DARYL PARDO, APPELLANT,
v.
DENNY'S, INC. AND CRAWFORD & COMPANY, APPELLEES

Fla. 1st DCA | 1994-02-16
No. 93-1556
ZEHMER, C.J., and MINER and WOLF, JJ., concur.
631 So. 2d 388 Florida District Court of Appeal, First District (1994) Negative Treatment
Cited by 9 cases

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Synopsis

Daryl Pardo sought attorney's fees under Florida's 21-day rule for obtaining a vascular surgeon after the carrier failed to timely authorize and communicate authorization for medical services. The court reversed and remanded because the lower court's order did not make clear findings on whether the carrier actually communicated authorization to the surgeon and claimant within the 21-day period.


Holding

The court held that communication of authorization to both the health care provider and claimant is necessary within 21 days; the lower court's order was reversed and remanded because it failed to make clear findings on whether such communication occurred within the statutory period.


Headnotes

[1] An employer or carrier must communicate authorization to a healthcare provider and inform the claimant or their attorney to make an appointment for medical services to be…

[2] A workers' compensation order is insufficient if it fails to make findings on whether the employer/carrier communicated authorization for medical services and notified th…

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Key Quotes

“the employer shall famish to the employee such medically necessary remedial treatment, care, and attendance by a health care provider and for such period as the nature of the injury or the process of recovery may require”

Establishes the statutory obligation of employers to furnish authorized medical treatment

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Facts & Procedural History

Pardo needed vascular surgery due to a possible pulmonary embolism. The carrier, Crawford & Company, initially authorized Dr. Crist as the vascular su…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

Daryl Pardo appeals a workers’ compensation order that denies his claim to have the employer and carrier, Denny’s, Inc. and Crawford & Company, pay for his attorney’s fees incurred in securing the services of a vascular surgeon. The claim for fees was based on the 21-day rule in subsection 440.34(3)(b), Florida Statutes (1989).

The judge of compensation claims denied the claim on the ground that Crawford’s action in telling Claimant’s attorney that Dr. Crist, a vascular surgeon, was authorized within 21 days of receipt of notice of the claim precluded a fee award. It appears, however, that Crawford was to make arrangements for Claimant to see Dr. Crist; but due to confusion on Crawford’s part (it erroneously thought Dr. Crist had died), it made no appointment for Claimant to see Dr. Crist, and Dr. Crist never provided any medical services to Claimant. As the order recites, “vascular consultation was needed as soon as possible due to the possibility of a pulmonary embolism which might ultimately threaten the claimant’s life.” Accordingly, the carrier subsequently authorized another vascular surgeon and set up an appointment for Claimant. While the letter authorizing the surgeon was dated within the 21-day period, it apparently was not communicated to Claimant until the 26th day after the notice of claim was received, and the appointment was not set until the 27th day. Claimant was ultimately seen by this doctor on November 1, 1990.

Subsection 440.13(2)(a) provides that “the employer shall famish to the employee such medically necessary remedial treatment, care, and attendance by a health care provider and for such period as the nature of the injury or the process of recovery may require.....”' (Emphasis added.) Before a health care provider may provide medical services under the act, it must be informed by the employer or its carrier of authorization to provide such services, even if it is contemplated that the claimant is to make an appointment to see the provider. Unless the employer and carrier communicate such authorization, no services can be “furnished.” Hence, in respect to the claim for an attorney’s fee, the relevant fact was whether Crawford, within 21 days of receiving notice, ever communicated authorization to Dr. Crist and informed Claimant or his attorney to make an appointment.

We find, however, that the order under review is silent as to whether Dr. Crist and Claimant were so notified.1 Moreover, there is confusion in the record concerning the apparent authorization and deauthorization of Dr. Crist.

Accordingly, we reverse and remand for further findings on these matters.

REVERSED AND REMANDED.

ZEHMER, C.J., and MINER and WOLF, JJ., concur. . The order only recites:

As noted above, the record evidence shows that the adjuster had Notice [sic] of the claim seeking authorization of a vascular surgeon on October 4, 1990 when the adjuster contacted Dr. Andriola concerning the necessity of a vascular consultation. Furthermore, the claimant's attorney has stipulated that the employer/carrier agreed to provide a vascular surgeon and, for that reason, the emergency hearing scheduled for October 15, 1990 was cancelled. As such, it appears to the Court that the employer/carrier did not fail or refuse to pay a claim more than 21 days after receiving Notice [sic] of said claim.

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Citator

Cited By

  • Mylock v. Champion Int'l & Sedgwick Claims Mgmt., 906 So. 2d 363 (Fla. 1st DCA 2005)
    …claimant treatment. The judge apparently considered the lack of communication to claimant’s attending physician critical to a determination of claimant’s entitlement to attorney fees. In support of his decision, the JCC cited Pardo v. Denny’s, Inc., 631 So. 2d 388 (Fla. 1st DCA 1994), wherein this court concluded that because the carrier had not notified a physician of claimant’s request for medical services within 21 days after the filing of same, the carrier was required to pay claimant’s attorney fees, pur…
  • Watson Grene v. State, 702 So. 2d 510 (Fla. 3d DCA 1996)
    …reversing the conviction, as well as the sentence, for possession of a controlled substance. The cause is remanded for resentencing in accordance with the panel opinion, as modified by this opinion. We certify direct conflict with Graham v. State, 631 So. 2d 388 (Fla.1st DCA 1994); Perrin v. State, 599 So. 2d 1365, 1365-66 (Fla.1st DCA 1992); and Wright v. State, 573 So. 2d 998, 1000 (Fla.1st DCA 1991). Affirmed in part, reversed in part, and remanded for further proceedings consistent herewith; direct con…
    1 / 3
  • Austin v. State, 699 So. 2d 314 (Fla. 1st DCA 1997)
    …tutes fundamental error and that both the convictions and sentences may be attacked for the first time on appeal. For the reasons explained below, we recede from the line of cases on which the state relies, including Perrin; Wright; Graham v. State, 631 So. 2d 388 (Fla. 1st DCA 1994); Kio v. State, 624 So. 2d 744 (Fla. 1st DCA 1993), review denied, 634 So. 2d 627 (Fla.1994); and Salgat v. State, 630 So. 2d 1143 (Fla. 1st DCA 1993), review denied, 652 So. 2d 815 (Fla.1995), to the extent that they hold that pu…
    1 / 2

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