Hampton v. Fantastic Sam's
| Decision Date | 25 February 2008 |
| Docket Number | No. 1D06-6234.,1D06-6234. |
| Citation | 977 So.2d 667 |
| Parties | Gloria HAMPTON, Appellant, v. FANTASTIC SAM'S and United Self Insured Services, Appellees. |
| Court | Florida District Court of Appeals |
Wendy S. Loquasto of Fox & Loquasto, P.A., Tallahassee; Susan W. Fox of Fox & Loquasto, P.A., Tampa; and Laurie T. Miles of Smith, Feddeler, Smith & Miles, P.A., Lakeland, for Appellant.
Bettina N. Carrier of Ross Vecchio, P.A., Lakeland, for Appellees.
Claimant appeals the JCC's order denying payment for previously received psychiatric care and denying further psychiatric treatment. Because we determine that the JCC erred by overruling his previous order when denying payment of Claimant's previously received psychiatric treatment, we reverse in part and remand. We affirm the JCC's denial of payment of other previously received psychiatric care and authorization of further treatment, as no authority exists in chapter 440, Florida Statutes, for a physician to transfer a claimant's care to another physician upon the original physician's retirement.
Claimant was employed as a hairstylist from 1989 until 2002. She suffered two work-related accidents in 2001 and 2002, which Employer/Carrier (E/C) accepted as compensable. After attempting numerous therapies as well as a reduced work schedule, she could not alleviate the pain in her arms; therefore, Employer could no longer employ her, and Claimant became increasingly depressed because she could no longer work as a hairstylist. Claimant's attorney corresponded with E/C on February 5, 2003, requesting psychiatric care, but E/C did not authorize treatment. Id. In April 2003, Claimant began treating with Dr. Arturo Gonzalez, who subsequently diagnosed her with depression.
Claimant sent Dr. Gonzalez's bill to E/C on April 14, 2003, along with another treatment request; both were denied. E/C later requested an independent medical examination, where Claimant was diagnosed with depression attributable to her workplace injuries and it was found that Dr. Gonzalez's treatment was reasonable and necessary. In September 2003, E/C authorized psychiatric care and provided Claimant with the names of three psychiatrists. Claimant instead elected to continue treating with Dr. Gonzalez and, following his retirement, with Dr. Gonzalez' partner and nurse, Dr. Charles Walker and Nurse Susan Hansted.
After a merits hearing held in 2003, the Judge of Compensation Claims (JCC) issued a final order granting Claimant indemnity benefits. In his 2004 order, the JCC admitted Dr. Gonzalez's testimony over E/C's objection, finding that Dr. Gonzalez became an authorized provider by operation of law pursuant to section 440.13(2), Florida Statutes (2001), as Claimant had requested psychiatric care on January 31, 2003, but E/C had refused "for some time" to provide such treatment. The JCC found Dr. Gonzalez's treatment to be reasonable and necessary as a result of Claimant's workplace injuries, and he accepted Dr. Gonzalez's testimony as that of an authorized treating physician "for all purposes." The JCC recognized that Claimant had not filed a petition for psychiatric treatment at the time of the 2003 merits hearing because her claim for psychiatric treatment was still within the managed care grievance process.
In 2004 and 2005, Claimant filed several petitions for benefits seeking payment of her medical bills and authorization for future psychiatric care. E/C denied the petitions for benefits because Drs. Gonzalez and Walker and Nurse Hansted were not authorized treating providers, Claimant had not exhausted the managed care grievance procedure, and it had timely authorized three alternative psychiatrists within the managed care network.
A merits hearing was held in 2006 on Claimant's medical benefits claim. The JCC denied payment of Dr. Gonzalez's bills and any further treatment, finding that Claimant had waived the issue of whether she was entitled to psychiatric care by not raising it in a petition seeking such care before the 2003 merits hearing. The JCC concluded that his 2004 order was res judicata on the issue of Claimant's entitlement to psychiatric care and payment of her medical bills. The JCC acknowledged that in his 2004 order he accepted Dr. Gonzalez's testimony as that of an authorized provider, but not as an authorized psychiatric care provider. The JCC further found that he had not ruled on Claimant's entitlement to psychiatric care in 2004 because her claim was still within the managed care grievance process.
The JCC also denied Claimant's request for payment of Dr. Walker's and Nurse Hansted's bills and her request for authorization of future treatment with them, reasoning that even if...
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