ATTITUDES & TRENDS AND AETNA LIFE & CASUALTY COMPANY, APPELLANTS,
v.
MICHAEL ARSUAGA, APPELLEE
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This case addresses whether an employer/carrier can deny attendant care benefits in workers' compensation if a physician did not explicitly prescribe or state the medical necessity of the care before it was rendered. The court held that the statute does not require a physician's prior prescription and that the employer/carrier cannot avoid payment through "willful ignorance."
No, the statute does not preclude an award of attendant care benefits under these circumstances. The claimant is entitled to benefits if they present the required medical testimony, and the employer/carrier cannot avoid payment by claiming ignorance of the need for care.
[1] An award of attendant care benefits in workers' compensation is not precluded by the absence of a physician's prescription or statement of medical necessity prior to the…
[2] An employer/carrier may not avoid payment of benefits by demonstrating willful ignorance of a claimant's potential entitlement.
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“We reject the employer/carrier’s contention that section 440.13(2)(f), Florida Statutes (Supp.1990), precludes an award of attendant care for services rendered before a physician prescribes such care or states that it is medically necessary.”
This quote directly addresses and rejects the main argument of the appellants.
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Join FLexlaw to unlock all legal intelligenceThe employer and carrier appealed a workers' compensation order awarding attendant care benefits and an attorney's fee to the claimant. The employer/c…
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JORGENSON, Associate Judge.
The employer/carrier appeal a workers’ compensation order by which the claimant was awarded attendant care benefits and found entitled to an attorney’s fee. We reject the employer/carrier’s contention that section 440.13(2)(f), Florida Statutes (Supp.1990), precludes an award of attendant care for services rendered before a physician prescribes such care or states that it is medically necessary. The claimant presented the required medical testimony at a hearing on the claim, and the statute does not mandate that the physician must state his opinion or provide a prescription before the care commences.1 Furthermore, the circumstances were sufficient to put the employer/carrier on notice of the need to investigate the claimant’s possible entitlement to such benefits. It is well established that the employer/carrier may not avoid payment by hiding behind a “wall of willful ignorance.” Davis v. Edwin M. Green, Inc., 240 So. 2d 4 (Fla.1970); see also, e.g., Smith v. DRW Realty Ser vices, 569 So. 2d 462 (Fla. 1st DCA 1990); Sistrunk, v. City of Dunedin, 513 So. 2d 200 (Fla. 1st DCA 1987); Walt Disney World Inc. v. Harrison, 443 So. 2d 389 (Fla. 1st DCA 1983).
The appealed order is affirmed.
WIGGINTON and MICKLE, JJ., concur. . The claimant’s accident and injury occurred prior to the effective date of section 440.13(2)(f), Florida Statutes (Supp.1990), and the statute may apply in these circumstances as a procedural burden of proof enactment. See e.g., City of Clermont v. Rumph, 450 So. 2d 573 (Fla. 1st DCA), rev. denied, 458 So. 2d 271 (Fla.1984). But the statute should not be construed as imposing a condition precedent apart from the claimant’s burden of proof. Given this limited construction, section 440.13(2)(f), Florida Statutes (Supp.1990), is applicable in this case. Compare Smith v. DRW Realty Services, 569 So. 2d 462 (Fla. 1st DCA 1990), n. 1, with Jackson Manor Nursing Home v. Ortiz, 606 So. 2d 422 (Fla. 1st DCA 1992) (Ervin dissenting).
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Solar Pane Insulating Glass, Inc. v. Hanssen, 727 So. 2d 961 (Fla. 1st DCA 1998)…s Ins. Co. v. Workmen's Compensation Appeal Bd., 68 Pa.Cmwlth. 24, 447 A. 2d 1116 (Pa.Cmwlth.1982). .- This is not a case in which the carrier was ‘‘willfully ignorant” of the continued use of a medical appliance. Cf. Attitudes & Trends v. Arsuaga, 616 So. 2d 1103 (Fla. 1st DCA 1993). . Imputing knowledge to Solar Pane is particularly problematic since it had been out of business at least since 1988.…
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Rockette v. Space Gateway Support & AIG Claims Servs., Inc., 877 So. 2d 852 (Fla. 1st DCA 2004)…ot prescribe attendant care is not, as the judge appeared to believe, determinative of the claimant’s right to recover such benefits. It is sufficient that the physician provided the necessary testimony at the hearing. Attitudes & Trends v. Arsuaga, 616 So. 2d 1103, 1103 (Fla. 1st DCA 1993). Because we reverse the denial of attendant care benefits, we must also reverse the denial of penalties, interest and attorneys’ fees. We affirm in part, reverse in part, and remand. On remand, the judge shall revisit the…
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Winn Dixie Stores, Inc. v. Frank, 665 So. 2d 271 (Fla. 1st DCA 1995)…606 So. 2d 422 (Fla. 1st DCA 1992). Under section 440.13(2)(g), Florida Statutes (1993), the claimant cannot meet that burden of proof without a statement by a physician that such care is medically necessary. See also Attitudes & Trends v. Arsuaga, 616 So. 2d 1103, 1103 n. 1 (Fla. 1st DCA 1993) (section 440.13(2)(f) (Supp.1990) is a procedural burden of proof enactment). The only witness to testify in the hearing below was a doctor who stated that, though claimant is still wearing a brace to support her injur…
Previewing 3 of 6 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- City OF Clermont & Aetna Ins. Co. v. Rumph, 450 So. 2d 573 (Fla. 1st DCA 1984)
- Walt Disney World Co. v. Harrison, 443 So. 2d 389 (Fla. 1st DCA 1983)
- Davis v. Edwin M. Green, Inc., 240 So. 2d 4 (Fla. 1970)
- Amos A. Sistrunk v. City OF Dunedin & Gallagher Bassett Ins. Servs., 513 So. 2d 200 (Fla. 1st DCA 1987)
- Smith v. DRW Realty Servs. & Aetna Life & Cas., 569 So. 2d 462 (Fla. 1st DCA 1990)
- Jackson Manor Nursing Home & Fireman's Fund Ins. v. Ortiz, 606 So. 2d 422 (Fla. 1st DCA 1992)