GORY ASSOCIATED INDUSTRIES AND HARTFORD INSURANCE COMPANY, APPELLANTS,
v.
GENE THOMAS, APPELLEE
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In this workers' compensation appeal, the Florida First District Court of Appeal affirmed the deputy commissioner's findings regarding notice of injury and temporary partial disability awards, but reversed and remanded the medical expense award because the deputy commissioner improperly excused the hospital and physician's failure to timely file required medical reports.
The court held that the refusal to provide medical services, the contested nature of a claim, and the reasonableness and necessity of medical treatment are all insufficient to excuse compliance with statutory medical reporting requirements. Good cause must be established separately and cannot be presumed from these factors alone.
[1] An employer/carrier's refusal to provide medical services does not constitute good cause to excuse the failure to timely submit required medical reports in a workers' com…
[2] The fact that a workers' compensation claim is being contested is insufficient to establish good cause for the failure to timely submit required medical reports.
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“the refusal to provide medical services is not good cause which excuses the failure to timely submit the required reports, nor is the fact that a claim is being contested sufficient to constitute good cause”
Establishes the legal standard that employer/carrier refusal to provide medical services and claim contestation do not excuse late filing of medical reports.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceGene Thomas, a part-time employee, suffered a work-related injury. The employer/carrier refused to provide medical services, and Thomas obtained treat…
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PER CURIAM.
In this appeal from a workers’ compensation order, the employer/carrier challenge the adequacy of the notice of injury, the award of temporary partial disability during the period the claimant Gene Thomas was employed (part-time), and the award of medical expenses. We affirm the order of the deputy commissioner on the first two points because there is competent, substantial evidence to support those determinations. On the issue of medical expenses, however, we reverse and remand for further proceedings for the reasons explained below.
At issue on the question of payment of medical expenses is the failure of the hospital and the attending physician to timely file medical reports. Section 440.13(1), Florida Statutes. The deputy commissioner’s order excuses the failure to timely file the reports based on the fact that the medical treatment was “reasonable and necessary” and “the circumstances involved.” It must be presumed from the context of the order that the phrase “the circumstances involved” refers to the fact that the employer/carrier refused to provide medical services. In Broward Industrial Plating, Inc. v. Weiby, 394 So. 2d 1117 (Fla. 1st DCA 1981), this court held that the refusal to provide medical services is not good cause which excuses the failure to timely submit the required reports, nor is the fact that a claim is being contested sufficient to constitute good cause. See also, St. Francis Hospital v. Feinberg, 192 So. 2d 753 (Fla.1966). Furthermore, an excusal based solely on the finding that the medical treatment was “reasonable and necessary” is also insufficient. Broward Industrial Plating, Inc. v. Weiby, supra. Accordingly, we must remand this cause for appropriate findings as to whether there was good cause to excuse the failure to comply with the statutory reporting requirements.
AFFIRMED in part, REVERSED in part, and REMANDED for further proceedings.
MILLS, ERVIN and LARRY G. SMITH, JJ., concur.
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The Crown Hotel & Kent Ins. Co. v. Phillip Friedman and the Division of Workers' Compensation, 438 So. 2d 993 (Fla. 1st DCA 1983)…yer/carrier contested the claim and has not provided any [*995] medical services — have been specifically held by this Court to be insufficient grounds alone for excusal of the section 440.13(1) requirement. See Gory Associated Industries v. Thomas, 402 So. 2d 1341 (Fla. 1st DCA 1981) and Broward Industrial Plating, Inc. v. Weiby, 394 So. 2d 1117 (Fla. 1st DCA 1981). As in Gory and Weiby, we reverse and remand on this point to the deputy commissioner for a further determination of whether good cause existed to…
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Cedars OF Lebanon Health Care Ctr., Inc. v. Summerset, 409 So. 2d 185 (Fla. 1st DCA 1982)…an essential prerequisite to an order for payment for medical services where these reporting requirements have not been satisfied. Broward Industrial Plating, Inc. v. Weiby, 394 So. 2d 1117 (Fla. 1st DCA 1981); Gory Associated Industries v. Thomas, 402 So. 2d 1341 (Fla. 1st DCA 1981); Arkin Building Corporation v. Miller, 401 So. 2d 874 (Fla. 1st DCA 1981); Walt Disney World Company v. Schiebel, 397 So. 2d 1004 (Fla. 1st DCA 1981); Olson v. Wagner, 390 So. 2d 1247 (Fla. 1st DCA 1980). On remand, the deputy co…
Authorities Cited
- Broward Indus. Plating, Inc. v. Weiby, 394 So. 2d 1117 (Fla. 1st DCA 1981)
- ST. Francis Hosp., Inc. v. Eileen Feinberg & the Fla. Indus. Comm'n, 192 So. 2d 753 (Fla. 1966)