Cases

Where the JCC’s findings are called into question as not consistent with the evidence, appellate review is based on abuse of discretion.

This case involved conflicting medical opinions as to the claimant’s need for surgery.  Medical testimony that was adopted by the JCC found that the surgery was reasonable.  However, reasonableness is not the only standard to apply when awarding medical care.  As noted in Section 440.13(2)(a), the treatment ordered must also be medically necessary.  It is the claimant’s burden to prove medical necessity.  In this case, the doctor whose opinion the JCC adopted did not opine that the surgery was medically necessary.  To the contrary, he made it clear that he was not recommending the surgery since it was unlikely that the patient would benefit from the surgery.  The doctor explained that his concern was that the surgery could possibly make the claimant worse and was unlikely to offer the claimant any relief.

Court determined that JCC committed error in relying on the reasonableness of requested treatment and ignoring medical necessity.  The doctor did acknowledge that another physician might perform such a surgery but the court determined that this is not clear and convincing evidence of medical necessity. 

Court determined that the JCC failed to apply the correct standard in assessing the doctor’s opinion that was accepted and further failed to clearly articulate a reason for rejecting the EMA’s opinion finding that the surgery was not appropriate.