SHIRLEY A. JOHNSON, APPELLANT,
v.
ORANGE COUNTY CORRECTIONS AND JOHNS EASTERN RISK MANAGEMENT, APPELLEES
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A workers' compensation claimant appealed an order denying her request for an independent medical examination. The court held that because the claimant sought the examination to resolve disputes about maximum medical improvement and permanent impairment—not to challenge the managed care plan's medical care—the managed care plan grievance procedure did not apply, and she was entitled to the examination under a different statute.
The independent medical examination was properly sought to resolve disputes regarding maximum medical improvement and permanent impairment, not to challenge medical care provided by the managed care plan. Therefore, the managed care plan grievance procedure in section 440.134 is inapplicable, and the claimant is entitled to the independent medical examination under section 440.1925.
[1] A managed care plan grievance procedure is inapplicable when an independent medical examination is requested to resolve disputes regarding maximum medical improvement or…
[2] An employee is entitled to an independent medical examination to determine maximum medical improvement and permanent impairment when the employer has a managed care plan…
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Join FLexlaw to unlock all legal intelligence“the claimant seeks review of an order denying her request for an independent medical examination because the employer had in effect a managed care plan on the date of the accident”
Establishes the lower court's reasoning for denying the examination request.
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Join FLexlaw to unlock all legal intelligenceThe claimant was injured while employed by Orange County Corrections, which had a managed care plan in effect on the date of the accident. The claiman…
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PER CURIAM.
In this workers’ compensation case, the claimant seeks review of an order denying her request for an independent medical examination because the employer had in effect a managed care plan on the date of the accident, as contemplated by section 440.134, Florida Statutes (1997). We conclude that the independent medical examination was requested to resolve disputes regarding whether the claimant had reached maximum medical improvement and whether she had any permanent impairment, rather than a dispute regarding medical care provided by the managed care plan; and that, therefore, the grievance procedure set out in section 440.134 is inapplicable. Accordingly, we reverse.
It is apparent from the record that claimant requested an independent medical examination because of disputes regarding whether she had reached maximum medical improvement, and whether she had any permanent impairment. It is equally apparent that no dispute existed regarding the medical care that had been provided by the managed care plan. Because 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 statute, she is entitled to the independent medical examination requested.
The order denying claimant’s request for an independent medical examination is reversed, and the case is remanded with directions that the judge of compensation claims grant claimant’s request and appoint an independent medical examiner. REVERSED and REMANDED, with directions.
ERVIN, WEBSTER and BENTON, JJ., CONCUR.
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Cortina v. State of Florida-Dept. OF HRS & Div. of Risk Mgmt., 901 So. 2d 273 (Fla. 1st DCA 2005)…the basis that the claimant had achieved overall MMI, the claimant’s request to present medical opinion evidence from a psychiatric IME was directly related to demonstrating her entitlement to TPD benefits. In Johnson v. Orange County Corrections, 786 So. 2d 678 (Fla. 1st DCA 2001), this court held that a dispute regarding whether an injured worker had achieved MMI supported the claimant’s entitlement to an IME. See also Kimmins Corp. v. Collier, 664 So. 2d 299, 300 (Fla. 1st DCA 1995) (holding that when E/…
Authorities Cited
- Wiggins v. B & L Servs., Inc., 701 So. 2d 570 (Fla. 1st DCA 1997)
- Claims Mgmt., Inc. v. Grenier, 777 So. 2d 1039 (Fla. 1st DCA 2000)