Avalon Center v. Hardaway, No. 1D06-2698.

CourtCourt of Appeal of Florida (US)
Writing for the CourtPolston
Citation967 So.2d 268
Decision Date21 September 2007
Docket NumberNo. 1D06-2698.
PartiesThe AVALON CENTER and Unisource Administrators, Appellants, v. Jane HARDAWAY, Appellee.
967 So.2d 268
The AVALON CENTER and Unisource Administrators, Appellants,
v.
Jane HARDAWAY, Appellee.
No. 1D06-2698.
District Court of Appeal of Florida, First District.
September 21, 2007.
Rehearing Denied October 26, 2007.

[967 So.2d 270]

Mark S. Spangler, of The Law Offices of Mark S. Spangler, P.A., Maitland, and Stephen Hogan, of McConnaughhay, Duffy, Coonrod, Pope & Weaver, P.A., Tallahassee, for Appellants.

T. Rhett Smith and Teresa E. Liles, of T. Rhett Smith, P.A., Pensacola, for Appellee.

POLSTON, J.


In this workers' compensation appeal, appellants The Avalon Center and Unisource Administrators, the employer and insurance carrier respectively (E/C), appeal a final compensation order, wherein the Judge of Compensation Claims (JCC) ordered payment of $1,891.00 in medical bills to claimant's authorized treating psychiatrist. The JCC also awarded claimant entitlement to attorney's fees and costs. Because we agree with the E/C's alternative arguments that the Agency for Healthcare Administration (AHCA) has exclusive jurisdiction over these disputes between the E/C and psychiatrist, and that the claimant lacks standing, we reverse the final compensation order.

I. BACKGROUND

On December 11, 1991, appellee/claimant Jane Hardaway was employed by The Avalon Center as a child therapist, when she was attacked by one of her patients, a seven year-old boy. Claimant suffered injuries, primarily cuts and bruises, to her face, neck, and arms. Accordingly, the E/C authorized and provided claimant treatment for her resulting physical and mental injuries.

In November 1995, claimant began treatment with Dr. Paul Neal, a clinical psychologist with the Christian Psychological Center. The E/C has continually authorized Dr. Neal's treatment of claimant. From his initial interview with the claimant in 1995, through the present date, Dr. Neal has diagnosed Ms. Hardaway as suffering severe depression, post-traumatic stress disorder, and suicidal ideation, causally related to her accident in 1991.

The E/C alleges that, since beginning treatment in 1995, Dr. Neal has billed the carrier more than $37,000 for claimant's psychotherapy. Accordingly, Ms. Allison Tomme, a senior claims representative for Unisource Administrators, testified by deposition that after several years of ongoing treatment, she submitted Dr. Neal's charges to the E/C's attorney, appellate counsel Mark S. Spangler, for a utilization review pursuant to section 440.13(6), Florida Statutes (2006). That statute requires that workers' compensation insurance carriers review all bills submitted for payment by authorized health care providers, in order to "identify overutilization and billing errors." See § 440.13(6), Fla. Stat. (2006). If the carrier indeed finds that the provider has over utilized the medical services provided, or otherwise discovers a violation of the parameters for treatment set forth in the Workers' Compensation Act, the carrier "must disallow or adjust payment for such services." Id.

Dr. Neal testified in his deposition that he received the utilization review Advisement Letter and Notices of Disallowance from the carrier, and that he understood from the letters that certain bills for claimant's treatment were disallowed. He further testified that he was aware claimant was not responsible for payment of the disallowed bills. Indeed, Dr. Neal testified that, from the carrier's letters, he knew he could challenge the carrier's disallowance

967 So.2d 271

by filing a petition with AHCA. Nonetheless, Dr. Neal conceded he did not file a petition, at the claimant's urging, but rather decided to allow the claimant to pursue the dispute through proceedings before the JCC.

Claimant filed a petition for benefits on October 24, 2005, seeking reimbursement, on Dr. Neal's behalf, for the dates of service disallowed by the carrier. The E/C subsequently filed a motion to dismiss the petition for lack of subject matter jurisdiction, arguing that AHCA has exclusive jurisdiction to resolve reimbursement disputes between an insurance carrier and a health care provider. The JCC reserved ruling on the motion until the final order.

Thereafter, on August 24, 2006, the JCC held a compensation hearing on the petition. Relevant to this appeal, claimant's counsel objected during the hearing to the admission into evidence of the E/C's Advisement Letter and the Notices of Disallowance relating to the disallowed medical charges. Claimant argued that the correspondence was inadmissible hearsay. She also asserted that the letters could not be authenticated, because the E/C's attorney had drafted the letter, but was not presented as a witness. The JCC again reserved ruling on claimant's objection until the final order.

On April 28, 2006, the JCC entered the instant final compensation order. The JCC ruled that the Letter of Advisement and the Notices of Disallowance were excluded from evidence, on grounds that the documents were both unauthenticated and hearsay, subject to no exceptions. Regarding the E/C's motion to dismiss for lack of jurisdiction, the JCC found that, pursuant to Florida Statutes, a claimant may bring a petition for benefits seeking payment of past medical bills and that it had jurisdiction to resolve petitions for past medical bills. While the JCC noted that AHCA has jurisdiction over utilization reviews, the JCC found there was no admissible evidence of a utilization review in this case. Accordingly, the JCC ruled it had subject matter jurisdiction to resolve claimant's petition. Ultimately, the court awarded claimant $1,891.00 in medical benefits owed to Dr. Neal, as well as attorney's fees and costs. The E/C presently appeals the order.

