3d 654 (The presumption is an adequate substitute for evidence
of occupational causation, and compels the legal result that a claimant has proven occupationa l causation).
9 Butler v. City of Jacksonville, 980 So. 2d 1250 (Fla. 1st DCA 2008).
10 S. 943.13(6), F.S.
11
Id.
12 S. 633.412(5), F.S.
13 Rule 69A-37.037 and Form DFS-K3-1022.
14 Ch. 440, F.S.
15 S. 440.13(2)(a), F.S.
16 The term “health care provider” includes a physician or any recognized practitioner licensed to provide skilled services pursuant to a
prescription or under the supervision or direction of a physician. It also includes any hospital licensed under chapter 395 a nd any health
care institution licensed under chapter 400 or chapter 429. S. 440.13(1)(g), F.S.
17 S. 440.13(12), F.S.
18 Ss. 440.13(12) and (13), F.S., and Ch. 69L-7, F.A.C.
19 Ch. 120, F.S.
20 Ch. 2023-144, Laws of Fla.
21 Id.
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 Medical Services
The Division of Workers’ Compensation (DWC) is responsible for ensuring that employers provide
medically necessary treatment, care, and attendance for injured workers. Healthcare providers must
receive authorization from the insurer before providing treatment and submit treatment reports to the
insurer. Insurers must reimburse healthcare providers based on statewide schedules of maximum
reimbursement allowances developed by the DWC or an agreed-upon contract price. DWC mediates
utilization and reimbursement disputes.22
Eligibility for the Workers’ Compensation Presumption
In a disputed Workers’ Compensation determination, the legal presumption does not apply if a law
enforcement, correctional, or correctional probation officer:
 Departed from the course of treatment prescribed by his or her physician, resulting in a
significant aggravation of the disease or disability or need for medical treatment; or
 Was previously compensated for the disabling disease and departed from the treatment
prescribed by his or her physician, resulting in disability or increasing the disability or need
for medical treatment.23
To be eligible for workers’ compensation benefits, a law enforcement officer, correctional officer, or
correctional probation officer must make a claim for benefits prior to or within 180 days of leaving the
employment or the employing agency.24
Firefighters are not subject to the exclusion for prior treatment or compensation and they are not
covered by the claim-fling deadline that lets a law enforcement officer, correctional officer or
correctional probation officer file a claim up to 180 days after leaving the employment.
Thus, a firefighter suffering from tuberculosis, heart disease, or hypertension must advise his or her
employer of the injury within 90 days of the initial manifestation of the disease or 90 days after the
firefighter obtains a medical opinion that the injury (occupational disease) is due to the nature of the
firefighter’s employment.25
Reimbursement for Healthcare Providers
A three-member panel (panel), consisting of the Chief Financial Officer (CFO) or their designee and
two Governor appointees, sets the MRAs.26 Beginning with rates developed in 2024 and implemented
with rates effective January 1, 2025, health care providers and non-hospital rates are annually
published by DFS, instead of being included in the reimbursement manuals.27 DFS incorporates the
statewide schedules of the MRAs through rulemaking. In establishing the MRA manuals, the panel
considers the usual and customary levels of reimbursement for treatment, services, and care;28 the cost
impact to employers for providing reimbursement that ensures that injured workers have access to
necessary medical care; and the financial impact of the MRAs on healthcare providers and facilities. 29
Florida law requires the panel to develop MRA manuals that are reasonable, promote the Workers’
Compensation system’s healthcare cost containment and efficiency, and are sufficient to ensure that
medically necessary treatment is available for injured workers. 30
There are three different reimbursement manuals that determine statewide schedules of maximum
reimbursement allowances. The healthcare provider manual, developed by the DWC, limits the
22 S. 440.13, F.S.
23 S. 112.18(1)(b)(1), F.S.
24 S. 112.18(1)(b)(4), F.S.
25 S. 440.151(6) and 440.185(1), F.S.
26 Id.
27 Ch. 2023-144, Laws of Fla.
28 S. 440.13(12)(i)(1), F.S.
29 S. 440.13(12)(i)(2), F.S.
30 S. 440.13(12)(i)(3), F.S.
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 maximum reimbursement for licensed physicians to 110 percent of Medicare reimbursement,31 while
reimbursement for surgical procedures is limited to 140 percent of Medicare. 32 The hospital manual,
developed by the panel, sets maximum reimbursement for outpatient scheduled surgeries at 60 percent
of usual and customary charges,33 while other outpatient services are limited to 75 percent of usual and
customary charges.34 Reimbursement of inpatient hospital care is limited based on a schedule of per
diem rates approved by the panel.35 The ambulatory surgical centers manual, developed by the panel,
limits reimbursement to 60 percent of usual and customary as such services are generally scheduled
outpatient surgeries. The prescription drug reimbursement manual limits reimbursement to the average
wholesale price plus a $4.18 dispensing fee.36 Repackaged or relabeled prescription medication
dispensed by a dispensing practitioner has a maximum reimbursement of 112.5 percent of the average
wholesale price plus an $8.00 dispensing fee.37 Fees may not exceed the schedules adopted under ch.
440, F.S., and department rule.38
Effect of the Bill
The bill permits firefighters, law enforcement officers, correctional officers, or correctional probation
officers in need of medical treatment for a compensable, presumptive condition to file a written notice
with their employer/carrier to obtain authorization of treatment from the selected medical specialist. The
employer/carrier may approve the selected medical specialist or authorize an alternative specialist with
equal or greater qualifications. The employer/carrier must authorize the selected medical specialist
within 5 business days of receiving the written notice. The appointment date with the authorized
medical specialist must be within 30 days of the written notice.
In the event that the employer/carrier fails to provide timely authorization, the firefighter’s or officer’s
selected medical specialist is automatically authorized. This notice and authorization process is an
express exception to the standard employer-directed provider selection process under the Workers'
Compensation law, wherein the employer/carrier selects the specialist.
The bill also increases the maximum reimbursement for selected medical specialists licensed under ch.
458 or ch. 459, F.S. The maximum reimbursement is raised from 110 percent (non-surgeons) and 140
percent (surgeons) to 200 percent of the Medicare allowance for both non-surgeons and surgeons.
This bill provides an effective date as of October 1, 2024.
B. SECTION DIRECTORY:
Section 1. Amends s. 112.18, F.S., relating to firefighters and law enforcement or correctional officers;
special provisions relative to disability.
Section 2. Providing an effective date of October 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON