Case Law Update March 2020

HR Law Cases

JCC Medina-Shore (Miami) (Andy Borah) – Denied the authorization of Dr. Ibraheim as the claimant’s one- time change, denied authorization for epidural injections, lumbar brace, physical therapy and pharmaceuticals, and denied the claim for authorization of outstanding medical bills. The claimant alleged that his seven page letter in Spanish requesting a “pain doctor” was actually a request for a one-time change. The adjuster was on medical leave and when she returned she set up an appointment outside the five days with his previous pain doctor. The claimant failed to attend that appointment, instead obtaining an evaluation with Dr. Ibraheim without carrier authorization. The claimant then filed a PFB asking for Dr. Ibraheim as his one-time change. The JCC found that the claimant’s request for a pain doctor was not a sufficient request for a one time change. The JCC found all of Dr. Ibraheim’s opinions and referrals inadmissible.
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DCA Cases

Dominguez v. S.E. Personnel/Packard/Center Line Drilling/Lion Ins., ___ So.3d ____ (Fla. 1st DCA 3/12/20) Dismissal of Claims/Jurisdiction of JCC 
Claimant was injured in April 2017. On September 7, 2018, he filed the first of two PFBs seeking PTD benefits. The E/C filed their first response to the PFB on October 4, 2018 stating: “The employer/carrier voluntarily accepts the injured worker as permanently totally disabled starting on August 21, 2018,” and agreed to pay “reasonable taxable cost associated with the filing of the petition.” The JCC concluded that she lacked jurisdiction and dismissed the PFB. The DCA explained the JCC had jurisdiction over the case when the first PFB was filed, because the E/C did not administratively accept Claimant as PTD until October 4, 2018. The E/C’s voluntary acceptance did not remove the matter from the JCC’s jurisdiction because the JCC retained jurisdiction over costs, and because it was never clear that Claimant received any benefits between the date the E/C concedes Claimant was entitled to PTD benefits (August 21, 2018) and the date Claimant lodged his claim for PTD benefits (September 7, 2018). Claimant’s counsel argued that the E/C had not paid those benefits and argued that Claimant was entitled to an evidentiary hearing on the matter. The DCA agreed and reversed and remanded for further proceedings in accordance with the opinion.
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Morgan v. American Airlines/Sedgwick CMS, ___ So.3d ___ (Fla. 1st DCA 3/24/2020) Attorney Fees and Costs 
The DCA affirmed the JCC’s denial of attorney fees and costs. The DCA found the E/C never denied the benefits that were the subject of the PFBs, which did not entitle the claimant to attorney fees, or prevailing party costs.
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Please note that the DCA Opinions and Merit Orders contained in this newsletter are non-final until 30 days after their rendition. Until that time, they are subject to amendment, vacation, or other action which may remove or alter some or all of the decision. Please contact any HRMCW attorney if you have a question as to the finality and applicability of an Opinion or Order. We endeavor to include any amendments or alterations to Opinions or Orders that may occur at a later date