Cases

Court determined that the exclusive jurisdiction for adjudicating disputes between medical care providers and carriers over the amount payable for providers’ bills is with the Agency for Healthcare Administration (AHCA). The JCC has no jurisdiction over these issues. Court also determined that the issues in this case raise pure questions of law and statutory construction and accordingly, the appellate review is de novo. The provisions of Section 440.13, Florida Statutes, which grant jurisdiction in reimbursement disputes are procedural in nature and accordingly, the law in effect at the time of the hearing applies as opposed to the law as of the date of accident which would be applicable if the statute was deemed to be substantive in nature.

 

Because of the fact that there existed in this case a "reimbursement dispute" between the carrier and the doctor exclusive jurisdiction for deciding this dispute was with AHCA. This also related to the question of over utilization of medical care. If the claimant was seeking additional medical care, he would have standing to pursue such a claim. However, this was not the issue in this case and the court concluded that the JCC did not have jurisdiction to make the decision on the issues before him. The JCC did have jurisdiction to resolve disputes regarding the claimant’s need for medical care apart from any utilization or reimbursement issues.