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…)

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(Ed. note: I worked on an a separate appeal on this case, albeit with a different date of accident and a different Carrier.)

The number of Carriers contracted into a manage care plan has dwindled over the years.  However, there are still some left and if you are a claims professional or Employer still associated with such a managed care plan, it is important to understand all of the legal “wrinkles” in your plan. 

For one, section 440.134 works hand-in-glove with s. 440.13 and with this most recent case it is important to understand there can be two opportunities for a Claimant to choose a change in doctors.  (more…)

If you play baseball with blinders, than you will only see half of the field and expect to get beaned in the head.  At least that ‘s what my grandpa told me.  The same can be applied to claims adjusting.  In this case, the fact that the Legislature removed Claimant’s right to a second opinion does not mean a Claimant can never receive a second opinion.

Case in point, Florida Detroit v. Nathai.  Here the First DCA found Claimant was entitled to a second opinion.  (more…)