SCARLET HARMAN, APPELLANT,
v.
GADSDEN CORRECTIONAL FACILITY AND AIG CLAIM SERVICES, INC., APPELLEES
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
In a workers' compensation case, the Florida First District Court of Appeal held that an employer must provide a medically necessary orthopedic evaluation to determine objective findings supporting a claimant's injury claim, even when the doctor cannot initially identify objective findings. The court clarified that the relevant statutory test is medical necessity under section 440.13(2)(a), not the existence of objective findings under section 440.09(1).
The employer must authorize the orthopedic evaluation because it is medically necessary under section 440.13(2)(a), Florida Statutes. The relevant statutory test is whether the requested benefit is medically necessary, not whether objective relevant medical findings already exist under section 440.09(1). A referral for evaluation cannot be denied merely by characterizing it as a transfer of care.
[1] A workers' compensation claimant is entitled to a medically necessary orthopedic evaluation to determine objective findings supporting subjective complaints, even if the…
[2] In workers' compensation cases, the determination of whether a requested medical benefit is compensable should be based on the standard of medical necessity under section…
Previewing 2 of 5 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“The judge should have relied on section 440.13(2)(a), Florida Statutes (2007), and its test of whether the requested benefit is medically necessary, and not section 440.09(1), and its test of whether objective relevant medical findings exist to support an award.”
Establishes the correct statutory framework for determining whether an evaluation must be authorized in workers' compensation cases.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceScarlet Harman sought an orthopedic evaluation in a workers' compensation case involving a knee injury claim. The accident was accepted as compensable…
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Medical Necessity cases and more on FLexlaw
In this workers’ compensation case, the claimant sought an orthopedic evaluation based on undisputed medical testimony that the evaluation was necessary to determine whether there were objective findings to support her claim of knee pain. The Judge of Compensation Claims initially denied the claim on the ground that section 440.09(1), Florida Statutes (2007), precluded an award because there were no objective relevant medical findings of an injury. On appeal, this court issued an opinion stating, in its entirety: “REVERSED and REMANDED. See Morrow v. Sam’s Club, 17 So.3d 763 (Fla. 1st DCA2009).”
On remand, the judge denied the evaluation, once again, this time finding that the medical referral was for a transfer of care rather than an evaluation. Although our earlier opinion in this case could have been more detailed, we conclude now, as we did then, that the evaluation is required by our holding in the Morrow case. Here, as in Morrow, the accident was accepted as compensable, the doctor could not find an objective basis for the claimant’s subjective complaints, the doctor recommended an evaluation to find such a basis, the employer and carrier refused to provide an evaluation on the ground that there were no objective relevant medical findings under section 440.09(1), and the judge erroneously accepted this position. The error is the same in both cases. The judge should have relied on section 440.13(2)(a), Florida Statutes (2007), and its test of whether the requested benefit is medically necessary, and not section 440.09(1), and its test of whether objective relevant medical findings exist to support an award. In the present case, the only doctor who addressed the issue testified that the evaluation was medically necessary.
The principle established in the Morrow decision cannot be avoided merely by characterizing the referral in this case as a transfer of care. This is a distinction without a difference. Even if the doctor’s request were for transfer of care, the transfer of care is for an evaluation. Moreover, to the extent a transfer of care is distinct from an evaluation, in that its purpose is to obtain proof of objective relevant medical findings; Morrow held that an evaluation is compensable even if it is “to determine whether there was an objective basis for [the] claimant’s symptoms.” 17 So.3d at 764.
For these reasons, we conclude that the claimant is entitled to relief. We reverse the order on the previous remand and remand the case once again with directions to enter an order requiring the employer and carrier to pay for the orthopedic evaluation and to award the claimant attorney fees and costs for the proceedings in the lower tribunal on this issue.
Reversed and remanded.
BENTON, PADOVANO, and CLARK, JJ., concur.