Court: District Court of Appeal of Florida; June 19, 2000; Florida; State Appellate Court
The case involves TERNERS OF MIAMI CORP. and Stirling Cooke Ins. Co. as petitioners against Elisa Busot, with the District Court of Appeal of Florida, First District, addressing whether section 440.13(2)(d) of the Florida Statutes restricts the authority of a judge of compensation claims (JCC) in evaluating the appropriateness of an employer/carrier's (E/C's) unilateral deauthorization of a healthcare provider. The court concluded that the statute does not eliminate the JCC's role in such determinations, thus denying the E/C's petition for certiorari relief.
The claimant, employed as a leather seamstress, developed wrist conditions leading to surgeries by Dr. Jorge Cabrera, initially authorized by the E/C. Following surgery on her right wrist, the claimant continued to experience issues with her left wrist, prompting Dr. Cabrera to recommend additional surgery, which the E/C did not authorize. Instead, the E/C sought an independent medical examination (IME) by Dr. Lewis Eastlick, who advised that the claimant was not improving under Dr. Cabrera's care. Subsequently, the E/C deauthorized Dr. Cabrera and transferred care to Dr. Franklin Reyes based on Dr. Eastlick's findings.
The claimant contested the deauthorization, leading to a hearing where the JCC found the E/C's actions improper, rejecting the E/C's argument that the statute eliminated the JCC's role in assessing the unilateral deauthorization's appropriateness. The E/C's appeal focused solely on the interpretation of section 440.13(2)(d), which allows for transferring care if an IME finds the employee is not making adequate progress.
The provision in question was part of significant amendments to the Workers' Compensation Act enacted in 1994, specifically addressing the deauthorization of treating physicians and transfer of care in workers' compensation cases. Prior to 1994, Florida courts mandated that an Employer/Carrier (E/C) must obtain a Judge of Compensation Claims (JCC) order to deauthorize a treating physician against a claimant's wishes or prove good cause for such action at a subsequent hearing. The 1987 statute prohibited deauthorization without the employer's consent unless deemed in the injured employee's best interest by a deputy commissioner.
In 1989, the legislature allowed E/Cs to unilaterally deauthorize a provider based on internal findings of overutilization, but retained the requirement for JCC approval in other cases. By 1990, prior JCC approval for deauthorization was eliminated, although courts maintained that a JCC could later assess the appropriateness of the deauthorization. The 1994 amendment granted E/Cs the right to transfer care based on an independent medical examination (IME) showing inadequate recuperation progress, akin to the previous 1989 provision regarding overutilization.
The interpretation of this new provision does not negate the JCC's role in later evaluating whether the deauthorization and transfer were in the claimant's best interests. The court upheld the JCC's interpretation of section 440.13(2)(d) as consistent with legal requirements and denied the E/C's petition for certiorari relief. Notably, the case involved a managed care context, and there were clarifications about the qualifications of medical experts involved, specifically Dr. Eastlick, who specialized in hand surgery rather than orthopedics. The E/C acknowledged the claimant's need for a repeat surgical procedure despite questioning the necessity of a prior surgery.
