E.T. USHER AND PROFESSIONAL ADMINISTRATORS, INC., APPELLANTS,
v.
LARRY J. COTHRON, APPELLEE
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An employee injured in a compensable traffic accident sought reimbursement for unauthorized medical treatment from Dr. Jones after the employer/carrier offered alternative authorized physicians. The court reversed the compensation order, holding that absent an emergency, an employee cannot unilaterally obtain treatment from an unauthorized physician and demand reimbursement without first securing approval through a hearing.
An employee is not entitled to unilaterally obtain treatment from an unauthorized physician and demand reimbursement when alternative authorized medical care has been offered, unless an emergency exists. The employee's obligation is to request a hearing and secure a ruling authorizing the unauthorized physician before obtaining treatment from him.
[1] A claimant is not entitled to reimbursement for treatment from an unauthorized physician of their choice when alternative authorized medical care has been offered, absent…
[2] A claimant must obtain a ruling from the deputy commissioner authorizing a change in physician before unilaterally seeking treatment from an unauthorized physician, unles…
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Join FLexlaw to unlock all legal intelligence“Except in an emergency, a claimant who has been offered alternative medical care is not entitled to unilaterally obtain treatment from an unauthorized physician of his choice and then obtain reimbursement from the E/C.”
Establishes the core legal principle that unauthorized treatment without authorization or emergency cannot be reimbursed
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Join FLexlaw to unlock all legal intelligenceThe claimant was injured in a compensable traffic accident on January 4, 1983, and received authorized treatment at Shands Teaching Hospital. On Febru…
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THOMPSON, Judge.
This is an appeal from a. compensation order authorizing medical treatment by the physician of claimant’s choice and award ing payment of the past medical bills of the physician chosen by claimant. The employer and carrier (E/C) contend that the deputy commissioner (deputy) erred because the factual findings which form the basis of the order are unsupported by competent substantial evidence. We agree and reverse.
The claimant was injured in a compensable traffic accident which occurred on January 4,1983. Authorized medical treatment, including brief hospitalization and the fitting of a back brace, was furnished at Shands Teaching Hospital in Gainesville (Shands). Claimant became dissatisfied with the authorized treatment being afforded at Shands and, on February 16,1983, his attorney telephoned the E/C to request authorization of Dr. Jones, a physician recommended by claimant’s attorney. On the same date the E/C declined the request for authorization of Dr. Jones, but reaffirmed their authorization of the Shands physicians and offered additional alternative care by two private physicians. On February 18, 1983, the claimant, without having attempted to obtain an appointment with either of the authorized alternative physicians, proceeded to obtain treatment from Dr. Jones.
In the order on appeal, the deputy found, inter alia:
6. That, in an effort to obtain relief from his pain ... the Claimant made an appointment with Dr. Harry Jones ... who upon obtaining a history from and examining the Claimant, changed the Claimant’s back-brace and method of treatment.
7. That the Claimant, upon experiencing considerable relief from the change in treatment and an increasing ability to function, requested the consent of the Employer/Carrier to change his primary treating physician ... to Dr. Harry Jones.
8. That the Employer/ Carrier refused the requested change of physician, and instead added [the two private physicians] to the list of approved physicians.
9.That the Claimant, having experienced a significant decrease in his pain and discomfort and an increase in his functional ability as a result of the treatment of Dr. Harry Jones, was justified in refusing the treatment of any of the listed physicians.
The quoted finding that the E/C did not offer alternative care until after the claimant received treatment from Dr. Jones is not supported by any competent substantial evidence. On the contrary, the record affirmatively shows claimant first received treatment from Dr. Jones two days after the E/C offered alternative care and that the claimant made no effort to see either of the authorized alternative physicians.
Except in an emergency, a claimant who has been offered alternative medical care is not entitled to unilaterally obtain treatment from an unauthorized physician of his choice and then obtain reimbursement from the E/C. City of Fort Lauderdale v. Flanders, 416 So. 2d 1234 (Fla. 1st DCA 1982); § 440.13, Fla.Stat. Here, the deputy did not find, and the record includes no evidence which could have supported a finding, that claimant sought the care of Dr. Jones on an emergency basis. Because alternative medical care was authorized, and because no emergency existed, it was the obligation of the claimant to request a hearing and secure a ruling by the deputy authorizing Dr. Jones before obtaining treatment from him. Because the claimant failed to meet this obligation, the order on appeal is REVERSED.
SHIVERS and JOANOS, JJ., concur.
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Cited By (11 total)
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State v. Wilcox, 458 So. 2d 1207 (Fla. 1st DCA 1984)…he seeks by her alleged failure to gain authorization from the E/C before incurring these expenses. However, this cause is not controlled by cases such as Atkins v. Greenhut Construction Co., 447 So. 2d 268 (Fla. 1st DCA 1984), and Usher v. Cothren, 445 So. 2d 387 (Fla. 1st DCA 1984), which hold that a claimant who is offered alternative medical care may not unilaterally obtain medical treatment from a physician of her choice and subsequently be reimbursed by the E/C, because the deputy below found as a matte…
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Bradley Constr. & Se. Fire Ins. v. White, 457 So. 2d 547 (Fla. 1st DCA 1984)…treatment. Instead, claimant himself sought a determination from the deputy commissioner that chiropractic treatment would be in claimant’s best interest, following the proper procedure for resolving treatment disputes outlined in Usher v. Cothron, 445 So. 2d 387 (Fla. 1st DCA 1984), and Sears, Roebuck and Company v. Viera, supra, at 51. As previously noted, Dr. Arslanian released claimant from his care for reasons other than claimant’s or, for that matter, Dr. Arslanian’s satisfaction with the previous cou…
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Champlain Towers & Old Republic Ins. Co. v. Earl Dudley and the Division of Workers' Compensation, 481 So. 2d 532 (Fla. 1st DCA 1986)…is the burden of the claimant to seek a decision through the deputy. Since the claimant failed to ask for resolution of the deadlocks, he is responsible....” Wackenhut Corp. v. Freilich, 464 So. 2d 217, at 218 (Fla. 1st DCA 1985); Usher v. Cothron, 445 So. 2d 387 (Fla. 1st DCA 1984). Assuming each party properly complied with all statutory duties, these decisions appear to be proper implementations of the statute, even when we consider its further provision that “[i]t is unlawful ... to coerce or attempt to…
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Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- City OF Fort Lauderdale v. Grady Flanders, 416 So. 2d 1234 (Fla. 1st DCA 1982)