RAMADA INN, APPELLANT,
v.
MILLICENT GATES, APPELLEE

Fla. 1st DCA | 1982-08-31
No. AB-51
ERVIN, J., concurs in part and dissents in part with written opinion., BOOTH and THOMPSON, JJ., concur.
418 So. 2d 1160 Florida District Court of Appeal, First District (1982) Positive Treatment
Cited by 4 cases

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Synopsis

Ramada Inn appeals a workers' compensation order awarding temporary total disability benefits and medical bills. The court affirms the finding of a compensable accident but reverses the award of unauthorized medical treatment expenses because the claimant failed to follow statutory procedures for obtaining medical care authorization.


Holding

The court affirmed the finding of a compensable accident because it was corroborated by witness testimony and medical records. However, the court reversed the award of unauthorized medical bills because the claimant failed to follow Section 440.13(2), Florida Statutes, requiring authorization before obtaining medical treatment, and the Deputy Commissioner's finding of reasonableness did not excuse this procedural failure.


Headnotes

[1] A deputy commissioner's finding of a compensable accident, when supported by corroborated testimony and physician's history, is supported by competent substantial evidenc…

[2] An employer/carrier is not responsible for unauthorized medical treatment obtained by an employee without following statutory procedures or seeking employer authorization…

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Key Quotes

“The Deputy's finding that such treatment was "reasonable and necessary" does not excuse the failure to obtain authorization.”

Establishes that compliance with statutory authorization procedures is mandatory in workers' compensation cases, regardless of whether treatment is reasonable and necessary.

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Facts & Procedural History

Claimant Millicent Gates, a maid at Ramada Inn, sustained an injury while cleaning a bathroom on December 4, 1979. Her employer immediately provided a…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

The employer/carrier appeals a workers’ compensation order awarding temporary total disability benefits, payment of certain outstanding medical bills, transportation and drug reimbursement costs. The employer/carrier first contends that the Deputy Commissioner erred in accepting claimant’s testimony that she sustained a compensable accident on December 4, 1979, while rejecting other large portions of her testimony as “inherently difficult to believe” because of “their lack of plausiblity” and because of claimant’s demeanor. However, the claimant’s testimony that a compensable accident occurred while she was cleaning a bathroom in the course of her employment as a maid at Ramada Inn was corroborated by that of other witnesses as well as by the history recorded by her physician shortly after the accident. Therefore, the Deputy’s finding on this issue was supported by competent substantial evidence and must be affirmed.

The Deputy Commissioner erred, however, in finding that unauthorized medical treatment rendered by Drs. Simon and Sherman, including expenses related to claimant’s January 18, 1980 abortion, was the responsibility of the employer/carrier. Immediately after claimant informed her employer that an accident occurred on December 11, 1979, she was provided with authorized medical care by Dr. Green, an orthopedic surgeon, who instructed her to return if she had further problems. Nevertheless, without following the procedures set forth in Section 440.13(2), Florida Statutes (1979), or seeking alternative treatment, claimant continued to receive duplicate unauthorized treatment by Dr. Simon, including treatment for nausea and vomiting which were unrelated to her industrial accident. The Deputy’s finding that such treatment was “reasonable and necessary” does not excuse the failure to obtain authorization. Palm Beach Newspapers, Inc. v. Roston, 404 So. 2d 174 (Fla. 1st DCA 1981). The award of Dr. Sherman’s bills was also erroneous, as claimant was referred to Dr. Sherman by Dr. Simon, who was unauthorized, again without notifying the employer/carrier. Cf., McKinney v. McKinney Farms, 380 So. 2d 469, 470 (Fla. 1st DCA 1980). Therefore, we reverse the award of payment of Dr. Simon’s and of Dr. Sherman’s outstanding medical bills, as well as transportation costs, incurred while the employer/carrier was providing authorized care by Dr. Green.1

We note that the employer/carrier specifically controverted the payment of medical bills. Whether the medical bills were to be paid or not was a stated issue2 before and was determined by the deputy. Indeed, claimant does not contend that the issue is not properly before us on appeal.

Since we do not interpret Paragraph 11 of the Deputy Commissioner’s order reserving “jurisdiction ... to consider payment of wage loss benefits” as finding that claimant is entitled to such benefits, we find it unnecessary to rule on this question at this time.

REVERSED and REMANDED for proceedings in accordance with this opinion.

ERVIN, J., concurs in part and dissents in part with written opinion.

BOOTH and THOMPSON, JJ., concur. . Dr. Green was deauthorized by the employer/carrier by letter on April 14, 1980, subsequent to claimant’s treatment by Drs. Simon and Sherman.

. R. 15.

Other
ERVIN, Judge,

ERVIN, Judge,

concurring in part and dissenting in part.

