LINDA BEVERLY, APPELLANT,
v.
PUBLIX SUPERMARKETS AND PUBLIX SUPERMARKETS, INC., APPELLEES
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.
In a workers' compensation case, the Florida District Court of Appeal affirmed the denial of surgery costs due to lack of prior authorization but reversed the denial of penalties for the employer/carrier's failure to timely pay temporary total disability benefits, remanding for reconsideration under recent statutory amendments.
The court affirmed the denial of surgery costs because the claimant failed to obtain required prior authorization. However, the court reversed the denial of penalties because the employer/carrier failed to either pay the temporary total disability benefits within seven days or exercise the 120-day pay-and-investigate option, and mere lack of knowledge of the surgery does not excuse compliance with the statutory payment requirements.
[1] A claimant must request prior authorization for surgery to be reimbursed for its costs, as required by statute.
[2] A voluntary dismissal of a petition for benefits acts to dismiss the entire petition.
Previewing 2 of 6 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“an E/C can no longer avoid penalties under the 1994 statute simply by filing a notice of denial within 14 days of a claim. Rather, the E/C must either pay the benefits within seven days or exercise the 120-day pay-and-investigate option under section 440.20(4).”
Establishes the controlling legal standard for when an employer/carrier becomes liable for penalties under workers' compensation law.
Previewing 1 of 2 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceLinda Beverly, a claimant in a workers' compensation case against Publix Supermarkets, underwent surgery performed by Dr. Fitzgerald on March 5, 1999,…
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 Claim For Penalties cases and more on FLexlaw
ERVIN, J.
We affirm the denial of payment for the costs relating to the surgery performed by Dr. Fitzgerald on March 5, 1999, because claimant failed to request prior authorization for the surgery, as required by sections 440.13(2)(c) and 440.13(3)0), Florida Statutes (Supp.1994). In so ruling, we note that the voluntary dismissal claimant filed in April 1997, relating to the pain-management claim included in the 1996 petition for benefits, acted to dismiss the entire petition. See Perez v. Winn-Dixie, 639 So. 2d 109 (Fla. 1st DCA 1994).
We reverse, however, the denial of penalties authorized by section 440.20(6), Florida Statutes (Supp.1994), because the employer/carrier (E/C) failed to pay temporary total disability (TTD) benefits that were awarded for the period from March 5 to May 27, 1999, pursuant to a second petition for benefits filed on April 23, 1999. As explained in Eastern Industries, Inc. v. Burnham, 750 So. 2d 748 (Fla. 1st DCA 2000), an E/C can no longer avoid penalties under the 1994 statute simply by filing a notice of denial within 14 days of a claim. Rather, the E/C must either pay the benefits within seven days or exercise the 120-day pay-and-investigate option under section 440.20(4).
Here, the E/C did neither, yet it contends on appeal, based on section 440.20(6) and Burnham, that penalties are not due, because it was unaware of claimant’s surgery on March 5, 1999, and thus nonpayment resulted from conditions over which it had no control.
Although the E/C may have been unaware initially of claimant’s surgery and resultant temporary disability, it was on notice of the TTD claim, based upon the petition for benefits claimant had executed on April 23, 1999, and filed -with the Division on May 10, 1999.. Because the E/C did not pay the TTD benefits within seven days, as required by section 440.20(6), or exercise the 120-day pay-and-investigate option under section 440.20(4), it appears that the JCC should have awarded penalties under section 440.20(6).
Nevertheless, because the JCC did not have the benefit of Burnham when he entered the final order, we reverse and remand with directions to reconsider the penalty issue in accordance with the 1994 amendments and Burnham. See also Service Mgmt. Sys. v. Hood, 790 So. 2d 578 (Fla. 1st DCA 2001) (reversing and remanding penalty issue to determine whether penalties were appropriate under Burnham and, if so, from what date).
AFFIRMED in part, REVERSED in part, and REMANDED for further proceedings.
WEBSTER and BENTON, JJ„ CONCUR.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Authorities Cited
- Perez v. Winn-Dixie & Crawford & Co., 639 So. 2d 109 (Fla. 1st DCA 1994)
- E. Indus., Inc. v. Burnham, 750 So. 2d 748 (Fla. 1st DCA 2000)
- Serv. Mgmt. Sys. & Crawford & Co. v. Bilal Hood, 790 So. 2d 578 (Fla. 1st DCA 2001)