ROBERT A. LOMBARDI, APPELLANT,
v.
SOUTHERN WINE & SPIRITS AND FIREMAN'S FUND, APPELLEES

Fla. 1st DCA | 2004-11-30
No. 1D03-4061
WEBSTER, and POLSTON, JJ, CONCUR.
890 So. 2d 1128 Florida District Court of Appeal, First District (2004) Positive Treatment
Cited by 54 cases

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Holding

A claimant entitled to workers' compensation benefits may receive a second medical opinion at the employer/carrier's expense, provided there is an evidentiary showing that it is both reasonable and medically necessary.


Headnotes

[1] A claimant entitled to workers' compensation benefits may be entitled to a second medical opinion at the employer/carrier's expense, provided the opinion is shown to be b…

[2] An independent medical examination (IME) is distinct from a second medical opinion, with an IME serving to obtain expert testimony for dispute resolution, while a second…

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Facts & Procedural History

A claimant suffered a back injury and sought a second medical opinion at the employer/carrier's expense. The employer/carrier argued this was only per…

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Opinion of the Court
KAHN, J.

KAHN, J.

May a claimant entitled to workers’ compensation benefits under section 440.13, Florida Statutes' (2001), receive a second medical opinion at the expense of the employer/carrier (E/C)? We hold that such an opinion may be required, contingent, however, upon an evidentiary showing that such is, both reasonable and medically necessary. We reverse because the JCC denied the request below as a matter of law.

Claimant, Robert Lombardi, suffered a back injury in the course of his employment with Southern Wine and Spirits. The E/C accepted claimant’s injury as compensable and provided initial treatment. , Claimant subsequently filed a petition for benefits in which he sought a second medical opinion at the E/C’s expense. In response, the E/C filed a motion for summary order asserting that claimant was not entitled to a second opinion at the E/C’s expense because the E/C did not participate in a managed care arrangement at the time of claimant’s accident. The E/C argued a second opinion is authorized only under section 440.134, Florida Statutes, which governs the provision of benefits under a managed care arrangement. The E/C sought dismissal because section 440.13, Florida Statutes, which controls medical benefits outside managed care arrangements, authorizes only the provision of an independent medical examination (IME).

The JCC agreed with the E/C’s argument and dismissed claimant’s petition concluding, as a matter of law, that a claimant can never obtain a second opinion at E/C expense under section 440.13.

The question presented is one of statutory interpretation. Thus, we apply the de novo standard of review. See Socolow v. Flanigans Enters., 877 So. 2d 742, 743 (Fla. 1st DCA 2004). We reject the E/C’s contention that a claimant seeking a second medical opinion is limited to obtaining an IME under section 440.13(5), Florida Statutes. We reach this conclusion because we cannot categorically rule out instances where a second medical opinion would constitute “medically necessary remedial treatment, care, and attendance” under section 440.13(2)(a).

The E/C in this case offered claimant an IME in lieu of authorizing a second medical opinion. The E/C’s offer, however, assumed no distinction between an IME and a second medical opinion. We have long recognized that an IME is a means of obtaining expert medical testimony. See, e.g., Reed v. Reed, 643 So. 2d 1180, 1182 (Fla. 1st DCA 1994) (“By granting the party seeking the IME the choice of selecting the examining physicians,[section 440.13] effectively recognizes that such physicians are essentially expert witnesses of the party requesting the examinations.”); Adelman Steel Corp. v. Winter, 610 So. 2d 494, 505 (Fla. 1st DCA 1992) (“[A] physician performing an independent medical examination (IME) in workers’ compensation cases is essentially an expert witness for the party requesting the examination.”).

Although an IME may ultimately assist a claimant in securing necessary medical treatment, it is not, in and of itself, a form of medical treatment. Our conclusion is bolstered by the language of section , 440.13(5)(a), Florida Statutes (2001), which authorizes the selection of an independent medical examiner to assist in the resolution of “any dispute concerning overutilization, medical benefits, compensability, or disability.” Thus, while an IME is useful in resolving disputes, it does not fall under the “medically necessary remedial treatment, care, and attendance” that an E/C must furnish under section 440.13(2)(a).

On the other hand, occasions may arise where the “nature of the injury or the process of recovery” renders a second medical opinion medically necessary as contemplated by section 440.13(2)(a). Section 440.13(l)(m) defines “medically necessary” as:

[A]ny medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to the patient’s diagnosis and status of recovery, and is consistent -with the location of service, the level of care provided, and applicable practice parameters.

We do not read section 440.13 as evincing a legislative intent to deny a claimant the opportunity to demonstrate the medical necessity of a second opinion. We are unable to define in advance the universe of possible situations where a second opinion would be medically necessary. We do, however, conclude that the claimant’s request for a second opinion presents a question of fact, similar to any other request under section 440.13(2)(a), Florida Stat utes. The JCC must resolve such questions after an evidentiary hearing where claimant will bear the burden of demonstrating entitlement. ' See Robinson v. Shands Teaching Hosp., 625 So. 2d 21, 23 (Fla. 1st DCA 1993) (finding that it is “incumbent upon claimant to establish” the medical necessity of treatment dehied by the E/C); Polk County Bd. of Comm’rs v. Varnado, 576 So. 2d 833, 837 (Fla. 1st DCA 1991) (“The initial inquiry in determining the validity of an award of benefits pursuant to section '440.'13(2)(a), Florida Statutes, is the employee’s medical 'heed for the benefit.”).

Accordingly, we REVERSE and REMAND for further proceedings.

WEBSTER, and POLSTON, JJ, CONCUR.


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Citator

Cited By (27 total)

  • …e is appropriate in this case, because it is clear from the record and the initial brief that the argument for reversal is without merit. Whether a second opinion is medically necessary is a question of fact. See Lombardi v. Southern Wine & Spirits, 890 So. 2d 1128 (Fla. 1st DCA 2004). In workers’ compensation cases, as in other fields of the law, a decision that turns on a finding of fact must be affirmed on appeal if the finding is supported by competent substantial evidence. See De Groot v. Sheffield, 95 So…
  • Matrix Emp. Leasing, Inc. v. Hadley, 78 So. 3d 621 (Fla. 1st DCA 2011)
    …de from a prior opinion of this court.” . The issue presented in this appeal is one of statutory interpretation and the application of [*624] the proper rule of law. Thus, our standard of review is de novo. See, e.g., Lombardi v. S. Wine & Spirits, 890 So. 2d 1128, 1129 (Fla. 1st DCA 2004); Gilbreth v. Genesis Eldercare, 821 So. 2d 1226, 1228 (Fla. 1st DCA 2002). . All statutory references are to the 2006 version of the Workers' Compensation Law in effect at the time of Claimant's accident. See Southern Bake…
  • …9) (noting that when “[t]he pertinent facts are undisputed ... the issue is one purely of law, subject to de novo review”). To the extent resolution of an issue requires statutory interpretation, review is de novo. See Lombardi v. S. Wine & Spirits, 890 So. 2d 1128, 1129 (Fla. 1st DCA 2004) (holding statutory interpretation is subject to de novo review). In construing a statute, courts must first look to its plain language. See Perez v. Rooms To Go, 997 So. 2d 511, 512 (Fla. 1st DCA 2008). “A basic tenet of st…

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