Cases

Claimant's authorized doctor recommended a cervical fusion which was wrongfully denied by the employer/carrier.  Claimant therefore went to another doctor and had a different less intrusive surgical procedure.  The employer/carrier asserted that the less intrusive surgical procedure was not the major contributing cause of the claimant's on-the-job accident.  

An injured worker may obtain wrongfully denied medical treatment at the expense of the employer/carrier under the self-help provisions of Section 440.13(2)(c), Florida Statutes. Where this self-help provision applies, the JCC has the statutory authority to authorize a doctor for care provided during the period of wrongful denial.

The claimant's burden under the "self-help" provision of Section 440.13(2)(c) is to show that the surgery that he actually received (a different surgery than what the authorized doctor recommended) was compensable, reasonable, and medically necessary.  In this case, no medical testimony concerning the cause and medical necessity of the less invasive surgery received from the unauthorized doctor, the JCC only cited evidence of medical necessity based on the medical records from the self-help doctor.  This was error under 440.13(5)(e). 

Only opinions from authorized providers, Independent Medical Examiners, and Expert Medical Advisors are admissible in workers' compensation proceedings. The medical opinions of an unauthorized self-help doctor are not admissible unless and until it is established (by other admissible evidence and medical opinions) that the care rendered by the self-help doctor was compensable and medically necessary.  The self-help doctor's opinion on compensability and medical necessity cannot "bootstrap" itself into evidence. In this case, the judge appeared to bootstrap records of the self-help provider because no other admissible evidence existed that the claimant's surgery was compensable and medically necessary.