LONG GROVE BUILDERS, INC. AND GENERAL ACCIDENT INSURANCE, APPELLANTS,
v.
WARREN MICHAEL HAUN, APPELLEE

Fla. 1st DCA | 1987-06-05
No. BO-248
WENTWORTH and BARFIELD, JJ., concur.
508 So. 2d 476 Florida District Court of Appeal, First District (1987) Caution
Cited by 14 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

A Florida workers' compensation appeal addressing whether a deputy commissioner may adjudicate disputes over the amount of an authorized treating physician's bill under the Medical Services Fee Schedule. The court held that the deputy commissioner lacked jurisdiction because the claimant lacked standing to bring such a dispute, as the claimant is statutorily insulated from liability for medical bills.


Holding

The deputy commissioner may not decide the amount of the medical bill at the claimant's request. The claimant lacked standing to bring the dispute because he is statutorily insulated from liability for the physician's bill under section 440.13(3) and Rule 38F-7.021. The administrative framework in Rule 38F-7.021 is the proper venue for resolving such disputes between the parties truly affected—the health care provider and the employer/carrier.


Headnotes

[1] A deputy commissioner in a workers' compensation case may not decide the amount of an authorized treating physician's bill payable under the Medical Services Fee Schedule…

[2] A claimant lacks standing to bring a dispute over the conformance of a medical bill to the fee schedule before a deputy commissioner for adjudication.

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Key Quotes

“The health care provider or health care facility providing services pursuant to this section shall be paid for the services solely by the employer or its insurance carrier, except for payments from third parties who have been determined to be liable for such payment.”

Establishes that the injured employee is not liable for medical bills, supporting the conclusion that the claimant lacked standing.

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Facts & Procedural History

Warren Haun injured his left hand in a power saw accident on November 23, 1983. His authorized treating physician, Dr. Thomson, submitted a bill for $…

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Opinion of the Court
MILLS, Judge.

MILLS, Judge.

The question presented in this workers’ compensation appeal is whether a deputy commissioner may decide, at the claimant’s request, the amount of an authorized treating physician’s bill payable under the Medical Services Fee Schedule adopted by the Division of Workers’ Compensation pursuant to section 440.13, Florida Statutes. We hold he may not, and reverse the order appealed.

The claimant, Warren Haun, injured his left hand in a power saw accident on 23 November 1983. An authorized treating physician, Dr. Thomson, submitted a bill for $3,010 to the employér/carrier (e/c). The e/c paid Dr. Thomson only $478, contending that was the full amount due under the Medical Services Fee Schedule.

In his client’s behalf, the claimant’s attorney requested a hearing before a deputy commissioner on the issues of medical fees due Dr. Thomson, interest, attorneys’ fees and costs. The claimant’s attorney also submitted a request in behalf of Dr. Thomson, pursuant to Florida Administrative Code Rule 38F-7.021 (formerly 38F-7.21), to the Office of Medical Services of the Division of Workers’ Compensation, seeking a determination of the correctness of the amount paid Dr. Thomson by the e/c. Pursuant to the latter request, Dr. Thomson’s bill was reviewed by a registered nurse employed by the Office of Medical Services, who determined that under the Medical Services Fee Schedule the e/c owed Dr. Thomson an additional $84. The e/c paid the additional $84, resulting in a total payment to Dr. Thomson of $562.

At the hearing before the deputy commissioner, the e/c objected to consideration of Dr. Thomson’s bill on the ground that administrative review of the medical bill pursuant to Rule 38F-7.021 deprived the deputy of subject matter jurisdiction to hear the claim. In his order, the deputy commissioner concluded he had jurisdiction to decide how much of Dr. Thomson’s bill was payable under the schedule. Then, based on his own analysis of the nature of the services rendered by Dr. Thomson, the deputy commissioner conformed the bill to the schedule and found the e/c should have paid Dr. Thomson a total of $1,674.

Section 440.13(3), Florida Statutes (1983), provides in part:

The health care provider or health care facility providing services pursuant to this section shall be paid for the services solely by the employer or its insurance carrier, except for payments from third parties who have been determined to be liable for such payment.

In addition, subsection 2 of Rule 38F-7.-021 specifically prohibits holding the injured employee liable or billing him for services under the Workers’ Compensation Program. Given the claimant’s apparent insulation from liability for Dr. Thomson’s medical bill, we conclude the claimant was without standing to 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 resolving the issue is provided in Florida Administrative Code Rule 38F-7.021. It is within the framework of the rule that the parties truly affected by the ultimate determination— the health care provider or facility and the employer/carrier — may have the issue decided.

Because the order must be reversed on the ground that the deputy commissioner erred in deciding the amount payable by the e/c under the schedule, the question of whether the deputy erred in conforming the bill to the schedule based on his own analysis of the nature of the services rendered is moot.

REVERSED.

WENTWORTH and BARFIELD, JJ., concur.


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Citator

Cited By

  • SUN Bank/South Fla., N.A. v. Baker, 632 So. 2d 669 (Fla. 4th DCA 1994)
    …). In addition to the limitation on charges, the workers’ compensation law makes the employer and insurance carrier legally responsible for paying medical bills, while the employee is insulated from liability. See Long Grove Builders, Inc. v. Haun, 508 So. 2d 476, 477 (Fla. 1st DCA 1987); §§ 440.-10(l)(a) and 440.13(3), Fla.Stat. (1993).6 To deliver medical benefits to the injured worker quickly and efficiently, as the Act requires, the statute cannot be read to place the worker in the position of shopping f…
  • Emerson Williams v. Triple J Enters. & Erc, Inc., 650 So. 2d 1114 (Fla. 1st DCA 1995)
    …t for the cost of his prescriptions was not an issue of reimbursement which was part of the utilization review process; Mr. Williams does not even have standing to participate in the utilization review process. Cf. Long Grove Builders, Inc. v. Haun, 508 So. 2d 476, 477 (Fla. 1st DCA 1987) (injured worker insulated from all liability for services rendered in the workers’ compensation program; therefore, injured worker lacked standing in proceeding before deputy commissioner regarding whether the physician’s bi…
  • Atl. Found. v. Gurlacz, 582 So. 2d 10 (Fla. 1st DCA 1991)
    …urisdiction of this matter, relying on section 440.13(2)(i)l., Florida Statutes (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 dism…

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