Florida Hospital Deland and A H S Compnet v. Van Wagner-Vick
31 FLW D2724
On cross-appeal, claimant asserted that JCC erred in not awarding temporary total benefits subsequent to the date that her personal physician (authorized) placed her in a no-work status. The opinion of the doctor who placed the claimant in a no-work status was rejected by the JCC based upon medical opinions of other doctors. Court determined this to be error. While the JCC may accept the opinion testimony of one physician over that of another, the resolution of the issue of claimant’s entitlement to temporary total disability benefits does not turn on the JCC’s prerogative as a fact finder to accept a particular expert’s testimony while rejecting another’s. Rather, the issue as to entitlement to temporary total disability is whether the claimant should have reasonably relied on the instructions given her by her authorized treating physician. In this case, the medical opinion accepted by the JCC was that of an IME doctor who saw the claimant on one occasion nearly five months after the doctor who told the claimant not to work. Accordingly, in this case, the claimant could not reasonably be expected to ignore the directions of her treating physician to remain off work.
The appropriate test for determining the "medical necessity" of treatment is whether the authorization of medical benefits would improve the condition caused by a compensable accident or would aid in the recovery from such accident. In this case, the JCC denied medical care as recommended by two physicians based on the fact that the claimant had provided the two physicians an inaccurate history of the cause of her injury. Court determined that the provision of an inaccurate history is not a basis for denying medically necessary care.
In addition, the treatment provided by the medical care provider rejected by the JCC was based on a referral of the injured worker by an authorized doctor. An authorized physician’s referral of an employee to another health care provider constitutes sufficient authorization for the treatment by the referred provider if the referral was made in the treating physician’s own judgment, rather than at the claimant’s request.
As for one of the recommended treatment plans by a doctor whose testimony was rejected by the JCC, the court determined that the treatment recommended was emergency in nature. Emergency care is ordinarily considered to be authorized.