II. JURISDICTION

The E/C assert that the JCC erred in asserting jurisdiction over the disputes between the insurance carrier and authorized psychiatric care provider, Dr. Neal, and alternatively, that the claimant is without standing to petition the JCC for reimbursement of the disallowed bills on Dr....

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13 practice notes
  • Sims Crane & Equip. Co. v. Preciado, 1D21-2661
    • United States
    • Court of Appeal of Florida (US)
    • 12 Octubre 2022
    ..."general" jurisdiction over any subject matter beyond that specifically conferred by statute." Avalon Ctr. v. Hardaway, 967 So.2d 268, 272 (Fla. 1st DCA 2007) (citing Travelers Ins. Co. v. Sitko, 496 So.2d 920, 921-22 (Fla. 1st DCA 1986) ("We begin our analysis with the ......
  • Bend v. Shamrock Serv., No. 1D10–0019.
    • United States
    • Court of Appeal of Florida (US)
    • 13 Abril 2011
    ...of general jurisdiction, and cannot reform contracts or effect a remedy not provided for in chapter 440. See Avalon Ctr. v. Hardaway, 967 So.2d 268, 272 (Fla. 1st DCA 2007); see also Fred Stevens Tree Co. v. Harrison, 944 So.2d 1109, 1111 (Fla. 1st DCA 2006); see also McArthur, 35 So.3d at ......
  • Bend v. Shamrock Serv., CASE NO. 1D10-0019
    • United States
    • Court of Appeal of Florida (US)
    • 28 Febrero 2011
    ...of general jurisdiction, and cannot reform contracts or effect a remedy not provided for in chapter 440. See Avalon Ctr. v. Hardaway, 967 So. 2d 268, 272 (Fla. 1st DCA 2007); see also Fred Stevens Tree Co. v. Harrison, 944 So. 2d 1109, 1111 (Fla. 1st DCA 2006);see also McArthur, 35 So. 3d a......
  • J.B.D. Brother's v. Miranda, No. 1D09-3402.
    • United States
    • Court of Appeal of Florida (US)
    • 25 Enero 2010
    ...440.13(1)(r) and (11)(c), Fla. Stat. (2008); Orange County v. Willis, 996 So.2d 870, 871 (Fla. 1st DCA 2008); Avalon Center v. Hardaway, 967 So.2d 268, 271-73 (Fla. 1st DCA 2007). Moreover, Claimant has no standing to seek payment of a bill on behalf of a health care provider because he is ......
  • Request a trial to view additional results
13 cases
  • Sims Crane & Equip. Co. v. Preciado, 1D21-2661
    • United States
    • Court of Appeal of Florida (US)
    • 12 Octubre 2022
    ...do not have "general" jurisdiction over any subject matter beyond that specifically conferred by statute." Avalon Ctr. v. Hardaway, 967 So.2d 268, 272 (Fla. 1st DCA 2007) (citing Travelers Ins. Co. v. Sitko, 496 So.2d 920, 921-22 (Fla. 1st DCA 1986) ("We begin our analysis with the premise ......
  • Bend v. Shamrock Serv., No. 1D10–0019.
    • United States
    • Court of Appeal of Florida (US)
    • 13 Abril 2011
    ...of general jurisdiction, and cannot reform contracts or effect a remedy not provided for in chapter 440. See Avalon Ctr. v. Hardaway, 967 So.2d 268, 272 (Fla. 1st DCA 2007); see also Fred Stevens Tree Co. v. Harrison, 944 So.2d 1109, 1111 (Fla. 1st DCA 2006); see also McArthur, 35 So.3d at ......
  • Bend v. Shamrock Serv., CASE NO. 1D10-0019
    • United States
    • Court of Appeal of Florida (US)
    • 28 Febrero 2011
    ...of general jurisdiction, and cannot reform contracts or effect a remedy not provided for in chapter 440. See Avalon Ctr. v. Hardaway, 967 So. 2d 268, 272 (Fla. 1st DCA 2007); see also Fred Stevens Tree Co. v. Harrison, 944 So. 2d 1109, 1111 (Fla. 1st DCA 2006);see also McArthur, 35 So. 3d a......
  • J.B.D. Brother's v. Miranda, No. 1D09-3402.
    • United States
    • Court of Appeal of Florida (US)
    • 25 Enero 2010
    ...440.13(1)(r) and (11)(c), Fla. Stat. (2008); Orange County v. Willis, 996 So.2d 870, 871 (Fla. 1st DCA 2008); Avalon Center v. Hardaway, 967 So.2d 268, 271-73 (Fla. 1st DCA 2007). Moreover, Claimant has no standing to seek payment of a bill on behalf of a health care provider because he is ......
  • Request a trial to view additional results

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