VIC LANE CONSTRUCTION, INC. AND GULF INSURANCE GROUP, APPELLANTS,
v.
DONALD B. HOLLAND, APPELLEE

Fla. 1st DCA | 1984-07-18
No. AW-222
MILLS and SHIVERS, JJ., concur.
453 So. 2d 79 Florida District Court of Appeal, First District (1984) Positive Treatment
Cited by 2 cases

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Synopsis

In a workers' compensation appeal, the court reversed the deputy commissioner's order requiring the employer/carrier to provide medical treatment and a spinal CAT scan to an injured worker who had previously stipulated to reaching maximum medical improvement and requiring no further treatment. The court held that absent conflicting medical evidence, bare complaints of pain are insufficient to require post-MMI medical benefits.


Holding

The employer/carrier may not be required to bear the expense of evaluation by an additional physician based merely on the claimant's assertions of continued pain absent conflicting medical evidence. The claimant must demonstrate that such further treatment is reasonably required by the nature of the injury or the process of recovery. The deputy commissioner erred in authorizing the treatment because the uncontradicted medical evidence supported that claimant required no further treatment following the industrial accident.


Headnotes

[1] A claimant who stipulates to having reached maximum medical improvement and requiring no further treatment as a result of an industrial accident cannot later claim entitl…

[2] Remedial medical care is not awardable following a claimant's attainment of maximum medical improvement.

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Key Quotes

“Absent a conflict in the medical evidence, the employer/carrier may not be required to bear the expense of an evaluation by an additional physician based merely on claimant's assertions of continued pain. Instead, claimant must demonstrate that such further treatment is reasonably required by the nature of the injury or the process of recovery.”

Establishes the legal standard for post-MMI medical benefits, requiring either conflicting medical evidence or a demonstrated need for further treatment, not merely subjective pain complaints.

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Facts & Procedural History

Claimant suffered a compensable head and back injury on September 15, 1981. Following treatment by the employer/carrier's authorized physicians, claim…

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Opinion of the Court
WIGGINTON, Judge.

WIGGINTON, Judge.

The employer/carrier appeal from the final order of the deputy commissioner requiring them to provide for claimant medical care and a spinal CAT scan. We reverse.

Claimant suffered a compensable injury to his head and back on September 15, 1981. Following remedial treatment afforded by the E/C’s authorized physicians, claimant entered into a “Stipulation and Joint Petition for Partial Final Settlement” on April 26, 1983, pursuant to section 440.-20(12)(a) and (b), Florida Statutes. Claimant stipulated that he had been discharged from further treatment, had reached maximum medical improvement on October 12, 1981, and required no further treatment as a result of the industrial accident.

The deputy approved the stipulation, and ordered that upon payment of the stipulated lump sum, “the liability of the employer for future payments of compensation on account of the subject injury shall be fully discharged_” However, the order further provided that “[t]he responsibility of the Employer/Carrier for future medical benefits remains as it now is for the time and in the manner provided by law.”

In June, 1983, claimant filed a claim requesting further medical care and treatment by Dr. Haney Helmy, which request had earlier been denied by the E/C based on the fact that claimant had reached MMI, and on their. opinion that there was no causal relationship between claimant’s alleged continued need for medical care and the industrial accident.

At the hearing, claimant’s case rested on his testimony of continued pain, in which he stated, “I just want to go to him [Dr. Helmy] and go to someone who didn’t have prior knowledge about it and see what he said. I want to know. I mean there is definitely a problem here.” Being under the impression that a novel CAT scan diagnostic procedure would benefit claimant, the deputy authorized treatment by Dr. Helmy and the scan examination at the Florida Hospital South in Orlando. By so doing, the deputy erred.

The medical evidence before the deputy was uncontradicted that claimant required no further treatment on account of the industrial accident. Claimant had previously stipulated to that fact, and the deputy approved the stipulation in his order granting the lump sum award. Claimant had reached maximum medical improvement. “Absent a conflict in the medical evidence, the employer/carrier may not be required to bear the expense of an evaluation by an additional physician based merely on claimant’s assertions of continued pain_ Instead, claimant must demonstrate that such further treatment is reasonably required by the nature of the injury or the process of recovery ... [citations omitted].” Amoco Container Company v. Singh, 418 So. 2d 395 (Fla. 1st DCA 1982).

Claimant would argue that under the order approving the stipulation, he is entitled to future medical benefits. However, we must emphasize to claimant that he is not unconditionally entitled to those medical benefits; rather, the language on which claimant relies expressly conditions the E/C’s responsibility to provide future medical benefits on their present responsibility for such benefits and, beyond that, in the manner “as provided by law.” At “present,” or, just prior to the hearing, the E/C had no responsibility to provide medical benefits because claimant stipulated that he had reached MMI and required no further treatment. At the hearing, claimant produced no evidence to establish a need for further medical treatment, other than his bare complaints of pain. “By law,” those complaints are simply insufficient under the circumstances to justify the E/C’s bearing the expense of further medical evaluation. Amoco Container Company v. Singh.

For that reason, the deputy erred in awarding the treatment at this juncture.

REVERSED.

MILLS and SHIVERS, JJ., concur. . It should also be kept in mind that, whatever medical treatment is sought by claimant, remedial medical care is not awardable following maximum medical improvement. Manns Jiffy Food Mart, et al. v. O'Neil, 453 So. 2d 78 (Fla. 1st DCA 1984).


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Citator

Cited By

  • Reed v. BAY CON Gen., Inc., 496 So. 2d 963 (Fla. 1st DCA 1986)
    …ment or evaluation was reasonably required as provided in Amoco. The record reflects that he made no such showing. Nor would an award of remedial treatment have been proper given that Reed had reached MMI. See Vic Lane Construction, Inc. v. Holland, 453 So. 2d 79, 80 n. 1 (Fla. 1st DCA 1984) citing Manns Jiffy Food Mart v. O’Neil, 453 So. 2d 78 (Fla. 1st DCA 1984). Affirmed. BOOTH, C.J., and WENTWORTH, J., concur.…

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