SARASOTA COUNTY SCHOOL BOARD AND GALLAGHER BASSETT, APPELLANTS/CROSS-APPELLEES,
v.
VERA CASTAGNA, APPELLEE/CROSS-APPELLANT
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The Florida District Court of Appeal affirmed a workers' compensation judge's finding that an employee's automobile accident was compensable but reversed the limitation of medical benefits to only "unpaid" bills, holding that the employer must cover all medical benefits due with a lien protecting third-party insurers.
The court affirmed that the accident was compensable but reversed the limitation to unpaid medical bills only. The ESA must award all medical benefits due to the claimant, subject to a lien in favor of third-party insurers, and the claimant may seek reimbursement for amounts personally expended.
[1] A workers' compensation order finding an accident compensable will be affirmed if supported by the evidence.
[2] A Judge of Compensation Claims lacks jurisdiction to order a workers' compensation employer/servicing agent to reimburse a third-party insurer not before the court.
Previewing 2 of 4 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“the JCC should award to claimant all the medical benefits due, subject to a lien in favor of her insurers against the payments due claimant, and she shall insure that those entities are properly reimbursed”
Establishes the proper remedy for medical benefits when third-party insurers have paid some bills—award all benefits to claimant with a protective lien for insurers
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Join FLexlaw to unlock all legal intelligenceThe claimant was injured in an automobile accident and filed a workers' compensation claim. The employer/servicing agent (ESA) initially denied the cl…
The full statement of facts, procedural history, and disposition for this case are member content.
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BARFIELD, Judge.
The employer/servicing agent (ESA) appeal a workers’ compensation order finding that appellee claimant was injured in a compensable automobile accident. Claimant cross-appeals the ruling of the Judge of Compensation Claims (JCC) that the ESA “will pay the unpaid medical bills adjusted to the Medical and Surgical Fee Schedules claimed and will be responsible for the provision of medical care which may be warranted by the claimant’s condition in the future.” We affirm the finding of compensability, but reverse that aspect of the order which limits the ESA’s responsibility only to claimant’s “unpaid” medical bills.
The evidence adduced established that the ESA denied claimant’s accident was compensable ánd accordingly provided no medical benefits. Some portion of claimant’s hospital bills were paid by her husband's insurance coverage, which is unrelated to claimant’s workers’ compensation coverage. Although the JCC is without jurisdiction to order the ESA to reimburse a third party insurer who is not before the JCC, the JCC should award to claimant all the medical benefits due, subject to a lien in favor of her insurers against the payments due claimant, and she shall insure that those entities are properly reimbursed. Popovich v. Overland Transport, 543 So. 2d 302 (Fla. 1st DCA 1989); Travelers Ins. Co. v. Sitko, 496 So. 2d 920 (Fla. 1st DCA 1986); Greynolds Park Manor v. George, 417 So. 2d 990, appeal after remand, 423 So. 2d 485 (Fla. 1st DCA 1982). Claimant is also entitled to seek reimbursement for any amounts personally expended. § 440.13(2)(b), Fla.Stat. Therefore, the finding of compensability is affirmed, but the award of only “unpaid” medical benefits is reversed and the matter is remanded for further proceedings consistent herewith.
AFFIRMED in part, REVERSED and REMANDED in part.
NIMMONS and ALLEN, JJ., concur.
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Amparo Alvarez v. Kendall Assocs. & Cont'l Ins. Co., 590 So. 2d 518 (Fla. 3d DCA 1991)…the care, it was the responsibility of the trial judge, once it was determined that the care had not been provided, to enforce that order by awarding the claimant payment for the unpaid medical benefits. See Sarasota County School Board v. Castagna, 577 So. 2d 635 (Fla. 1st DCA 1991). Accordingly, we reverse the trial court’s second order vacating the original order, which granted the Petition for Rule Nisi, with instructions to the trial judge to enforce the workers’ compensation order by calculating and aw…
Authorities Cited
- Travelers Ins. Co. v. Sitko, 496 So. 2d 920 (Fla. 1st DCA 1986)
- Greynolds Park Manor & R. P. Hewitt & Assocs. of Fla., Inc. v. Lovie George, 417 So. 2d 990 (Fla. 1st DCA 1982)
- Greynolds Park Manor & R.P. Hewitt & Assocs. of Fla., Inc. v. Lovie George and Division of Workers' Compensation, 423 So. 2d 485 (Fla. 1st DCA 1982)
- Popovich v. Overland Transp. & INA/AETNA, 543 So. 2d 302 (Fla. 1st DCA 1989)