ANTHONY KOHOUT, PETITIONER,
v.
BENEFIT ADMINISTRATORS, N/K/A WORK FORCE SOLUTIONS, INC. AND COMMERCIAL GENERAL UNION, RESPONDENTS
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.
A Florida workers' compensation employee sought an independent medical examination (IME) to establish causation of his injury after his employer and carrier entirely controverted his claim without offering medical care. The court held that when an employer contests causation as the threshold issue, the employee is entitled to an IME by an examiner of his choosing, even within a managed care arrangement.
An employee is entitled to an independent medical examination by an examiner he selects when the employer and carrier have entirely controverted the claim and offered no medical care, because the dispute concerns the threshold determination of causation rather than medical treatment. The managed care restrictions on outside medical evaluations do not apply when causation itself is in dispute.
[1] An employer or its workers' compensation insurance carrier may provide medical diagnosis and treatment through a managed care arrangement that meets statutory requirement…
[2] When an employee is covered under a managed care arrangement, the employee generally has no right to an independent evaluation outside the arrangement without exhausting…
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“But here, having controverted Mr. Kohout's claim in its entirety, the employer and carrier have 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.”
Establishes the holding that total contravention without medical care provision entitles employee to IME to resolve causation.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceAnthony Kohout filed a workers' compensation claim. His employer and insurance carrier entirely controverted the claim and offered no medical care wha…
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.
Explore caselaw by topic → Browse Indemnity Benefits cases and more on FLexlaw
PER CURIAM.
We grant Anthony Kohout’s petition for writ of certiorari seeking review of an order declining to grant his motion for an independent medical examination by a health care provider, see § 440.13(l)(i), Fla. Stat. (2000), whom the respondents do not employ in their managed care arrangement. Mr. Kohout seeks an independent assessment of the cause or etiology of his medical condition.
An employer or its workers’ compensation insurance carrier may provide medical diagnosis and treatment through a managed care arrangement that meets statutory requirements. See § 440.134(2)(a), Fla. Stat. (2000); Farhangi v. Dunkin Donuts, 728 So. 2d 772, 773 (Fla. 1st DCA 1999). In such cases, the employee has no right to go outside the managed care arrangement for an independent evaluation as to diagnosis or treatment without following the grievance procedures required by the managed care arrangement. See § 440.134(15)-(16), Fla. Stat. (2000); Weather Eng’rs v. Presgraves, 774 So. 2d 938, 939 (Fla. 1st DCA 2001) (“When an employee is covered under a managed care arrangement pursuant to section 440.134, Fla. Stat. (1997), the JCC has authority to determine indemnity benefits, but lacks authority to determine entitlement to medically necessary remedial treatment, care and attendance if the claimant has not exhausted existing managed care procedures.”); Wiggins v. B & L Servs. Inc., 701 So. 2d 570, 572 (Fla. 1st DCA 1997).
But here, having controverted Mr. Kohout’s claim in its entirety, the employer and carrier have 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. 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.”); see also Morton v. Rinker Material Corp., 753 So. 2d 768, 768 (Fla. 1st DCA 2000) (“We are unable to conclusively determine that, at the time the judge of compensation claims entered the order compelling an independent medical examination by a physician outside the managed care network, no dispute existed concerning provision of indemnity benefits.”); Wiggins, 701 So. 2d at 572 (“[W]e conclude that denial of claimant’s request was proper if the purpose of the IMEs was the resolution of a dispute regarding the provision of medical treatment, care, or attendance, but was improper if the purpose of the IMEs was to resolve a dispute regarding entitlement to indemnity benefits.”). Because the employer and carrier are contesting causation, Mr. Kohout is entitled to an independent medical examination by an examiner he selects. See § 440.13(5)(a), Fla. Stat. (2000).
BENTON, VAN NORTWICK and LEWIS, JJ., concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Jefferson v. Wayne Dalton Corporation/Hartford, 793 So. 2d 1081 (Fla. 1st DCA 2001)…grounds that Mr. Jefferson did not prove that he had exhausted the managed care grievance process. Mr. Jefferson had requested medical care, and did not request an independent medical examination for any other purpose. Cf. Kohout v. Benefit Adm’rs, 781 So. 2d 1164, 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…
-
Grainger v. Indian River Transport/Zurich U.S., 869 So. 2d 1269 (Fla. 1st DCA 2004)…A claimant must establish a causal relationship between his injury and the compensable accident in order to secure treatment, but not to be entitled to diagnostic testing to determine the cause of his symptoms. See Kohout v. Benefit Administrators, 781 So. 2d 1164, 1165 (Fla. 1st DCA 2001); Kentucky Fried Chicken v. Tyler, 716 So. 2d 295 (Fla. 1st DCA 1998). [*1272] The claimant in the present case established through the testimony and medical records that the nature of his injury made the requested evaluatio…
-
Miller v. Jupiter Med. Ctr. & Commercial Risk Mgmt., 928 So. 2d 485 (Fla. 1st DCA 2006)…sonable because of the lapse of time); Cortina v. Dep’t of HRS, 901 So. 2d 273 (Fla. 1st DCA 2005) (observing that a dispute warranting an IME is clearly created when the employer disputes the claimant’s right to benefits); Kohout v. Benefit Adm’rs, 781 So. 2d 1164, 1165 (Fla. 1st DCA 2001) (observing that a party is entitled to an IME “to resolve the threshold question of causation”). See also Karell v. Miami Airport Hilton/Miami Hilton Corp., 668 So. 2d 227 (Fla. 1st DCA 1996) (observing that the E/C has the…
Authorities 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)
- Claims Mgmt., Inc. v. Grenier, 777 So. 2d 1039 (Fla. 1st DCA 2000)
- Weather Eng'rs & Kemper Ins. Grp. v. Presgraves, 774 So. 2d 938 (Fla. 1st DCA 2001)
- Vanny Phillip Floyd v. State, 753 So. 2d 768 (Fla. 1st DCA 2000)