NOVA SOUTHEASTERN UNIVERSITY, AND THE SERVICING AGENT, GALLAGHER BASSETT SERVICES, INC., APPELLANTS,
v.
YVETTE MAJNERICH, APPELLEE
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Nova Southeastern University and its servicing agent appealed a workers' compensation order awarding permanent total disability benefits to an employee injured by mold exposure. The court affirmed the disability award but modified the order regarding payment obligations, clarifying that reimbursement to third-party insurers must be handled directly between those parties rather than through the workers' compensation judge.
The court held that the compensation judge lacked authority to order direct reimbursement to the third-party health insurance carrier, but the employer must pay the claimant for all medically necessary treatment and medications, with the claimant responsible for ensuring third parties are properly reimbursed. The 'prescription account' requirement was construed as simply requiring payment for covered prescriptions as statutorily mandated.
[1] A judge of compensation claims lacks authority to order an employer to directly reimburse a claimant's private health insurance carrier for payments made to healthcare pr…
[2] A judge of compensation claims may award a claimant all medical benefits due, with the claimant responsible for ensuring reimbursement to third-party entities not before…
Previewing 2 of 3 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“[I]t was not proper to direct the employer to pay directly persons or entities which had paid for the care but were not actually before the deputy.”
Establishes the core principle that a compensation judge lacks authority to order reimbursement to third parties not before the court.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceYvette Majnerich was employed by Nova Southeastern University and suffered debilitating effects from mold exposure during her employment, with an acci…
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BENTON, J.
Nova Southeastern University (Nova) and its servicing agent, Gallagher Bassett Services, Inc. (Gallagher), appeal the compensation order awarding Yvette Majne-rich, the claimant below, permanent total disability benefits on account of the debilitating effects she suffered from exposure to mold during her employment with Nova. The parties stipulated to an “accident date” of April 29, 2002. We affirm the order as modified.
Nova and Gallagher argue and Ms. Majnerich concedes that the judge of compensation claims acted without authority in requiring them to “reimburse the [claimant’s private] health insurance carrier, Humana Healthcare Insurance, for” payments it made to her health care providers. See Greynolds Park Manor v. George, 417 So. 2d 990, 991 (Fla. 1st DCA 1982) (“[I]t was not proper to direct the employer to pay directly persons or entities which had paid for the care but were not actually before the deputy.”); see also Orlando Reg’l Healthcare Sys. v. Hurst, 763 So. 2d 1243, 1244 (Fla. 1st DCA 2000); Orkin Pest Control v. Dykes, 464 So. 2d 1299, 1300 (Fla. 1st DCA 1985).
Accordingly, we modify the order on review to require payment to the claimant. See Greynolds Park, 417 So. 2d at 992 (on pets, for reh’g & clarification) (“Our decision does not mean that employer/carrier is temporarily absolved from the duty to pay for the treatment and care which was provided to the claimant. It means that the treatment and care are to be paid for by employer/carrier and collateral disputes as to reimbursement of outside entities not before the deputy commissioner are to be settled among the parties involved.... [T]he claimant ... shall insure that those entities are properly reimbursed.”).
See also Sarasota County Sch. Bd. v. Castagna, mi So. 2d 635, 636 (Fla. 1st DCA 1991) (“Although the JCC is without jurisdiction to order the ESA to reimburse a third party insurer who is not before the JCC, the JCC should award to claimant all the medical benefits due ..., and she shall insure that those entities are properly reimbursed.”).
The judge also ordered Nova and Gallagher to “provide the Employee/Claimant with a prescription account and pay the outstanding bills of Workers’ Comp Rx for medications filled after the Notice of Denial dated December 20, 2004.” Because there is no statutory authority for “prescription accounts,” we construe this as requiring nothing more than that Nova and Gallagher pay for covered prescriptions as part of their duty to “furnish to the employee such medically necessary remedial treatment ... for such period as the nature of the injury or the process of recovery may require, including medicines[.]” § 440.13(2)(a), Fla. Stat. (2001).
See also § 440.13(3)(j), Fla. Stat. (2001); Remington v. City of Ocala/United Self Insured, 940 So. 2d 1207, 1211-12 (Fla. 1st DCA 2006).
The judge of compensation claims can require compliance with the statute, but nothing more.
The order is affirmed, as modified.
POLSTON and HAWKES, JJ., Concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Authorities Cited
- Greynolds Park Manor & R. P. Hewitt & Assocs. of Fla., Inc. v. Lovie George, 417 So. 2d 990 (Fla. 1st DCA 1982)
- Theron Remington v. City OF Ocala/United Self Insured, 940 So. 2d 1207 (Fla. 1st DCA 2006)
- Orkin Pest Control (Rollins v. Dykes, 464 So. 2d 1299 (Fla. 1st DCA 1985)
- Cliff Vincent Darbie v. State, 763 So. 2d 1243 (Fla. 1st DCA 2000)