I concur in all portions of the majority’s opinion except that part reversing the deputy’s order directing the employer/carrier (e/c) to pay the medical services performed by Doctors Simon and Sherman. At the outset it should be observed that the order did not specify the amount of the medical services that were required to be paid by the e/c. Although I have doubts as to whether that portion of the order is a final, appealable order, cf. Mills Electrical Contractors v. Marthens, 417 So. 2d 700 (Fla. 1st DCA 1982); The Wash House v. Tucker, 413 So. 2d 813 (Fla. 1st DCA 1982); General Electric Co. v. Hawkins, 413 So. 2d 836 (Fla. 1st DCA 1982), because of the lack of consistency in this court’s opinions distinguishing between orders which are final and non-final, see Deinema v. Pierpoint Condominiums, 415 So. 2d 811 (Fla. 1st DCA 1982), I am content to consider the order final.

My more serious concern with the majority’s reversal is that the point urged on appeal — the physician’s non-authorization— in my judgment has not been preserved for appellate review; hence the majority’s opinion appears to conflict with our prior opinion in Sunland Hospital/State of Florida v. Garrett, 415 So. 2d 783 (Fla. 1st DCA 1982), which declined to honor issues that were first raised on appeal. I have been unable to find in the record any objection raised by the e/c before the deputy encompassing the point it now asserts before us— the doctors’ nonauthorization to provide medical treatment. Perhaps the primary reason for the failure to object was the fact that the medical bills were never admitted into evidence. Their nonadmission was entirely consistent with the parties’ apparent tacit agreement that the determination of the medical bills’ validity would be contingent upon the deputy’s prior determination that the injury was one that occurred within the scope and course of the employment; or, if so, a further hearing would be conducted to ascertain the amount of the bills. Thus, at the commencement of the hearing, the deputy stated: “In the event this claim is held compensable it may be necessary to conduct a further hearing on medical bills, past medical bills. It depends upon whether they come in in evidence today.” As reflected in the deputy’s final order, and in the e/c’s notice to controvert, there was in effect only one issue in controversy— whether the injury arose within the scope and course of employment. The notice to controvert listed the following defenses:

1. No accident occurred as claimed by the Claimant.

2. No injury occurred as claimed by the Claimant.

3. No disability exists or existed as claimed by the Claimant.

4. No medical care, treatment or attention was required or given to the Claimant; or will be required or will be given to the Claimant in the future because of the occurrence of any accident, injury or disability as claimed by the claimant.

5. No wage loss occurred as claimed by the Claimant.

My belief that the defenses were limited only to the above issue is further bolstered by the portion of the record in which the deputy stated in the presence of the attorneys for both parties during the pretrial stipulation conference that the e/c had adopted the position stated in its notice to controvert. Moreover, at the conclusion of the conference the deputy asked both attorneys whether there was anything either wished to add, to which both responded negatively.

I had thought that such improvidently raised questions as those now before us had been finally laid to rest in Sunland, where we forcefully declared:

We decline to become the tribunal of first resort on complex questions latent in the record but not substantially raised before the deputy. To the extent our own record of decisions these past three years may have given the appearance of a present and continuing readiness to decide questions not substantially raised before the deputy, thus misleading counsel, we now forswear that implication.

415 So. 2d at 785. It now appears from the majority’s opinion that Sunland’s forswearance of such practice was in fact premature.

For the reasons stated, I respectfully dissent to that portion of the majority’s opinion reversing the deputy’s order directing the e/c to pay the medical treatment furnished to the claimant by Doctors Simon and Sherman.


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Citator

Cited By

  • Dump ALL, Inc. v. Grossman, 475 So. 2d 976 (Fla. 1st DCA 1985)
    …nding that Dr. Grossman’s unauthorized treatment was “necessary and reasonable” is insufficient to excuse claimant’s failure to submit the matter again to the deputy and to show good cause for a reversal of the month-old ruling. Ramada Inn v. Gates, 418 So. 2d 1160 (Fla. 1st DCA 1982). We also hold that Dr. Gross-man is not entitled to an award of attorney’s fees or costs, either below or on appeal to this court. Since the award of attorney’s fees by statute is in derogation of the common law, such statutes m…
  • Fcci Mut. Ins. Co. & Interlachen Country Club v. Schnupp, 697 So. 2d 1234 (Fla. 1st DCA 1997)
    …osts for an unauthorized physician will not be reimbursed (absent an emergency) if authorization for the procedure is not requested beforehand, so that the employer can elect to provide the service or litigate its necessity. See Ramada Inn v. Gates, 418 So. 2d 1160 (Fla.App.1982); Universal Studios v. Roberts, 643 So. 2d 1182, 1184 (Fla. 1st DCA 1994); Hillsborough County Sch. Bd. v. Brown, 565 So. 2d 867 (Fla. 1st DCA 1990); Palm Beach Newspapers, Inc. v. Roston, 404 So. 2d 174 (Fla. 1st DCA 1981). Since Janu…

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