FL Case Law Summaries – 4/5/16
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JCC ORDERS
Carlos Antonia Sanchez v. AIMCO/Bethesda Holdings, Inc./Broadspire, ACE USA
JCC Rosen; Miami District; Order Date: April 1, 2016
OJCC Case: 09-031713GCC; D/A: 6/16/2009
Claimant’s Counsel: Mark Touby
Employer/Carrier’s Counsel: Alexander Blanco
Briefly: AUTHORIZATION OF MEDICAL TREATMENT – JCC Rosen denied the claim for authorization of physical therapy and found the only direct evidence regarding medical necessity came from Dr. Restrepo whose opinions were not admissible into evidence as he was not an authorized treating physician, independent medical examiner, or Expert Medical Advisor.
Summary: The JCC denied the claimant’s reliance on the “self-help” provisions of Florida workers’ compensation law, and found there was no medical evidence of the medical necessity of the requested physical therapy.
The JCC also found there was no evidence presented that the claimant was not receiving treatment from the authorized treating physician, Dr. Amar. The JCC found the claimant simply wanted more treatment than the authorized physician prescribed.
The JCC also found there was no evidence that the physical therapy was administrated on an emergency basis or that the claimant even visited an emergency facility, as a result of the accident.
Rosa Estela Rubio v. Gymboree Corp./Gallagher Bassett Services, Inc.
JCC Humphries; Jacksonville District; Order Date: April 1, 2016
OJCC Case: 14-002781RJH; D/A: 11/17/2013
Claimant’s Counsel: Mario Arango
Employer/Carrier’s Counsel: Robert Rodriguez
Briefly: EMERGENCY MEDICAL TREATMENT – JCC Humphries denied the claim for authorization of payment of Dr. Joseph Mouhanna and found that the claimant’s visit with Dr. Mouhanna was not an emergency requiring payment by the Carrier and that authorized medical treatment remained available to the claimant. The claimant argued that his visit with Dr. Mouhanna was emergency medical treatment under F.S. §440.13(3)(b) and that his medical condition met the definition of “emergency medical condition” under F.S. §395.002(8).
Summary: The JCC noted that at the claimant’s initial visit to Dr. Mouhanna, he presented with low back pain, leg pain, arm pain, and neck pain that he described as a 7 out 10.
After reviewing the context of Dr. Mouhanna’s deposition, the JCC concluded this was not severe pain and that no emergency treatment was rendered. The JCC noted that a follow-up appointment was not recommended for an additional two weeks, and that the condition was not deemed sufficiently severe to require an immediate MRI. Further, the JCC noted that Dr. Mouhanna was of the opinion the claimant could continue to work without restrictions.
Additionally, the JCC found that authorized medical treatment remained available to the claimant and that the claimant had two authorized physicians at that time, including Dr. Joel Salamon and Dr. Jan Hommen.