DAVID CHASE, APPELLANT,
v.
HENKEL & MCCOY AND LIBERTY MUTUAL INSURANCE COMPANY, APPELLEES

Fla. 1st DCA | 1990-06-07
No. 88-3207
WENTWORTH and WIGGINTON, JJ., concur.
562 So. 2d 831 Florida District Court of Appeal, First District (1990) Negative Treatment
Cited by 20 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.


Holding

The court held that the employer/carrier is responsible for the doctor's bills because the carrier's actions excused the doctor's failure to submit reports and the claimant was justified in continuing treatment.


Headnotes

[1] A claimant may seek medically necessary treatment at the employer's expense if the employer fails to provide such treatment after a request, with the reasonableness and n…

[2] An employer/carrier's failure to authorize requested chiropractic treatment, offer alternative care, or obtain a ruling that alternative care is not in the claimant's bes…

Previewing 2 of 5 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

Facts & Procedural History

Claimant injured at work and requested chiropractic treatment, which the carrier initially refused. The claimant sought treatment from Dr. Fralicker, …

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
•SMITH, Judge.

•SMITH, Judge.

Claimant appeals an order determining that the employer/carrier are not responsible for payment of certain doctor bills because the doctor did not submit his medical reports to the carrier and good cause did not exist for excusing the reporting requirement. We reverse.

Claimant injured his back while installing a telephone pole. He received treatment and was returned to work without restrictions. Thereafter, he requested chiropractic treatment, but the carrier refused authorization. The claimant then went to Dr. Fralicker, a chiropractor, on November 10, 1987. Initially, Dr. Fralicker submitted his reports and the carrier paid his bills.

However, medical reports were not submitted to the carrier for services rendered by Dr. Fralicker after December 21, 1987. He testified that he stopped sending reports to the carrier after being told by the carrier that the billing was not authorized for workers’ compensation and should be filed under a group health insurance policy. At approximately the same time, Dr. Fral-icker was advised by the carrier that he was not authorized to treat the claimant.

After the carrier refused to authorize Dr. Fralicker, claimant filed a claim on February 19, 1988, seeking authorization of Dr. Fralicker. On the same date, claimant filed an application for hearing.

On March 1, 1988, claimant was advised that the carrier was authorizing another chiropractor, Dr. Edwards. In the meantime, however, claimant continued treatment with his chiropractor, Dr. Fralicker. Ultimately, a hearing was held before the judge of compensation claims, after which the judge determined that Dr. Fral-icker’s treatment was reasonable and necessary and causally related to claimant’s industrial accident.

However, the judge ruled that the employer/carrier was not responsible for Dr. Fralicker’s bills between December 22, 1987, and September 20, 1988, because Dr. Fralicker failed to submit his medical reports. The judge reasoned that the employer/carrier, having authorized chiropractic care, albeit untimely, were not sent the reports required by law and to hold them responsible in this circumstance would require them to pay for services of which they were unaware.

Pursuant to section 440.13(2), Florida Statutes (1987), the employer is required to furnish the claimant medically necessary treatment, and should such treatment not be provided after request, the claimant may seek such treatment at the expense of the employer, the reasonableness and necessity to be approved by the judge of compensation claims. The statute provides for a separate reporting requirement which the doctor must comply with in order to be paid; but the judge may excuse, for good cause, the doctor’s failure to furnish reports.

Past decisions of this court have held that once a claimant requests chiropractic treatment, the E/C must authorize the chiropractic treatment, offer alternative chiropractic care, or obtain a ruling from the judge that such alternative care was not in the claimant’s best interest. The E/C’s failure to comply renders them responsible for unauthorized chiropractic treatment if it is determined to be reasonable and necessary. Jackson v. Publix Supermarkets, Inc., 520 So. 2d 50 (Fla. 1st DCA 1987); Kirkland v. Harold Pratt Paving, Inc., 518 So. 2d 1320 (Fla. 1st DCA 1987).

However, should the E/C authorize alternative chiropractic care, and the parties do not agree to a treating doctor, in a non-emergency situation it is the claimant’s burden to seek a decision through the judge or risk being required to pay the bill. Wackenhutt Corp. v. Freilich, 464 So. 2d 217 (Fla. 1st DCA 1985). If the claimant fails to ask for a resolution of the deadlock, he is responsible for the charges up to the hearing. Id.

