JEAN MARIE BARRIS, APPELLANT,
v.
TOPPERS OF FLORIDA, INC., AND PENINSULAR FIRE INSURANCE COMPANY, APPELLEES

Fla. 1st DCA | 1980-04-17
No. QQ-51
McCORD, LARRY G. SMITH and WENTWORTH, JJ., concur.
382 So. 2d 441 Florida District Court of Appeal, First District (1980) Positive Treatment
Cited by 18 cases

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Synopsis

In this workers' compensation appeal, the court reversed the denial of medical benefits for abdominal surgery and temporary disability, holding that compensability of diagnostic procedures and surgery is determined by the purpose of the procedure at the time it was performed, not by the ultimate causal findings revealed afterward.


Holding

Compensability for diagnostic procedures and surgery is based on the purpose of the diagnosis at the time it is performed, not on the ultimate causal relationship discovered afterward. The surgery was compensable because the doctor's purpose was to determine whether the trauma caused the cyst, and there was no contrary medical evidence at the time of diagnosis.


Headnotes

[1] Compensability for diagnostic tests and surgery is determined by the purpose of the diagnosis at the time it is made, not by the ultimate causal relationship of the sympt…

[2] Medical expenses incurred to diagnose a condition are compensable when the treating physician believes the condition may be related to a work-related injury, even if the…

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Key Quotes

“Compensability for diagnostic tests and surgery cannot be based upon an after-the-fact determination as to causation. It is the purpose of the diagnosis, as opposed to the ultimate causal relationship of the symptom, that determines whether or not the medical expenses necessary to make the diagnosis are compensable.”

Establishes the core holding that compensability turns on the contemporaneous purpose of the diagnosis, not subsequent findings about causation.

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Facts & Procedural History

Appellant Barris struck her abdomen on a steel rod while at work on October 18, 1978, and began vaginal bleeding immediately. She had a prior history …

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Opinion of the Court
PER CURIAM.

PER CURIAM.

This is an appeal from a final workers’ compensation order dated April 12, 1979, denying appellant medical benefits for abdominal surgery and temporary disability benefits following such surgery. Appellee cross-appeals, urging that certain diagnostic procedures prior to the abdominal surgery were not compensable.

Appellant had a prior history of pelvic inflammatory disease, which was asymptomatic at the time of her injury. She turned from her work area and walked into a steel rod, striking her abdomen on October 18, 1978. She began bleeding vaginally immediately after the trauma. She came under the care of Dr. Bennett, who prescribed Darvon.

Because of continuing pain and persistent symptoms, appellant came under the care of Dr. Schiwietz. Dr. Schiwietz’s diagnosis was pelvic inflammatory disease and a separate cystic swelling or mass. He felt that the swelling could represent bleeding in the area of the left ligament, possibly caused by the trauma appellant received at work.

The doctor performed other diagnostic tests, including a pelvic laparoscopy, but was still unable to make a diagnosis as to the etiology of the cyst. He recommended that appellant undergo exploratory surgery to determine the cause of the cyst. During surgery, the doctor excised the cyst and performed a total hysterectomy to remove appellant’s diseased structures caused by her pelvic inflammatory disease. The doctor stated that it would have been improper medical procedure not to remove the diseased structures during the abdominal surgery.

After surgery, the doctor was able to determine that the swelling was a congenital parametrial cyst, unrelated to appellant’s accident at work. However, the doctor testified that without surgery, he would have been unable to determine the etiology of the cyst. He also testified that the trauma at work aggravated appellant’s pelvic inflammatory disease.

The JIC found all diagnostic procedures prior to surgery compensable. However, he found the surgery noncompensable, since the purpose of the surgery was to determine the etiology of the cyst, which was found to be unrelated to the trauma. Accordingly, appellant was denied an award for the surgery and temporary disability benefits following surgery.

We disagree and reverse the order, It is clear the doctor felt that the swelling could have been caused by the trauma. In fact, there was no medical evidence to the contrary in the record. Compensability for diagnostic tests and surgery cannot be based upon an after-the-fact determination as to causation. It is the purpose of the diagnosis, as opposed to the ultimate causal relationship of the symptom, that determines whether or not the medical expenses necessary to make the diagnosis are compensable. Bridge Lumber Company v. Altman, IRC Order 2-3408 (April 21, 1978); Dura Clad Systems v. Jones, IRC Order 2-3073 (December 3,1976), cert, denied, 348 So. 2d 946 (Fla.1977). Also see Banyas v. American Mutual Fire Insurance Company, 359 So. 2d 506 (Fla. 1st DCA 1978), for an analogous situation involving Florida’s no-fault auto insurance law.

There was no evidence to support the judge’s finding of noncompensability. The only testimony was that of Dr. Schi-wietz, who stated that the purpose of the surgery was to determine if the trauma caused the cyst. Therefore, we remand with instructions that the surgery be held compensable and for further findings as to appellant’s temporary disability resulting from such surgery. The issue on cross-appeal is affirmed.

McCORD, LARRY G. SMITH and WENTWORTH, JJ., concur.


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Citator

Cited By

  • …hindrance to recovery from the com-pensable injury is merely an incidental effect of such treatment. “It is the purpose of the [treatment] . . . that determines whether or not medical expenses . are compensable.” Barris v. Toppers of Florida, Inc., 382 So. 2d 441, 442 (Fla. 1st DCA 1980). Accordingly, the order is affirmed except with respect to medical costs; it is reversed on that issue and remanded for reconsideration on this record or such additional evidence as is necessary to determine medical costs,…
  • Lanoris Nealy v. City OF W. Palm Beach & Crawford & Co., 491 So. 2d 585 (Fla. 1st DCA 1986)
    …Boykin v. American Marine Products, Inc., 395 So. 2d 1163 (Fla. 1st DCA 1981). This is true even though it should later be determined that the claimant suffered from both compensable and noncompensable conditions. Barris v. Toppers of Florida, Inc., 382 So. 2d 441 (Fla. 1st DCA 1980). We hold that Boykin and Barris control the outcome of this case. Glades County Sugar Growers v. Gonzales, 388 So. 2d 333 (Fla. 1st DCA 1980), and Newhouse v. Volusia County School Board, 474 So. 2d 1222 (Fla. 1st DCA 1985), rel…
  • Vero Beach Care Ctr. & Associated Indus. of Fla. v. Ricks, 476 So. 2d 262 (Fla. 1st DCA 1985)
    …the-fact findings of non-causation do not affect a claimant’s entitlement to diagnostic treatment for on-going complaints of pain. Lewis v. Town and Country Auto Body Shop, 447 So. 2d 403, 406 (Fla. 1st DCA 1984); Barris v. Toppers of Florida, Inc., 382 So. 2d 441, 442 (Fla. 1st DCA 1980). AFFIRMED in part, REVERSED in part, and REMANDED with directions. MILLS and THOMPSON, JJ., concur. . Soft-tissue injuries, such as lower back difficulties, are not readily observable, and hence are not susceptible to eva…

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