CLAIMS MANAGEMENT, INC., AND WAL-MART STORE # 2081, CLEARWATER, APPELLANTS,
v.
GLENN GRENIER, APPELLEE
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In this workers' compensation appeal, the court affirmed a Judge of Compensation Claims' authorization for an independent medical examination (IME) by a vascular surgeon to determine the causation of the claimant's symptoms, despite the existence of a managed care plan. The court held that managed care provisions do not restrict IMEs when the dispute concerns causation rather than the provision of medical treatment.
The court held that managed care provisions under section 440.134(16) only restrict IMEs when the dispute concerns the provision of medical treatment, care, and attendance. Because the dispute in this case involved the threshold determination of causation rather than the provision of medical treatment, the managed care provisions did not govern the authorization of the IME.
[1] A request for an "evaluation" by a physician in a workers' compensation case may be treated as a request for an independent medical examination (IME) when the context and…
[2] Under Florida Statutes section 440.134(16), a Judge of Compensation Claims must deny a claimant's request for an IME if its purpose is to resolve a dispute regarding the…
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Join FLexlaw to unlock all legal intelligence“Where a managed care plan exists, under section 440.134(16), Florida Statutes (1997), the JCC must deny a claimant's request for an IME, if the purpose of the IME is to resolve a dispute regarding the provision of medical treatment, care and attendance.”
Establishes the general rule that managed care provisions restrict IMEs when the dispute involves medical treatment provision
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Join FLexlaw to unlock all legal intelligenceGlenn Grenier, a claimant in a workers' compensation case, requested authorization for evaluation and treatment by a vascular surgeon based on Dr. Kam…
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PER CURIAM.
In this workers’ compensation appeal, Claims Management, Inc., and Wal-Mart Store # 2081, Clearwater, appeal a final order of the Judge of Compensation Claims (JCC) which authorizes an evaluation of Glenn Grenier, appellee and claimant, by a vascular surgeon for the purpose of determining the etiology of claimant’s symptoms notwithstanding the existence of a managed care plan. For the reasons that follow, we affirm.
As a threshold matter, we treat the claimant’s request for an “evaluation” by a vascular surgeon as a request for an independent medical examination (IME). First, we note that there is no provision for an “evaluation” per se in section 440.13, Florida Statutes (1997). Secondly, the petition for benefits dated March 4, 1999, seeks:
Authorization for a vascular surgeon for an evaluation and treatment if necessary, based upon the opinion of Dr. Kampsen;
Authorization for psychiatric evaluation and treatment if necessary based upon the claimant’s continuing symptoms and the opinion of Dr. Yolbracht.
Further, the pretrial stipulation lists the employee’s claims and defenses, in pertinent part, as:
(f) Auth. for IME with Dr. Sprehe
(g) “ vascular surgeon
Finally, in the order under review the JCC referred to an “evaluation” by a vascular surgeon, but used the term IME with respect to Dr. Sprehe. Thus, from the record before us, we believe the “evaluation” by a vascular surgeon is, in substance, an IME.
Where a managed care plan exists, under section 440.134(16), Florida Statutes (1997), the JCC must deny a claimant’s request for an IME, if the purpose of the IME is to resolve a dispute regarding the provision of medical treatment, care and attendance. See Wiggins v. B & L Servs., Inc., 701 So. 2d 570, 572 (Fla. 1st DCA 1997). Such disputes are to be resolved through a request for change of provider, see section 440.134(10)(c), Florida Statutes (1997), or a grievance under procedures established pursuant to section 440.134(15). See Farhangi v. Dunkin Donuts, 728 So. 2d 772 (Fla. 1st DCA 1999). When the dispute does not concern the provision of medical treatment, care and attendance, however, the managed care provisions do not govern the selection and use of medical expert witnesses under section 440.13(5). See Wiggins, 701 So. 2d at 572.
The record here does not establish that the dispute involves the provision of medical treatment, care and attendance. Rather, the dispute relates to the threshold determination of the causation of claimant’s condition. Because the record contains competent substantial evidence supporting the JCC’s authorization of an IME for purposes other than resolving a dispute concerning the provision of medical treatment, care and attendance, we affirm. Id.; see also Morton v. Rinker Material Corp., 753 So. 2d 768 (Fla. 1st DCA 2000).
Finally, we do not view the JCC’s authorization of an IME by a vascular surgeon to be violative of our holding in Watkins Eng’rs & Constr. v. Wise, 698 So. 2d 294 (Fla. 1st DCA 1997). Here, unlike Wise, the condition for which claimant seeks the opinion of a vascular surgeon concerns an aspect of claimant’s injury which falls outside of the fields of the prior IME physician Dr. Volbracht, a neurologist, as well as that of Dr. Sphere, a psychiatrist. See id. at 296.
In view of our holding, we do not address whether the JCC erred in finding that the evidence was insufficient to establish the existence of a managed care system.
AFFIRMED.
LAWRENCE, DAVIS and VAN NORTWICK, JJ., concur.
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Jefferson v. Wayne Dalton Corporation/Hartford, 793 So. 2d 1081 (Fla. 1st DCA 2001)…164, 1165 (Fla. 1st DCA 2001) (stating that the grant by the judge of compensation claims of claimant’s motion [*1083] for an independent medical examiner was justified where the employer offered absolutely no medical care); Claims Mgmt. v. Grenier, 777 So. 2d 1039, 1040-41 (Fla. 1st DCA 2000) (clarifying that the dispute involved causation, and not the provision of medical treatment, care and attendance); Wiggins v. B & L Servs., 701 So. 2d 570, 572 (Fla. 1st DCA 1997) (stating a judge of compensation claims…
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Kohout v. Benefit Administrators, 781 So. 2d 1164 (Fla. 1st DCA 2001)…offered no medical care whatsoever. Mr. Kohout is therefore entitled to an independent medical examination by an examiner he selects, see § 440.13(5)(a), Fla. Stat. (2000), to resolve the threshold question of causation. See Claims Mgmt. v. Grenier, 777 So. 2d 1039, 1041 (Fla. 1st DCA 2000) (“The record here does not establish that the dispute involves the provision of medical treatment, care and attendance. Rather, the dispute relates to the threshold determination of the causation of claimant’s condition. Be…
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Johnson v. Orange Cnty. Corr. & Johns E. Risk Mgmt., 786 So. 2d 678 (Fla. 1st DCA 2001)…use claimant was not seeking the independent medical examination to resolve a dispute regarding the medical care that had been provided by the managed care plan, the provisions of section 440.134 were inapplicable. See Claims Mgmt., Inc. v. Grenier, 777 So. 2d 1039, 1040-41 (Fla. 1st DCA 2000); Wiggins v. B & L Servs., Inc., 701 So. 2d 570, 572 (Fla. 1st DCA 1997). Instead, claimant’s entitlement to an independent medical examination is controlled by section 440.1925, Florida Statutes (1997). Pursuant to that…
Previewing 3 of 4 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Wiggins v. B & L Servs., Inc., 701 So. 2d 570 (Fla. 1st DCA 1997)
- Boltri v. Singletary, 728 So. 2d 772 (Fla. 1st DCA 1999)
- Nahid Farhangi v. Dunkin Donuts & Associated Indus. Ins. Co., 728 So. 2d 772 (Fla. 1st DCA 1999)
- Watkins Eng'rs & Constructors & Gallagher Bassett v. Wise, 698 So. 2d 294 (Fla. 1st DCA 1997)
- Vanny Phillip Floyd v. State, 753 So. 2d 768 (Fla. 1st DCA 2000)