CARLOS TEJEDA
v.
CITY OF HIALEAH/SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Fla. 1st DCA | 2021-12-29
No. 21-0704
46 Fla. L. Weekly D2057 Florida District Court of Appeal, First District (2021)

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

The appellate court affirmed the denial of a claimant's petition for benefits, holding that the Judge of Compensation Claims (JCC) had jurisdiction to interpret a stipulation and that the dispute was not a "reimbursement dispute" solely within the Department of Financial Services' jurisdiction. This clarifies the jurisdictional boundaries between JCCs and DFS in workers' compensation cases.


Holding

The court held that the JCC had jurisdiction because the dispute was not a "reimbursement dispute" as defined by statute, as it was between the claimant and the employer/carrier, not a healthcare provider/facility and carrier. The court also held that the JCC did not err in interpreting the stipulation, as JCCs are permitted to interpret contracts to determine parties' rights and responsibilities.


Headnotes

[1] A dispute between a claimant and an employer/carrier concerning payment for medical treatment does not constitute a statutory reimbursement dispute under section 440.13(1…

[2] A Judge of Compensation Claims may interpret a stipulation between the parties to determine their rights and responsibilities under the Workers' Compensation Law, and a p…

Previewing 2 of 2 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.

Join FLexlaw to unlock all legal intelligence

Key Quotes

“But Claimant is incorrect that the dispute here meets the statutory definition of a reimbursement dispute.”

Establishes the court's rejection of the claimant's primary jurisdictional argument.

Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.

Join FLexlaw to unlock all legal intelligence

Facts & Procedural History

A firefighter injured on the job underwent spinal fusion surgery without authorization from his current treating physician or a new opinion from the d…

The full statement of facts, procedural history, and disposition for this case are member content.

Join FLexlaw to unlock all legal intelligence

© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.


Opinion of the Court
Affirmed. Rowe

PER CURIAM.

Claimant appeals the denial of his petitions for benefits. Claimant contends that the Judge of Compensation Claims (JCC) did not have jurisdiction to adjudicate the issue of Claimant’s entitlement to reimbursement for the expenses from spinal fusion surgery because it was a “reimbursement dispute.” The Claimant therefore contends that the Department of Financial Services (DFS) had sole jurisdiction. Claimant also contends that JCC erred by construing the meaning of the stipulation between the parties. We reject both arguments as explained below, and all other issues raised by Claimant in this appeal.

Claimant was involved in a motor vehicle crash while on the job as a firefighter. He injured his back in the crash, and the Employer/Carrier (E/C) accepted the injuries as compensable. Before the petition for benefits at issue, Claimant underwent various procedures for his back, including surgeries with Dr. Brusovanik. In 2017, Dr. Vanni was designated as the new authorized physician, and Dr. Brusovanik was deauthorized. The parties stipulated, “If Dr. Vanni opines that Claimant does require further surgical invention, the Employer/Servicing Agent will authorize same, and the Claimant will decide whether he wants to undergo such procedure.”

In June 2020, despite Dr. Brusovanik being deauthorized as a treating physician, and without an opinion from Dr. Vanni, Claimant underwent spinal fusion surgery with Dr. Brusovanik. Claimant filed a petition for benefits seeking payment of the surgery bill and copayments as medically necessary. After a contested hearing, the JCC determined that the surgery was medically necessary. But the JCC also determined that the 2017 stipulation was binding on Claimant and denied reimbursement.

On appeal, Claimant contends that although he petitioned for benefits seeking reimbursement for the expenses of the spinal surgery, the 2017 stipulation made this a reimbursement dispute subject to the jurisdiction of DFS. Claimant is correct that subject matter jurisdiction may be raised at any time, including on appeal. See Seven Hills, Inc. v. Bentley, 848 So. 2d 345, 350 (Fla. 1st DCA 2003). But Claimant is incorrect that the dispute here meets the statutory definition of a reimbursement dispute.

A ruling on whether a proceeding is a reimbursement dispute is a conclusion of law reviewed de novo, to the extent it involves statutory construction. Avalon Ctr. v. Hardaway, 967 So. 2d 268, 271 (Fla. 1st DCA 2007). Section 440.13(1)(q), Florida Statutes (2020), defines a reimbursement dispute as “any disagreement between a health care provider or health care facility and carrier concerning payment for medical treatment.” DFS “has exclusive jurisdiction to decide any matters concerning reimbursement. . . .”

§ 440.13(11)(c), Fla. Stat. The E/C undoubtedly meets the statutory definition of carrier. See § 440.13(1)(c), Fla. Stat. But the Claimant does not meet the statutory definition of a health care facility or health care provider. See § 440.13(1)(f)–(g). A dispute between Claimant and the E/C therefore does not meet the statutory definition of a “reimbursement dispute.” Since this was not a reimbursement dispute as defined by chapter 440, the JCC had jurisdiction to adjudicate the claim.

As for the JCC interpreting the meaning of the stipulation, we have held that “a JCC may be required to interpret contracts” to decide whether workers’ compensation coverage exists. Bend v. Shamrock Servs., 59 So. 3d 153, 156 (Fla. 1st DCA 2011) (citing Curtis-Hale, Inc. v. Geltz, 610 So. 2d 558 (Fla. 1st DCA 1992)). We have further held that “[a] JCC may also be required to interpret a contract to determine the parties’ rights and responsibilities under the Workers’ Compensation Law.” Id. (citing Tampa Bay Area NFL Football, Inc. v. Jarvis, 668 So. 2d 217 (Fla. 1st DCA 1996)).

“A stipulation properly entered into and relating to a matter upon which it is appropriate to stipulate is binding upon the parties and upon the Court.” Gunn Plumbing, Inc. v. Dania Bank, 252 So. 2d 1, 4 (Fla. 1971). Recently, we acknowledged that this holding from Gunn Plumbing applies in workers’ compensation cases. See Holcombe v. City of Naples/Johns E. Co., Inc., 46 Fla. L. Weekly D2057, D2059, 2021 WL 4189243, *5 (Fla. 1st DCA Sept. 15, 2021). There was no error by the JCC in determining that he could interpret the meaning of the stipulation.

AFFIRMED.

ROWE, C.J., and BILBREY and JAY, JJ., concur. _____________________________


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Authorities Cited

Full citator, related cases, and AI research tools

Open in FLexlaw