SYLVESTER DERISO, APPELLANT,
v.
GREAT WESTERN MEATS AND SELF INSURED SERVICES, INC., APPELLEES

Fla. 1st DCA | 1988-11-07
No. 88-500
BOOTH, SHIVERS and THOMPSON, JJ., concur.
534 So. 2d 748 Florida District Court of Appeal, First District (1988) Positive Treatment
Cited by 4 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

In this workers' compensation case, the court addressed whether an employer's servicing agent properly denied reimbursement for osteopathic medical care where the employee sought treatment without first obtaining authorization. The court held that while the employer had no obligation to pay for the initial unauthorized visit, it erred in denying subsequent bills because the employee had the statutory right to obtain specialized care and seek reimbursement for reasonable treatment.


Holding

The court affirmed the denial of the first unauthorized bill but reversed the denial of subsequent bills. The employer's statutory obligation to include a representative of each type of health-care provider (including osteopaths) on its provider list requires timely authorization; providing alternative care that does not include the requested type, or later authorizing different care within that category, does not satisfy this obligation. The case was remanded to determine whether Dr. Sun's late filing of medical reports should be excused.


Headnotes

[1] A claimant may proceed with unauthorized medical treatment and seek reimbursement if the employer/servicing agent fails to provide a health-care provider of a statutorily…

[2] An employer/servicing agent's obligation to provide authorized medical care is not excused by initially providing requested care, offering alternative care not of the req…

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Key Quotes

“a carrier's list of health-care providers must include a representative of each type of provider defined in Section 440.13(l)(f), Florida Statutes (1987). Osteopathic physicians are one such provider, and if the E/SA do not provide such treatment after request, the claimant may proceed and have the reasonableness of his actions determined later by the deputy commissioner.”

Establishes the employer's statutory obligation to include specified provider types and the employee's right to seek care if authorization is denied.

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Facts & Procedural History

Claimant injured his back and neck in a work accident in June 1987. After unsatisfactory chiropractic treatment, the employer and servicing agent auth…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

This cause is before us on appeal of an order denying a claim for reimbursement of orthopedic medical care rendered to claimant. We affirm in part and reverse in part.

Claimant injured his back and neck in a work accident in June 1987. Although initially treated by a chiropractor, his condition was not relieved. Claimant told the chiropractor he was unsatisfied, and the chiropractor told the employer and servicing agent (E/SA). They responded with a letter authorizing claimant to see any of three doctors, none of whom were osteopaths. Up to that time, claimant had not told anyone he specifically wanted an osteopath.

Claimant subsequently contacted Dr. Din-On Sun, an osteopath, and was treated once. Several days later, he filed a claim requesting authorization for Dr. Sun. The E/SA sent notices of controversion in three successive months, during which claimant continued to see Dr. Sun. Dr. Sun regularly forwarded his bills to the E/SA but did not send medical reports as required by Section 440.13(2)(b), Florida Statutes (1987). It is unclear from the record and the order whether the reports were ever filed. Shortly before the hearing on the claim, the E/SA authorized a different osteopath. Claimant testified he preferred Dr. Sun.

Under Section 440.13(2)(a), Florida Statutes (1987), a carrier’s list of health-care providers must include a representative of each type of provider defined in Section 440.13(l)(f), Florida Statutes (1987). Osteopathic physicians are one such provider, and if the E/SA do not provide such treatment after request, the claimant may proceed and have the reasonableness of his actions determined later by the deputy commissioner. § 440.13(2)(b), Fla.Stat. (1987). If the treatment is ultimately found reasonable and necessary, the employer and carrier will be held responsible for the hitherto unauthorized medical care. Kirkland v. Harold Pratt Paving, Inc., 518 So. 2d 1320, 1324-1325 (Fla. 1st DCA 1987).

Because claimant did not notify the E/SA that he desired an osteopath before seeing one, we affirm the deputy’s ruling as to Dr. Sun’s first bill. However, the deputy’s reasons for refusing to order payment of the remaining bills were erroneous. Although the deputy was factually correct that (1) the E/SA provided initial care as requested by claimant, (2) alternative care was offered, and (3) the E/SA ultimately provided the kind of treatment claimant wanted, those reasons were legally irrelevant under Kirkland, supra. Providing the care initially requested by a claimant does not bar claimant from subsequently requesting different care if needed; offering alternative care does not meet the E/SA’s obligation unless the alternatives offered include a health-care provider of the type described in Section 440.13(l)(f), Florida Statutes (1987), and requested by claimant; and ultimately providing the requested treatment does not meet the E/SA’s obligation to timely provide the requested care or seek a hearing. Jackson v. Publix Supermarkets, Inc., 520 So. 2d 50, 51 (Fla. 1st DCA 1987).

Although we regard the E/SA’s ultimate authorization of osteopathic care to be a tacit admission that the care was reasonable and necessary within the meaning of the statute, and direct that a finding be entered to this effect, we decline to order payment of Dr. Sun’s remaining bills on the record before us. On remand, the deputy is directed to enter a finding on whether Dr. Sun ever submitted reports and, if so, to determine whether the late filing should be excused on good cause or waiver grounds under the rationale in Lovell Brothers, Inc. v. Kittles, 518 So. 2d 319 (Fla. 1st DCA 1987).

AFFIRMED IN PART, REVERSED IN PART, AND REMANDED WITH DIRECTIONS.

BOOTH, SHIVERS and THOMPSON, JJ., concur.


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Citator

Cited By

  • …solely from the class of providers requested by an employee; however, the “carrier’s list of health care providers must include a representative of each type of provider defined in Section 440.13(l)(f), Florida Statutes.”2 Deriso v. Great W. Meats, 534 So. 2d 748, 749 (Fla. 1st DCA 1988). The above opinions clearly state that during the selection process of a requested list of physicians, discrimination against a specific requested class may occur if an E/C fails to offer a representative from such class. W…
  • Imperial Elec. v. Reeves, 647 So. 2d 199 (Fla. 1st DCA 1994)
    …y and totally disabled, and award benefits from that date forward. Second, we reverse the JCC’s order as to the E/C’s responsibility for payment of claimant’s initial treatment with Dr. Gonzalez on June 30, 1992. See Deriso v. Great Western Meats, 534 So. 2d 748 (Fla. 1st DCA 1988); Workman v. McDonnell Douglas Corp., 590 So. 2d 1035 (Fla. 1st DCA 1991). The record reveals that claimant did not request psychiatric care from the E/C until after this first treatment. Nor were claimant’s psychiatric problems k…

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