BONNIE BERGSTEIN, APPELLANT,
v.
PALM BEACH COUNTY SCHOOL BOARD AND F.A. RICHARD & ASSOCIATES, INC., APPELLEES

Fla. 1st DCA | 2012-08-17
No. 1D11-5035
PADOVANO, THOMAS, and CLARK, JJ., concur.
97 So. 3d 878 Florida District Court of Appeal, First District (2012) Positive Treatment
Cited by 4 cases

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Synopsis

In this workers' compensation case, the court affirmed that when an employer/carrier asserts a jurisdictional defense that a billing dispute is a reimbursement matter outside the Judge of Compensation Claims' jurisdiction, this constitutes a binding legal concession that the claimant cannot be held financially liable for the disputed medical bills.


Holding

The court held that assertion of the reimbursement dispute jurisdictional defense is a de facto concession by the employer/carrier that if any entity is financially responsible for the disputed bills, it is the carrier and not the claimant, thereby insulating the claimant from financial liability pursuant to section 440.13(3)(g), Florida Statutes.


Headnotes

[1] An employer/carrier's assertion of a jurisdictional defense regarding payment of outstanding medical bills constitutes a concession that the services were provided by an…

[2] A dispute over payment of outstanding medical bills from authorized providers for compensable conditions, where the employer/carrier raises defenses such as payment, dupl…

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Key Quotes

“assertion of this jurisdictional defense (codified at section 440.13(ll)(c), Florida Statutes (1994)) is a de facto concession by the Employer/Carrier (E/C) that the services or products billed were provided by an authorized provider for compensable injuries "in accordance with" or "pursuant to" chapter 440, Florida Statutes, so as to insulate a claimant from financial liability for such charges.”

The court's main holding establishing that raising the jurisdictional defense operates as a binding concession protecting the claimant from financial liability.

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Facts & Procedural History

Claimant appealed an order from the Judge of Compensation Claims regarding outstanding medical bills for compensable injuries. The employer/carrier (E…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

In this workers’ compensation case, Claimant appeals an order of the Judge of Compensation Claims (JCC) finding the parties’ disagreement regarding payment of outstanding bills for medical care to be a reimbursement dispute over which she has no jurisdiction, on the authority of Avalon Ctr. v. Hardaway, 967 So.2d 268, 271 (Fla. 1st DCA 2007). We agree, and hold that assertion of this jurisdictional defense (codified at section 440.13(ll)(c), Florida Statutes (1994)) is a de facto concession by the Employer/Carrier (E/C) that the services or products billed were provided by an authorized provider for compensable injuries “in accordance with” or “pursuant to” chapter 440, Florida Statutes, so as to insulate a claimant from financial liability for such charges.

Here, the E/C’s defense to this claim for payment of bills was that some bills had been paid, others were duplicative, and still others had not been properly submitted to the carrier for payment. In presenting this defense, the E/C represented to the JCC that the outstanding bills were from authorized medical providers for compensable conditions, and the dispute about their payment does not implicate Claimant but is between only itself and the medical providers. The E/C’s representation was a binding legal concession, by operation of section 440.32(3), Florida Statutes, and it waived any challenge to the medical necessity of the care such as was asserted in Williams v. Triple J Enter *879 prises, 650 So.2d 1114 (Fla. 1st DCA 1995). Thus, if any entity is financially responsible for these disputed bills, it is the carrier (per section 440.13(14)(a), Florida Statutes (1994)), and Claimant is thereby insulated from financial responsibility (per section 440.13(3)(g), Florida Statutes (1994)). We now hold that any E/C asserting this jurisdictional defense is conceding that, if any entity is financially responsible for the disputed bills, it is the carrier and not the claimant.

To the extent Claimant argues the JCC’s order lacks sufficient findings of fact or ultimate fact to support the ruling, we disagree; the operative finding here, premised on the affirmative averments made by the E/C, is contained in the order: the dispute is a reimbursement dispute. It follows from that finding, though, that section 440.13(3)(g) insulates Claimant from financial responsibility for the disputed bills.

AFFIRMED.

PADOVANO, THOMAS, and CLARK, JJ., concur.


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Citator

Cited By

  • Sansone v. Frank Crum/Frank Winston Crum Ins., Inc., 201 So. 3d 1289 (Fla. 1st DCA 2016)
    …l; it was his being relieved of any obligation to pay the hospital himself. Sansone became “insulated from financial responsibility” for the hospital bill after the employer/carrier accepted responsibility. See Bergstein v. Palm Beach Cty. Sch. Bd., 97 So. 3d 878, 879 (Fla. 1st DCA 2012); see also § 440.13(3)(g), (13)(a), Fla. Stat. (2014). At that point, when or whether the employer/carrier actually paid the bill became immaterial to Sansone; it was then only a matter between the hospital and the employer/c…
  • Fountain v. PMI Emp. Leasing, 98 So. 3d 788 (Fla. 1st DCA 2012)
    …PER CURIAM. AFFIRMED. See Bergstein v. Palm Beach County Sch. Bd., 97 So. 3d 878 (Fla. 1st DCA 2012). DAVIS, CLARK, and MARSTILLER, JJ., concur.…

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