WEATHER ENGINEERS AND KEMPER INSURANCE GROUP, PETITIONERS,
v.
JOSEPH PRESGRAVES, RESPONDENT
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A Judge of Compensation Claims (JCC) lacks authority to order an independent medical examination (IME) at employer/carrier expense for medical treatment when a managed care arrangement is in place and the claimant has not exhausted its procedures.
Employer/Carrier sought review of a JCC order granting a motion for an IME at their expense. The employee was covered by a managed care arrangement, a…
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PER CURIAM.
Employer/Carrier seek certiorari review of a Judge of Compensation Claim’s order granting a motion for an independent medical examination at Employer/Carrier’s expense. We gránt review, and reverse the Judge of Compensation Claim’s order. When an employee is covered under a managed care arrangement pursuant to section 440.134, Fla. Stat. (1997), the JCC has authority to determine indemnity benefits, but lacks authority to determine entitlement to medically necessary remedial treatment, care and attendance if the claimant has not exhausted existing managed care procedures. See §§ 440.134(2)(b) and 440.134(16); Florida Distillers v. Rudd, 751 So. 2d 754, 757 (Fla. 1st DCA 2000)(“The existence of a managed care arrangement would be relevant to the claim for medical treatment, but would not be dispositive of the claim for indemnity benefits”); Wiggins v. B & L Serv., Inc., 701 So. 2d 570, 572 (Fla. 1st DCA 1997) (after consideration of the applicable statutes in para materia, claimant’s request for an IME was properly denied if it involved the resolution of a dispute regarding medical treatment, care, or attendance, but not if the purpose was to resolve a dispute regarding entitlement to indemnity benefits).
At the hearing on Claimant’s motion for an IME, it was undisputed that Employer/Carrier had a workers’ compensation managed care arrangement in place, and that Claimant sought the IME in order to obtain medical treatment, not indemnity benefits. Therefore, the JCC departed from the essential requirements of law by ordering the psychiatric IME before Claimant had exhausted the existing managed care procedures, including its grievance procedure, pursuant to section 440.134. The JCC’s order granting Claimant’s motion for an independent medical examination is therefore REVERSED.
BOOTH, KAHN and BROWNING, JJ„ concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
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Kohout v. Benefit Administrators, 781 So. 2d 1164 (Fla. 1st DCA 2001)…managed care arrangement for an independent evaluation as to diagnosis or treatment without following the grievance [*1165] procedures required by the managed care arrangement. See § 440.134(15)-(16), Fla. Stat. (2000); Weather Eng’rs v. Presgraves, 774 So. 2d 938, 939 (Fla. 1st DCA 2001) (“When an employee is covered under a managed care arrangement pursuant to section 440.134, Fla. Stat. (1997), the JCC has authority to determine indemnity benefits, but lacks authority to determine entitlement to medically…
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Begyn v. State of Fla. Bus. & Prof'l Regulations & Risk Mgmt., 849 So. 2d 336 (Fla. 1st DCA 2003)…Stores, Inc. # H36 v. Capuano, 800 So. 2d 652 (Fla. 1st DCA 2001). We disagree. Both Farhangi and Capuano were argued in the briefs and fully considered by this court. Appellees also argue that this court overlooked Weather Engineers v. Presgraves, 774 So. 2d 938 (Fla. 1st DCA 2001); Dramis v. Palm Beach County School Board, 829 So. 2d 346 (Fla. 1st DCA 2002); and Florida Distillers v. Rudd, 751 So. 2d 754 (Fla. 1st DCA 2000), none of which were previously cited to this court. As stated in Blinn v. Florida D…
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Dramis v. Palm Beach Cnty. Sch. Bd. & F.A. Richards & Assocs., Inc., 829 So. 2d 346 (Fla. 1st DCA 2002)…authority to determine indemnity benefits, but lacks authority to determine entitlement to medically necessary remedial treatment, care and attendance if the claimant has not exhausted existing managed care procedures.” Weather Eng’rs v. Presgraves, 774 So. 2d 938, 939 (Fla. 1st DCA 2001). Although this case law (distinguishing between claims for indemnity benefits and medical benefits in situations where an E/C has managed care arrangement) has developed in the context of entitlement to an IME, the principle…
Authorities Cited
- Wiggins v. B & L Servs., Inc., 701 So. 2d 570 (Fla. 1st DCA 1997)
- Fla. Distillers & Humana Workers' Comp. Servs. v. Rudd, 751 So. 2d 754 (Fla. 1st DCA 2000)