August 2012

I’ve written before about the E/C’s jurisdictional defense to a claim for unpaid bills from authorized providers.  The Claimant has no standing to sue for payment of the bills and the Judge has no jurisdiction to order the payment of the bills.

Only the Agency for Health Care Administration (AHCA) has jurisdiction to settle such disputes.   In fact, sections 440.13(11)(c) and 440.13(3)(g) state that the Claimant does not have responsibility for such bills.   In the past, I’ve written the following on the matter:

Section 440.13(11)(c) dictates that the Agency for Health Care Administration (“AHCA”) has “exclusive jurisdiction” to decide any matters regarding provider reimbursement.  As long as the Carrier authorizes care with the doctor, the dispute about the doctor’s bills is outside the jurisdiction of the Judges of Compensation Claims.”

However, it is important that when the E/C asserts this defense, it is “buying” the bills and the treatment connected with said bills. (more…)

Nothing is as frustrating to an Employer/Carrier as when an employee suffers an accident and cannot explain how the accident took place.   This occurs often in slip and falls where the employee readily admits she does not know (or sometimes remember) how she fell.  She was walking down and a hallway at work one minute.  The next minute, she was on the ground and in pain.

Many E/C’s view these type of injuries as “idiopathic” and deny the claim because the accident could have occurred anywhere (at home or in public) and the fact it occurred at work was just a coincidence.  None of the physical aspects of the job caused the accident.

The problem is this thinking is wrong.  Even the definition of “idiopathic” is misinterpreted by many E/C’s.  All “idiopathic” means (as defined by Webster’s Dictionary)  “arising spontaneously or from an obscure or unknown cause.”   So, when an E/C cries out “idiopathic!” and denies the claim, all they are saying is they have no idea what happened.  And, that has no bearing to proving the claim is non-compensable.

The truth of the matter is that if no one (not even the Claimant) knows how an accident happened, the courts are going to favor the Claimant and award compensability.   And, we have a couple of new cases from the First DCA that proves this point. (more…)

I’ve written before about the dangers of denying an accident took place in the course and scope of employment.  Such a denial allows removes the exclusive remedy defense to an Employer and allows an injured worker to proceed with a tort action. 

While researching for a client, I found a case decided this past March that is based on the same principle.  But, in this case, the Employer never reported the accident to its Carrier after the injured workers reported their injuries.  This is a big no-no in and of itself, but considering the wider consequences an Employer is crazy to even think to take this position.

More after the jump. . . (more…)