Articles Posted in workers compensation

If you have a pending worker’s compensation claim, it is advisable to contact your claim’s adjuster prior to seeking treatment at an emergency room. If you do not obtain pre-approval, you run the risk of being personally responsible for the hospital bill.   Even if it is after hours or the weekend, we still urge that you make a good faith effort to obtain authorization.  Send an Email to the adjuster or leave a voice mail – your best bet is to do both.  If you are unable to contact your adjuster and you proceed to the emergency room, it is imperative that you inform the emergency room nurse that you have a pending worker’s compensation claim.   If you have your claim information (i.e., name, address and telephone number of the worker’s compensation carrier and/or claim number), be certain to provide same.   While providing this information is necessary for processing, the emergency room services must be approved and authorized by the claim’s adjuster so that the bill can be paid accordingly.   Please do not provide your personal health insurance card.  Continue reading →

The Florida Supreme Court on June 9, 2016 in the case of Westphal v. City of St. Petersburg, Case No. SC13-1976 declared Florida Statute 440.15(2)(a) unconstitutional.  That provision sought to limit disability (lost wage) benefits to an injured worker to only 104 weeks, even though the worker was on a no work status or disabled after the 104 weeks.

The Florida Supreme Court concluded that provision was unconstitutional based on a denial of right of access to the Courts.  The Florida Supreme Court said that the injured worker could have 5 years or 525 weeks to receive benefits for lost wages based on an earlier constitutional statute. Those weeks do not have to be sequential.

What this means for the injured worker, is that, the Florida Supreme is finding provisions of the workers compensation law so onerous that those provisions violate the constitutional rights of the injured worker. When this happens,  the prior constitutional provision of the workers compensation law becomes applicable.

In Miles vs. City of Edgewater Police, 1D15-0165 the First District Court of Appeal declared Florida Statutes 440.105(3)(c) and 440.34 unconstitutional because they infringe on the Claimant’s right to contract to pay attorney’s fees from their own funds for litigating a workers compensation claim.  Any contract for fees for representing an injured person must like all fees for Florida attorneys comply with the factors set forth in Lee Engineering, 209 So.2d. 454, 458 (Fla. 1968) and the Florida Bar Rule 4-1.5(b).  In Miles, the 1^st DCA stated “we hold that no attorney accepting fees, per such a fee contract in this situation may be prosecuted under 440.105(3)(c) Fla. Stat.  The right of the Claimant to contract is known as a civil liberty possessed by all persons and is within the rights guaranteed by the Constitution.”

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Are ex parte communications between a nurse case manager and a physician permissible?  The answer to this question truly depends on whether the nurse case manager is a qualified rehabilitative provider performing a reemployment assessment or if the nurse case manager is solely retained to perform medical care coordination services.  If the nurse case manager is a “qualified rehabilitation provider” and retained to perform a re-employment assessment,  then ex parte communications are appropriate and allowable pursuant to Florida Statue 440.13(4)(c).    Conversely, if the nurse case manager is retained by the employer or the carrier for the sole purpose of medical care coordination, ex parte communications are impermissible and a violation of the statute.  It is important to note that just because the nurse case manger is deemed a “qualified rehabilitation provider” that does not, in and of itself, permit ex parte communications between she and the physician.

While Florida Statute 440.13 (4)(c), allows the employer and or the carrier to have ex parte communications with the physicians, this statute does not extend to third parties or a qualified rehabilitation provider who is not performing a reemployment assessment.

If you have been assigned a nurse case manager, it is important to understand her role.  If you are unsure, please do not hesitate to contact our office as we would be more than happy to speak with you.

On 4-28-16, the Florida Supreme Court in the case of Castellanos v Next Door Company SC 13-2082 declared Florida Statute 440.34 unconstitutional because it violated the Constitutional due process right to the courts for the injured workers. The constitutional violation was based on the failure of that statute to allow claimants’ attorneys to obtain a reasonable attorney fee for litigating and obtaining benefits under the Florida Workers Compensation Act.  This is a victory for the injured workers as their attorneys can now receive reasonable compensation for obtaining needed benefits for the injured workers.

This firm has always been dedicated to protect the rights of the injured person. Angel Kirkconnell at this firm has litigated tirelessly to help the injured worker.  Now with the advent the ability of attorneys to get paid, this firm can give meaningful help to achieve benefits for those injured in the line of work.

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As we know, the law requires that a medical benefit which includes, but is not limited to, the treatment, a device or an aid be medically necessary.  In order to award that benefit, the test is whether it is medically necessary.  A Judge of Compensation Claims may award only those medical benefits that are medically necessary.  It is important to understand the distinction between a medically necessary benefit and those that are merely pleasant or convenient.  Simple convenience will not suffice nor would a benefit that would neither improve nor aid in recovery be considered medically necessary. Continue reading →