Chase v. Henkel & McCoy, 88-3207

• Citation: 562 So.2d 831
• Decision Date: 07 June 1990
• Docket Number: No. 88-3207,88-3207
• Court: Court of Appeal of Florida (US)
• Parties: 15 Fla. L. Weekly D1559 David CHASE, Appellant, v. HENKEL & McCOY and Liberty Mutual Insurance Company, Appellees.

Page 831

562 So.2d 831

15 Fla. L. Weekly D1559

David CHASE, Appellant, v. HENKEL & McCOY and Liberty Mutual Insurance Company, Appellees.

No. 88-3207.

District Court of Appeal of Florida,

First District.

June 7, 1990.

William W. Massey, III, Jacksonville, for appellant.

Mary Brand Love and Kristy D. Janda of Gobelman and Love, Jacksonville, for appellees.

SMITH, Judge.

Claimant appeals an order determining that the employer/carrier are not responsible for payment of certain doctor bills because the doctor did not submit his medical reports to the carrier and good cause did not exist for excusing the reporting requirement. We reverse.

Claimant injured his back while installing a telephone pole. He received treatment and was returned to work without restrictions. Thereafter, he requested chiropractic treatment, but the carrier refused authorization. The claimant then went to Dr. Fralicker, a chiropractor, on November 10, 1987. Initially, Dr. Fralicker submitted his reports and the carrier paid his bills. However, medical reports were not submitted to the carrier for services rendered by Dr. Fralicker after December 21, 1987. He testified that he stopped sending reports to the carrier after being told by the carrier that the billing was not authorized for workers' compensation and should be filed under a group health insurance policy. At approximately the same time, Dr. Fralicker was advised by the carrier that he was not authorized to treat the claimant.

After the carrier refused to authorize Dr. Fralicker, claimant filed a claim on February 19, 1988, seeking authorization of Dr. Fralicker. On the same date, claimant filed an application for hearing. On March 1, 1988, claimant was advised that the carrier was authorizing another chiropractor, Dr. Edwards. In the meantime, however, claimant continued treatment with his chiropractor, Dr. Fralicker.

Ultimately, a hearing was held before the judge of compensation claims, after which the judge determined that Dr. Fralicker's treatment was reasonable and necessary and causally related to claimant's industrial accident. However, the judge ruled that the employer/carrier was not responsible for Dr. Fralicker's bills between December 22, 1987, and September 20, 1988, because Dr. Fralicker failed to submit his medical reports. The judge reasoned that the employer/carrier, having authorized chiropractic care, albeit untimely, were not sent the reports required by law and to hold them responsible in this circumstance would require them to pay for services of which they were unaware.

Pursuant to section 440.13(2), Florida Statutes (1987), the employer is required to furnish the claimant medically necessary treatment, and should such treatment not be provided after request, the claimant may seek such treatment at the expense of the employer, the reasonableness and necessity to be approved by the judge of compensation claims. The statute provides for a separate reporting requirement which the doctor must comply with in order to be paid; but the judge may excuse, for good cause, the doctor's failure to furnish reports.

Past decisions of this court have held that once a claimant requests chiropractic treatment, the E/C must authorize the chiropractic treatment, offer alternative chiropractic care, or obtain a ruling from the judge that such alternative care was not in the claimant's best interest. The E/C's failure to comply renders them responsible for unauthorized chiropractic treatment if it is determined to be reasonable and necessary. Jackson v. Publix Supermarkets, Inc., 520 So.2d 50 (Fla. 1st DCA 1987); Kirkland v. Harold Pratt...