Terry Pearson v. BH Transfer And Chartis Claims, Inc.

District Court of Appeal of Florida

Terry Pearson v. BH Transfer And Chartis Claims, Inc.

163 So. 3d 1280

CourtDistrict Court of Appeal of Florida

DecidedMay 26, 2015

Docket1D14-4560

StatusPublished

This text of 163 So. 3d 1280 (Terry Pearson v. BH Transfer And Chartis Claims, Inc.) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Terry Pearson v. BH Transfer And Chartis Claims, Inc., 163 So. 3d 1280 (Fla. Ct. App. 2015).

Pincite

Opinion

PER CURIAM.

In this workers’ compensation appeal, Claimant, Terry Pearson, argues that the Judge of Compensation Claims (JCC) erred when he denied Claimant’s request for authorization of spinal surgery on grounds that the surgery was not medically necessary. Because the JCC’s interpretation of section 440.13(3)(i), Florida Statutes (2011), was erroneous, we reverse.

Claimant filed a petition for benefits requesting authorization for the surgical procedure recommended by his authorized treating physician and attached to the petition a copy of the doctor’s office note recommending the procedure. More than ten days after receipt of the written request, Chartis Claims, the carrier, filed its response to the petition. The JCC denied the request on the grounds that the procedure was not medically necessary. However, this Court has previously held that section 440.13(3)(i) requires a. carrier to respond to a request within a specific time-frame or forfeit its right to contest the medical necessity of the requested service. Andino-Rivera v. Se. Atl. Beverage Co., 132 So.3d 1191, 1193 (Fla. 1st DCA 2014) (“Under sections 440.13(3)(d) and (i), an employer or carrier ‘forfeits the right to contest’ the medical necessity of an authorized doctor’s referral for (additional) medical treatment, unless the employer or carrier responds to the authorized, doctor’s written request for a referral within the time allowed.”); City of Panama City v. Bagshaw, 65 So.3d 614, 615-16 (Fla. 1st DCA 2011) (same); Elmer v. Southland Corp., 5 So.3d 754, 756 (Fla. 1st DCA 2009) (same). Here, the carrier failed to timely respond to the request; thus, it forfeited the right to contest whether the referral was reasonable and medically necessary.

We, therefore, REVERSE the order on appeal and REMAND for entry of an order awarding the requested surgery.

WOLF, ROWE, and SWANSON, JJ., concur.

Free access — add to your briefcase to read the full text and ask questions with AI

PER CURIAM.

In this workers’ compensation appeal, Claimant, Terry Pearson, argues that the Judge of Compensation Claims (JCC) erred when he denied Claimant’s request for authorization of spinal surgery on grounds that the surgery was not medically necessary. Because the JCC’s interpretation of section 440.13(3)(i), Florida Statutes (2011), was erroneous, we reverse.

Claimant filed a petition for benefits requesting authorization for the surgical procedure recommended by his authorized treating physician and attached to the petition a copy of the doctor’s office note recommending the procedure. More than ten days after receipt of the written request, Chartis Claims, the carrier, filed its response to the petition. The JCC denied the request on the grounds that the procedure was not medically necessary. However, this Court has previously held that section 440.13(3)(i) requires a. carrier to respond to a request within a specific time-frame or forfeit its right to contest the medical necessity of the requested service. Andino-Rivera v. Se. Atl. Beverage Co., 132 So.3d 1191, 1193 (Fla. 1st DCA 2014) (“Under sections 440.13(3)(d) and (i), an employer or carrier ‘forfeits the right to contest’ the medical necessity of an authorized doctor’s referral for (additional) medical treatment, unless the employer or carrier responds to the authorized, doctor’s written request for a referral within the time allowed.”); City of Panama City v. Bagshaw, 65 So.3d 614, 615-16 (Fla. 1st DCA 2011) (same); Elmer v. Southland Corp., 5 So.3d 754, 756 (Fla. 1st DCA 2009) (same). Here, the carrier failed to timely respond to the request; thus, it forfeited the right to contest whether the referral was reasonable and medically necessary.

We, therefore, REVERSE the order on appeal and REMAND for entry of an order awarding the requested surgery.

WOLF, ROWE, and SWANSON, JJ., concur.

Cite This Page — Counsel Stack

Bluebook (online)

163 So. 3d 1280, Counsel Stack Legal Research, https://law.counselstack.com/opinion/terry-pearson-v-bh-transfer-and-chartis-claims-inc-fladistctapp-2015.

Opinion

Related

Cite This Page — Counsel Stack