Cases

To the extent a JCC's order turns on a resolution of the facts, the standard of review is competent and substantial evidence.  To the extent it involves an interpretation of the law, the standard is de novo. 

Once compensability of an injury is established, a carrier can no longer contest that the accident is the major contributing cause of the injury.  To avoid responsibility for treatment thereafter, the employer/carrier must demonstrate a break in the causation chain between the accident and the injury for which treatment is sought.  In this instance, the JCC rejected the assertion that the claimant suffered a subsequent injury that could have been the major contributing cause of the claimant's injuries along with all medical opinions founded upon this proposition.  Because of the fact that the employer/carrier produced no affirmative evidence of another competing cause of the claimant's injuries following the compensable accident, the claimant satisfied his burden of persuasion in establishing the compensability of the medical condition for which treatment was sought.

In determining the definition of emergency treatment as that term is used in Section 440.13(1)(f), Florida Statutes, the court referenced Section 395.002(9)(a), Florida Statutes.  An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:  (1) serious jeopardy to the patient's health (2) serious impairment to bodily functions (3) serious dysfunction of any bodily organ or part.  In proving whether emergency care services have been provided, and determining compensability under Chapter 440, the following questions must be answered in the affirmative:  (1) whether the service provider is a licensed physician (or other appropriate personnel acting under the supervision of a physician); (2) whether an evaluation, screening or examination was conducted by that physician (or other authorized personnel); and (3) whether such care was undertaken by the physician with the intent of determining if an emergency medical condition exists.  See Section 395.002(10), Florida Statutes (2005).  If each of these questions are answered in the affirmative, such services are deemed to be emergency.  The actual compensability of the emergency care without specific authorization from the carrier the care must be medically necessary and caused by the workplace injury.

In this case, the court determined that the emergency treatment being provided was in fact emergency care compensable under the workers' compensation statute.  Because it was compensable as emergency care, the medical provider was deemed to be "authorized" as a matter of law.  Routine medical care must be authorized by the carrier and only through such authorization can the physician become eligible for payment (except for the self help provisions of Section 440.13(2)(c), Florida Statutes, in which the employer/carrier had wrongfully denied treatment).  As an authorized doctor providing medical treatment, the doctor's opinions were admissible as an authorized doctor.

In determining whether treatment was emergency care, the patient/claimant need not actually suffer a loss of bodily function or serious function to a body part to meet the emergency definition; rather, the question is whether in the absence of immediate medical attention such effects might reasonably be expected to occur.

Court also reviewed the JCC's finding that the emergency surgery was not compensable since the emergency provider failed to give the employer/carrier timely notice of emergency treatment in accordance with Sectioin 440.13(3)(b), F.S.  Court noted however that Section 440.13(3)(b), Florida Statutes, does not set forth any penalty to the claimant for an emergency health care provider's failure to provide timely notice of emergency treatment to the employer/carrier.  To the extent that this statutory notice requirement might affect the amount of money that the doctor was entitled to receive, as opposed to his eligibility for treatment or compensability of the treatment, the JCC had no jurisdiction over any billing disputes between the doctor and the employer/carrier.  Concurring in part decision.