Greetings, I’m putting the finishing touches on a new CEU entitled “Poof! Ta da! Top 10 Claimant attorney tricks for 2019”. Basically a list of the things that have burned us, and I thought I’d share one.
(And on a lighter note, if you need a laugh, here is a link to our firm’s promotional video from the Live Surgery at the WCI convention last week… https://www.youtube.com/watch?v=uO-DJNhctT8
Often, a claimant will list surgery or indemnity on the PFB, even though there is no request for it from the treating doctor. The adjuster properly denies the request in the response. Down the road, while that PFB is still pending, they get an IME, surgery or indemnity becomes an issue, and…POOF, we owe an attorney’s fee.
The statute says the claimant must attach proof they are entitled to the benefits….
440.192 (2) (i) The type or nature of treatment care or attendance sought and the justification for such treatment. If the employee is under the care of a physician for an injury identified under paragraph (c), a copy of the physician’s request, authorization, or recommendation for treatment, care, or attendance must accompany the petition.
I have seen some adjusters in the PFB response state the PFB should be dismissed because they didn’t attach proof. Unfortunately, that is not enough, a Motion to Dismiss must be filed with the JCC within 30 days of the date the PFB was e-filed.
If the PFB doesn’t have attached proof, make sure to get the file to defense counsel quickly so we can get the Motion filed. That way if the situation changes later you are not hit with a surprise fee exposure.
Once the outline is approved by the state we can start scheduling it.
Morgan Indek | Partner