Abbey Adams Logo

Defending Liability, Workers' Compensation, Employment Claims and Appeals Since 1982

  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

  • Bloglovin
  • Facebook
  • LinkedIn
  • Phone
  • Home
  • Locations
    • Where We Practice in Florida
    • Where We Practice In Illinois
  • Practices
  • Attorneys
    • David J. Abbey
    • Jeffrey M. Adams
    • Bruce D. Burk
    • Robert P. Byelick
    • Jaime Eagan
    • Jennifer J. Kennedy
    • John D. Kiernan (1947-2016)
    • V. Joseph Mueller
    • Steven A. Ochsner
    • Alexis C. Upton
  • Blog
  • Links
  • Contact Us

November 20, 2015 by admin

Workers’ compensation — No error in awarding psychiatric treatment and temporary total disabilities based on finding that claimant suffered compensable and disabling mental injury

40
Fla. L. Weekly D2581a
Top of Form

Workers’
compensation — No error in awarding psychiatric treatment and temporary total
disabilities based on finding that claimant suffered compensable and disabling
mental injury — Evidence — Although judge of compensation claims improperly
considered medical opinions of physician who was not treating physician,
independent medical examiner, or expert medical advisor, error was harmless —
JCC reversibly erred by ordering employer/carrier to pay providers and any
third-party payers for services provided — JCC had jurisdiction only to
conclude that care was for compensable injury and medically necessary, and
therefore not claimant’s responsibility — JCC erred in concluding that
claimant’s first psychiatric hospitalization was not compensable emergency care

BOLEY CENTERS, INC./ COMP OPTIONS,
Appellants/Cross-Appellees, v. WILLIAM VINES, Appellee/Cross-Appellant. 1st
District. Case No. 1D14-5869. Opinion filed November 16, 2015. An appeal from
an order of the Judge of Compensation Claims. Stephen L. Rosen, Judge. Date of
Accident: January 8, 2014. Counsel: Ben H. Cristal and Gian-Franco Melendez of
Cristal Hanenian, LLC, Tampa, for Appellants/Cross-Appellees. Bill McCabe,
Longwood, and John H. Thompson, IV, St. Petersburg, for
Appellee/Cross-Appellant.

(PER CURIAM.) In this workers’ compensation case, the
Employer/Carrier (E/C) raises four issues on appeal to challenge the Judge of
Compensation Claims’ (JCC’s) award of psychiatric treatment and temporary total
disability benefits. On cross-appeal, Claimant raises one issue and argues the
JCC erred by concluding the first of his two psychiatric hospitalizations was
not compensable emergency medical care. As explained below, we affirm in part,
reverse in part, and remand for entry of an order consistent with our opinion
herein.

In the first issue on appeal, the E/C correctly points out
that the JCC improperly considered the medical opinions of a physician who was
not a treating physician, independent medical examiner (IME), or expert medical
advisor. § 440.13(5)(e), Fla. Stat. (2013). See also Cespedes v.
Yellow Transp., Inc.
, 130 So. 3d 243, 250-51 (Fla. 1st DCA 2013) (holding
proof of compensable emergency care requires medical opinion admissible under
subsection 440.13(5)(e) which establishes emergency care was both medically
necessary for, and causally related to, compensable workplace injury).
Nevertheless, based on this court’s review of the appellate record as a whole,
such error is harmless — as we conclude there is no reasonable possibility
that this error contributed to the result in this case, nor is there a
reasonable possibility that a different result would be reached were this case
remanded for reconsideration of the issue of compensability without the benefit
of the emergency room physician’s opinions. See Special v. W. Boca
Med. Ctr.
, 160 So. 3d 1251, 1256 (Fla. 2014) (holding that the test for
harmless error requires beneficiary of error to establish there was no
reasonable possibility that the error contributed to verdict).

We find no merit to the E/C’s second point on appeal, which
argues the JCC used an improper legal standard to find Claimant’s mental injury
compensable, and affirm without further comment.

On the E/C’s third point on appeal, we agree the JCC
reversibly erred when he ordered the E/C to pay the providers and any third
party payers for all psychiatric bills incurred after April 2, 2014. The JCC
had no jurisdiction to award payment to the emergency care providers or
reimbursement to any third party payer for services. Instead, the JCC could
only conclude that the care was for a compensable injury and was medically
necessary — and therefore not Claimant’s responsibility. See Williams
v. Triple J Enters.
, 650 So. 2d 1114, 1116 (Fla. 1st DCA 1995) (explaining
that although JCC does not have jurisdiction over reimbursement disputes
between medical providers and carriers, JCC has jurisdiction to resolve issues
of medical necessity as between claimant and carrier).