With regard to the separate requirement upon the doctor to timely file reports, it has been held that where the doctor files his reports with the group health insurer rather than the workers’ compensation carrier because of a confused legal situation, this constitutes good cause excusing the reporting requirement, and failure to file is not fatal. Exxon Co., U.S.A. v. Rodriguez, 410 So. 2d 571 (Fla. 1st DCA 1982).

Here, when claimant requested chiropractic treatment, the E/C refused authorization and did not offer alternative chiropractic care or obtain a ruling from the judge that such alternative care was not in claimant’s best interest. Claimant then began a doctor-patient relationship with his treating chiropractor, Dr. Fralicker, and filed a claim-seeking authorization of Dr. Fralicker and payment of his bills. Several months after claimant first requested chiropractic treatment, during which time claimant had been seeing his treating chiropractor, Dr. Fralicker, the carrier untimely authorized another chiropractor. Under the circumstances, it is our view that claimant was justified in choosing to remain under the care and treatment of his treating chiropractor pending a ruling by the judge of compensation claims. To rule otherwise would mean that claimant would have to terminate with his treating chiropractor while awaiting a ruling on his claim.

We find no basis in logic and reason, or in the law, for such a requirement.

Here, the judge determined that Dr. Fralicker’s treatment was reasonable and necessary.

Thus, under the statute and cited cases, there is no impediment to Dr. Fralicker’s bills being paid, except for the reporting requirement. On this point, we must disagree with the judge below. As mentioned above, Dr. Fralicker was advised by the carrier that billing was not authorized for workers’ compensation and should be filed under claimant’s group health insurance policy. The carrier’s failure to receive reports was of its own doing, and this is sufficient, in our judgment, to excuse his failure to file the medical reports in question. Exxon Co., U.S.A. v. Rodriguez, supra. As for claimant’s failure to introduce the actual bills into evidence at the hearing below, we note that Dr. Fralicker testified as to the amount of his charges and explained the reasonableness and necessity of the treatment, which testimony the judge accepted as true. Because the record establishes the causal connection between the charges and claimant’s injury, and there is testimony as to the amount of charges, it was error to deny recovery. Jung v. City of Sarasota, 457 So. 2d 577 (Fla. 1st DCA 1984).

REVERSED and REMANDED.

WENTWORTH and WIGGINTON, JJ., concur.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • Colace v. Hamlet Ests., Ltd., 573 So. 2d 994 (Fla. 1st DCA 1991)
    …1st DCA 1990), and cases cited therein. Where alternative care has been offered, and the parties cannot agree on a treating physician, the claimant must seek a decision through the judge or risk paying the bill. Id., at 868; Chase v. Henkel & McCoy, 562 So. 2d 831, 832 (Fla. 1st DCA 1990); Teimer v. Pixie Playmates, 532 So. 2d 37, 40 (Fla. 1st DCA 1988) review denied, 539 So. 2d 475 (Fla.1989); Ocean Manor Resort Hotel v. Garbalosa, 512 So. 2d 256, 257 (Fla. 1st DCA 1987). • On the other hand, where the emplo…
  • Dubois Farms, Inc. v. Paul, 566 So. 2d 923 (Fla. 1st DCA 1990)
    …twenty-four days after the request for authorization of Dr. Kaplan did the E/C authorize a local doctor, and by that time Dr. [*925] Kaplan and claimant had established a doctor-patient relationship. As we recently ruled in Chase v. Henkel & McCoy, 562 So. 2d 831 (Fla. 1st DCA 1990), under the circumstances, claimant was justified in choosing to remain under the care and treatment of her treating chiropractor, Dr. Kaplan, pending a ruling by the JCC; and upon the JCC’s subsequent ruling that Dr. Kaplan’s tre…
  • Borges v. Osceola Farms Co. & Nat'l Emp'rs Co., 651 So. 2d 173 (Fla. 1st DCA 1995)
    …and the parties do not agree on the physician offered, then, in a nonemergency case, it is the claimant’s burden to seek a decision through the JCC or risk being required to pay the bill. § 440.13(2), Fla.Stat. (Supp.1990); Chase v. Henkel & McCoy, 562 So. 2d 831, 832 (Fla. 1st DCA 1990); Jackson v. Publix Supermarkets, Inc., 520 So. 2d 50, 51 (Fla. 1st DCA 1987). Moreover, the authorization of neurological or orthopedic care does not satisfy the E/C’s obligation to authorize chiropractic care upon request f…

Previewing 3 of 10 citing cases — full citator treatment, depth of discussion, and citing context are member features.

Join FLexlaw to unlock all legal intelligence

Authorities Cited

Full citator, related cases, and AI research tools

Open in FLexlaw