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into joining otherwise unattractive panels. As a result, the physician has limited options when attempting to ensure that adequate payment is received for services provided to out-of-state patients. The first, and most obvious, option is to require payment in full at the time of service in all nonemergency situations. Only in this manner may the physician be assured of receiving full compensation. The second option, which is less effective, is to obtain an assignment from the patient, although the physician must be cognizant of the possibility that the assignment will not be honored and that payment will instead be made directly to the patient, who may not forward such payment to the physician. If neither of these techniques are successful, the physician may institute collection proceedings, although federal law makes it difficult to sue an out-of-state debtor for small amounts due to the jurisdiction requirements of the federal courts. Because of the inherent difficulties of obtaining payment after the time of services of out-of-state patients, it is recommended that physicians attempt to receive payment at the time of service from out-of-state patients. This article is presented for educational purposes only and should not be taken as a substitute for legal DEATH CERTIFICATES After the death of a patient, the medical examiner will often contact the patient's physician and ask him to sign the death certificate. Whether or not the physician is responsible for doing so depends on the circumstances surrounding the death. Section 382.008(3), Florida Statutes, provides that “within 72 hours after receipt of a death or fetal death certificate from the funeral director, the medical certification of cause of death shall be completed and made available to the funeral director by the decedent’s primary or attending physician or, if s. 382.011 applies, the district medical examiner of the county in which the death occurred or the body was found. The primary or attending physician or medical examiner shall certify over his or her signature the cause of death to the best of his or her knowledge and belief.” It is important to note that the term “primary or attending physician” means a physician who treated the decedent through examination, medical advice, or medication during the 12 months preceding the date of death. Therefore, physicians who neither were in attendance at the time of the patient's death nor treated the decedent immediately prior to death are not required to sign the death certificate. In such cases Florida law provides that the medical examiner is the responsible party for signing the death certificate. Except for emergency care treatment, fees for medical services are payable only to a health care provider certified and authorized to render remedial treatment, care, or attendance under Chapter 440, Florida Statutes. Carriers shall pay, disallow, or deny payment to health care providers in the manner and at times set forth in the chapter. A health care provider may not collect or receive a fee from an injured employee within this state, except as otherwise provided by Chapter 440. Providers have recourse against the employer or carrier for payment for services rendered in accordance with the chapter. Payment to health care providers or physicians shall be subject to the medical fee schedule and applicable practice parameters and protocols, as outlined in Chapter 440. A health care provider may not refer an injured employee to another health care provider, diagnostic facility, therapy center, or other facility without prior authorization from the carrier, except when emergency care is being rendered. Any workers’ compensation patient referral must be to a health care provider that has been certified by AHCA, unless the referral is for emergency treatment. The referral must be made in accordance with practice parameters and protocols of treatment as provided for in Chapter 440. This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: October 2005 WORKERS' COMPENSATION & THE PHYSICIAN BUSINESSMAN Today's physician faces numerous risks when establishing a practice. One of these risks is that of employees becoming hurt on the job, as Florida law states the employer must pay not only the medical expenses of the injured employee, but also a significant portion of the wages the employee would have earned had the injury not occurred. This expense, coupled with the need to hire a replacement, often is devastating to a practice. It is for this reason that many physicians voluntarily insure their practice by obtaining Workers' Compensation coverage. For others, however, the expense of such coverage is not justified by what is perceived to be the slight risk of liability. Therefore, every medical practice must evaluate its individual Workers' Compensation needs. For many practices, the choice of how to insure against workplace injuries is limited by Florida law. If the practice has four or more employees, the employer must secure coverage either by obtaining a policy through a commercial insurance carrier or by providing satisfactory evidence of the physician's ability to self-insure with the Division of Workers' Compensation. In determining whether a specific business has more than three employees, it should be noted that the definition of employee does not include independent contractors, and corporate officers may exclude themselves from the definition should they wish. For example, a professional association in which a sole physician (president of the PA) employs three office staff would not be required to obtain Workers' Compensation coverage if the president excludes himself from the definition of employee, as the office would maintain only three employees and not be subject to mandatory insurance. On the other hand, a similar physician employing four office staff members would be required to obtain coverage. Should an employer wish to self-insure, the Division of Workers' Compensation may require the employer to post a bond or other security to ensure the employer's ability to make any necessary payments, should the need arise. Assuming the physician has a choice of whether to obtain insurance, the costs of such insurance must be balanced against the likelihood and significance of any potential claim. If the business obtains coverage from a commercial carrier, it will incur regular billings at a set amount, but will incur no additional liability in the event of the workplace injury. Should the business wish to self-insure, the state may require that a specific amount of assets be placed into an escrow account to cover any future claims. Even this amount, however, may not be sufficient to cover the financial obligations of the business. For instance, if an employee physician earning $104,000 per year were to become disabled, the professional association would be required to pay not only the medical expenses of the employee, but also $1,333.34 per week for 700 weeks, resulting in a total payment of $933,338.00, not including medical expenses. In the event an eligible employer were to opt out of Workers' Compensation completely (which requires the submission of an affidavit to the Division of Workers' Compensation), the cost of such an employee injury would significantly increase. Under current Worker's Compensation law, an employer covered by Worker's Compensation either through a commercial carrier or through self-insurance may not be sued at common law. As a result, the employer is not liable for the full amount of damages, but only medical costs and 2/3 of the weekly earnings, and may not be sued for punitive damages. By contrast, if the employer above had elected not to be covered by