MT. SINAI MEDICAL CENTER AND ALL RISK CORP. OF FLORIDA, APPELLANTS/CROSS-APPELLEES,
v.
MAMIE SAMUELS, APPELLEE/CROSS-APPELLANT, AND DIVISION OF WORKERS' COMPENSATION, APPELLEE
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A workers' compensation appeal involving Mt. Sinai Medical Center and All Risk Corp. challenging a deputy commissioner's award of disability benefits and denial of medical bill payment to injured worker Mamie Samuels. The court affirmed most disability awards but reversed the temporary partial disability award for lack of evidence of work search and reversed the denial of medical bills.
The court reversed the TPD award for February 2 through June 22, 1982 due to lack of evidence of a work search, which is essential to such awards. The court affirmed all other disability benefits awards as supported by substantial competent evidence. The court reversed the denial of medical bills, holding that the deputy erred in excluding them based on lack of substantiation and fee schedule conformity, which are matters to be handled administratively.
[1] An award of temporary partial disability benefits requires competent evidence of a good faith work search during the period for which benefits are sought.
[2] Substantial, competent evidence supports awards of temporary total, temporary partial, and permanent total disability benefits when claimant's restrictions, limitations,…
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Join FLexlaw to unlock all legal intelligence“a good faith work search is essential to an award of TPD benefits”
Establishes the legal requirement for temporary partial disability awards
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Join FLexlaw to unlock all legal intelligenceMamie Samuels, a claimant, suffered an industrial injury requiring surgery that caused work restrictions and limitations. She sought temporary partial…
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WIGGINTON, Judge.
The employer/carrier appeal and the claimant cross-appeals the deputy commissioner’s order awarding temporary and permanent disability benefits, and related interest and costs, but denying payment of claimant’s medical bills. We affirm in part and reverse in part.
Initially, we reverse the award of temporary partial disability benefits for the period beginning February 2, 1982, and ending June 22, 1982. The record is devoid of competent evidence of a work search during this period, and a good faith work search is essential to an award of TPD benefits. Eastside Bait & Tackle v. Humphrey, 440 So. 2d 41 (Fla. 1st DCA 1983). Accordingly, the award of interest based on those benefits for that period is also reversed.
We affirm the remaining awards of temporary total, temporary partial, and permanent total disability benefits. Substantial, competent evidence supports these awards, in light of claimant’s restrictions, limitations, and surgery which was shown to be causally related to her industrial inju ry. Interest and costs based on these benefits similarly stand affirmed.
Finally, we reverse the deputy’s denial of claimant’s request for the employer/carrier’s payment of her medical bills. Although the medical bills were proffered at the hearing, the deputy sustained the employer/carrier’s objection to their introduction on the basis that the bills had not been “substantiated” by the claimant, and did not conform to the statutory medical fee schedule. In so doing, the deputy erred. Claimant testified at the hearing that she had received the bills; claimant’s treating physician testified at his deposition as to the amount of the bills. Whether the bills correspond to the fee schedule is immaterial, as that matter will be handled administratively under section 440.13(3)(a), Florida Statutes (1981), allowing for the health care provider to be paid either his customary charge or the maximum charge under the schedule, whichever is the lesser amount. Accordingly, on remand, the deputy is directed to admit into evidence the medical bills proffered at the original hearing on this claim.
AFFIRMED in part, REVERSED in part, and REMANDED for further proceedings consistent with this opinion.
MILLS and SHIVERS, JJ., concur.
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SUN Bank/South Fla., N.A. v. Baker, 632 So. 2d 669 (Fla. 4th DCA 1994)…excess of the fee schedule is authorized only "in unusual cases on the basis of individual consideration" subject to administrative rules. R.E. Ledford Constr. Co. v. King, 381 So. 2d 330, 332 (Fla. 1st DCA 1980); Mt. Sinai Medical Ctr. v. Samuels, 453 So. 2d 81 (Fla. 1st DCA 1984). . Fortune Insurance Co. v. Figueroa, 597 So. 2d 435, 436 (Fla. 3d DCA), rev. denied, 605 So. 2d 1263 (Fla.1992), contains language indicating that a medical provider may accept workers' compensation benefits and still pursue th…
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Atl. Found. v. Gurlacz, 582 So. 2d 10 (Fla. 1st DCA 1991)…es (Supp.1990) and F.A.C.Rules 38F-7.506 and .507. Petitioners also place reliance on Lamounette v. Akins, 547 So. 2d 1001 (Fla. 1st DCA 1989); Long Grove Builders v. Haun, 508 So. 2d 476 (Fla. 1st DCA 1987); and Mt. Sinai Medical Center v. Samuels, 453 So. 2d 81 (Fla. 1st DCA 1984). Respondent Lovaas opposes the petition, arguing first that prohibition is an inappropriate remedy to obtain review of an order denying a motion to dismiss. Respondent also refers this court to Freshwater v. Troy Manufacturing C…
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Long Grove Builders, Inc. v. Haun, 508 So. 2d 476 (Fla. 1st DCA 1987)…o bring the dispute over conformance of the medical bill to the fee schedule before the deputy commissioner for adjudication. The deputy commissioner therefore erred in deciding the issue. This Court observed in Mt. Sinai Medical Center v. Samuels, 453 So. 2d 81 (Fla. 1st DCA 1984), that the issue of whether medical bills correspond to the Medical Services Fee Schedule is handled administratively pursuant to section 440.13(3)(a), Florida Statutes (1981) (now 440.13(4)(a)). The administrative framework for r…
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Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- MT. Sinai Med. Ctr. & All Risk Corp. of Fla. v. Samuels, 453 So. 2d 82 (Fla. 1st DCA 1984)
- Eastside Bait & Tackle & Fla. Farm Bureau v. Corene S. Humphrey, 440 So. 2d 41 (Fla. 1st DCA 1983)