Ambroise v. Wood Lake Health & Rehabilitation Center / Consulate Heath Care dba Lavie Health Care Centers dba Wood Lake Health and Rehabilitation Center / Gallagher Bassett

Paul T. Terlizzese

JCC Johnson (West Palm Beach) (2-5-19) – Denied orthopedic specialist, awarded occupational medical specialist of claimant’s choice. The E/C initially authorized Concentra, and several of their physicians saw the claimant. On 7/28/17, Dr. Green, at that facility, placed her at MMI with a 0% rating. The claimant requested a one-time change from Dr. Green and the E/C timely authorized Dr. Rodriguez at MD Now, another walk-in-clinic. The next day (also timely) the E/C authorized Dr. Rosenthal of MD Now in order to get the claimant a quicker appointment. The claimant never showed to this clinic. The E/C argued that Concentra, with multiple physicians, was authorized, as opposed to a single doctor, and MD Now (similar clinic with multiple physicians) was appropriately authorized as the one-time change. The JCC disagreed finding the statute required a change in physician as defined in 440.13(1)(p) and concluded the entity of MD Now did not meet the definition of a physician. The JCC found that Dr. Green was primarily responsible for the claimant’s care at Concentra, specialized in occupational medicine, and was the proper one to request a one-time change from. The JCC further found that Dr. Rosenthal did not specialize in, or have any experience in, occupational medicine and held that 440.13(2)(f) requires the one-time change to be in the same specialty, and therefore, because the E/C did not timely authorize an occupational medicine specialist, the claimant could select. The claimant was also seen on an emergency basis at Wellington Regional following the accident. The ER physician noted, “I will make sure that she has a good follow-up with orthopedics.” However, the claimant failed to introduce any evidence establishing this care was medically necessary.
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