Because we find no reversible error regarding the JCC’s
finding and conclusion that Claimant suffered a compensable and disabling
mental injury, the E/C’s fourth point on appeal, which challenges an award of
disability benefits attributable to such injury, is affirmed.

Relative to Claimant’s cross-appeal, which challenges the
JCC’s finding that Claimant’s first psychiatric hospitalization was not
compensable emergency care, we conclude that the facts that establish the
second hospitalization as emergency services, as was concluded by the JCC
(under sections 440.13(1)(f) and 395.002(10), Florida Statutes (2013)), are not
meaningfully different than the facts surrounding the first hospitalization.
Accordingly, we reverse the JCC’s conclusion that the first hospitalization was
not compensable emergency medical care.

In summary, we AFFIRM the appealed order to the extent it
finds Claimant suffered a compensable psychiatric injury, REVERSE that portion
of the order requiring the E/C to make payment to medical providers, REVERSE
the JCC’s finding that Claimant’s first hospitalization was not compensable
emergency medical care, and REMAND for entry of an order consistent with this
opinion. (WOLF, THOMAS, and KELSEY, JJ., CONCUR.)

* *
*

Filed Under: Articles

Primary Sidebar

Recent Posts

  • Insurance — Homeowners — Attorney’s fees — Trial court erred in awarding attorney’s fees and costs in favor of insureds where filing of lawsuit was not a necessary catalyst to resolve dispute — Where insurer admitted coverage for damage to interior of home, but denied coverage for damage to roof, the dispute over cause of loss to roof was an amount of loss issue for appraisers, not a coverage issue for court — Where insurer demanded appraisal prior to filing of lawsuit by insured, and indicated that it would repair any damage awarded in appraisal, the filing of lawsuit was not a necessary catalyst to resolve dispute over roof damage
  • Insurance — Commercial liability — Exclusions — Assault and battery — Insurer had no duty to defend insured in action alleging injury arising out of assault and battery on insured’s premises where policy contained endorsement excluding coverage for injury arising out of or resulting from assault or battery
  • Insurance — Homeowners — Appraisal — Assignees — No error in finding that appraisal provision of insured’s homeowner’s policy applied to insured’s assignee and granting insurer’s motion to compel appraisal — Policy did not classify appraisal as a duty of the insured — Assignee received an assignment that entitled it to receipt of payment from insurer, and concomitant with that right was its duty to comply with the conditions of the contract that afforded it payment
  • Insurance — Homeowners — Water damage — Post-loss obligations — Sworn proof of loss — Trial court erred in entering summary judgment in favor of insurer after finding that insureds had forfeited their policy coverage for failure to provide a sworn proof of loss — Policy did not eliminate duty of insured to provide sworn proof of loss where insurer opted to repair — However, because insureds complied to some extent with policy requirements, and policy required insurer to prove it was prejudiced by insureds’ failure to provide sworn proof of loss, material issues of fact remain
  • Insurance — Homeowners — Watercraft exclusion — No error in determining that watercraft exclusion in the insureds’ homeowners’ insurance policy precluded coverage for injuries sustained by a third party in a boating accident that occurred when the insured son, who had permission to use the boat from the insured father, allowed another third party to pilot the boat while intoxicated — The only applicable exception to the watercraft exclusion unambiguously states that the watercraft exclusion does not apply if the outboard engine or motor is not owned by an insured, and the boat and engine in this case were owned by the insured father — Severability clause, which provides that the policy “applies separately to each insured,” did not render watercraft exclusion ambiguous — Exceptions to the watercraft exclusion are not dependent on the insured who seeks coverage, but on the nature of the watercraft at issue

Blog Archives

Footer

The materials available at this website are for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain advice with respect to any particular issue or problem. Use of and access to this Website or any of the e-mail links contained within the site do not create an attorney-client relationship between Abbey, Adams, Byelick & Mueller, L.L.P. and the user or browser. The opinions expressed at or through this site are the opinions of the individual author and may not reflect the opinions of the firm or any individual attorney. opens in a new windowAbbey, Adams, Byelick, & Mueller XML Sitemap Index

Copyright © 2021 · Abbey Adams Byelick & Mueller, LLP · All Rights Reserved · Defending Liability, Workers' Compensation, Employment Claims and Appeals Since 1982