Guerline Edouard v. Pioneer Growers / Zenith Insurance Company
Andrew R. Borah
JCC Stephenson – West Palm – (9-20-2019) – Denied authorization of TTD/TPD, chiropractic care, an ankle specialist, a podiatrist and payment of medical bills. Initially, the Employer failed to report the incident to the Carrier. The claimant treated at the ER and with five chiropractors at a single office. Once notified, the Carrier authorized orthopedist Dr. Jospeh Chalal for the back and ankle, paid TTD and agreed to pay previous chiropractic bills up to a specific date. The claimant failed to attend multiple appointments with Dr. Chalal, arguing she established a relationship with previous chiropractors and was uninterested in an orthopedic evaluation. She testified she wanted a specialist, although she admitted she did not know what an orthopedist treated and relied on her attorney’s advice not to attend. She also failed to attend an appointment with Cook Chiropractic Clinic. Instead, the claimant obtained unrequested and unauthorized diagnostics recommended by the previous chiropractors. A previous chiropractor referred the claimant to an “ankle specialist” although he did not specify the type of specialist and testified that an orthopedist would have sufficed. The E/C’s IME, Dr. Jeffrey Penner, only evaluated the claimant’s ankle as she did not complain of back pain. He testified Dr. Chalal is qualified to treat a heel fracture as both podiatrists and orthopedic surgeons are qualified. He found a foot or ankle specialist to be unnecessary as she did not require surgery. The Claimant’s IME, Dr. Simon-Mark, felt a podiatrist should provide care, although she agreed an orthopedist was more appropriate than a chiropractor. The JCC found the “self-help” period ended when the Carrier authorized Dr. Chalal and Cook Chiropractic Clinic and denied payment of subsequent medical bills, as they were not requested nor authorized. The JCC agreed with E/C’s IME indicating Dr. Chalal could treat the ankle and found the claimant failed to establish a doctor-patient relationship with any previous chiropractor as she treated with five different chiropractors. The JCC also denied any further indemnity benefits based on the claimant’s medical non-compliance.
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