Sun Bank/South Florida, N.A. v. Baker, No. 92-0867

• Court: Court of Appeal of Florida (US)
• Writing for the Court: GROSS, J.
• Citation: 632 So.2d 669
• Docket Number: No. 92-0867
• Decision Date: 23 February 1994
• Parties: 19 Fla. L. Weekly D407 SUN BANK/SOUTH FLORIDA, N.A.; Lane, Gelety, Woolsey & Centrone, P.A.; C.L.G., Inc.; and North CT Scan Center, Appellants, v. James BAKER, Appellee.

Page 669

632 So.2d 669 19 Fla. L. Weekly D407 SUN BANK/SOUTH FLORIDA, N.A.; Lane, Gelety, Woolsey &
Centrone, P.A.; C.L.G., Inc.; and North CT Scan
Center, Appellants,
v.
James BAKER, Appellee. No. 92-0867. District Court of Appeal of Florida,
Fourth District. Feb. 23, 1994.

Page 670

Jon Chassen and Kelly S. Slay of Kelley Drye & Warren, Miami, for appellant--Sun Bank/South Florida, N.A.

Laurence F. Leavy of Laurence F. Leavy, P.A., North Miami Beach, and Elizabeth Russo of Russo, Talisman & Moylan, P.A., Coconut Grove, for appellee.

GROSS, J., Associate Judge.

This appeal is from a final order dismissing a complaint. The issue is whether, under the workers' compensation law, a health care provider may recover a fee in excess of the statutory maximum reimbursement allowance from an employee who settles with a third party tort-feasor. We hold that it may not and affirm.

On April 25, 1985, appellee James Baker injured his back in an automobile accident which occurred in the course and scope of his employment. He claimed workers' compensation benefits from his employer. He also sued a third party for negligence in causing the accident.

Baker sought treatment for his injuries from the Center for Neurological Services, Inc. (CNS). ¹ Before beginning treatment, Baker signed an agreement which made no reference to workers' compensation coverage. One paragraph contained an assignment of insurance benefits, along with the patient's promise to pay any part of the bill not paid by an insurer. A second provision provided that the agreement "constitutes a lien against any recovery for any liability from any source whatsoever."

On February 25, 1986, a CNS physician performed a chemonucleolysis on Baker's back. One month later, when the first procedure had afforded Baker no relief, another CNS physician performed a laminectomy. CNS billed the workers' compensation carrier for the maximum allowed under the statutory fee schedule. ² The carrier paid CNS about $19,000, pursuant to the schedule. In addition, CNS billed Baker for the same services at rates far in excess of the fee schedule, ³ which it claimed to be its usual and customary fees for the services provided. Based on the higher charges, CNS sought an additional $20,492.30 from Baker.

Baker settled his liability suit with the third party tort-feasor for a lump sum. No fact finder ever made any finding as to a specific element of damage or as to the liability of any party. Baker's attorney withheld the $20,492.30 sought by CNS from Baker's recovery and deposited it into his trust account. When he refused to release the funds, CNS filed suit, with counts for breach of contract, open account and quantum meruit. The trial court granted Baker's motion to dismiss.

CNS contends that language added to section 440.13(3) in 1983 permits it to enforce its contract with Baker and carve its "usual and customary" fee out of his settlement. This argument ignores chapter 440's insulation of employees from liability and its limitation on medical fees. Accepting CNS's argument would upset the balance struck by the legislature between the participants in the workers' compensation system.

Proper analysis of the 1983 amendment begins with an overview of the system established by chapter 440, Florida Statutes. The declared legislative intent of the workers' compensation law is "to assure the quick and efficient delivery of disability and medical benefits to an injured worker at a reasonable cost to the employer." Sec. 440.015, Fla.Stat. (1993). To achieve that end, the statute provides for a schedule of maximum reimbursement allowances for medical services. Sec. 440.13(4)(a), Fla.Stat. (1993). A health care provider or physician is to be reimbursed the lesser of either (a) the usual and customary charge for the service or (b) the maximum reimbursement allowance in the schedule. Secs. 440.13(4)(a) and (f), Fla.Stat.

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(1993). ⁴ By implementing a fee schedule ceiling on charges, the statute seeks to "promote health care cost containment and efficiency with respect to the workers' compensation health care delivery system." Sec. 440.13(4)(f), Fla.Stat. (1993). Florida courts have rigorously enforced fee schedule limits against health care providers who have sought higher fees for their services. See, e.g., Easter Elevator Co. v. Hedman, 290 So.2d 56, 58 (Fla.1974). ⁵ In this case, having received the maximum reimbursement allowance for the services provided, CNS may not recover any fee exceeding that amount. Secs. 440.13(4)(a) and (f), Fla.Stat. (1993).

In addition to the limitation on charges, the workers' compensation law makes the employer and insurance carrier legally responsible for paying medical bills, while the employee is insulated from liability. See Long Grove Builders, Inc. v. Haun, 508 So.2d 476, 477 (Fla. 1st DCA 1987); Secs. 440.10(1)(a) and 440.13(3), Fla.Stat. (1993). ⁶ To deliver medical benefits to the injured worker quickly and efficiently, as the Act requires, the statute cannot be read to place the worker in the position of shopping for a reasonable fee, anticipating potential liability for an amount exceeding fee schedule limits. For this reason, too, CNS is precluded from recovering additional fees from Baker.

In 1983, the legislature added language to section 440.13(3):

The health care provider or health care facility providing services pursuant to this section shall be paid for the services solely by the employer or its insurance carrier, except for payments from third parties who have been determined to be liable for such payment.

Sec. 440.13(3), Fla.Stat. (1983); Ch. 83-305, Sec. 4, at 1783, Laws of Fla. It is this amendment, CNS argues, which authorizes its lawsuit against Baker. However, such an expansive reading does not harmonize with the purposes of the Act and is not supported by the legislative history and development of section 440.13(3). ⁷

No reliable indicator of legislative purpose demonstrates an intent to abandon fee schedule limits or to impose liability on employees for chapter 440 medical treatment. The Florida senate staff analysis of chapter 83-305, Laws of Florida, describes the amendment to section 440.13(3) as "[p]roviding an express limitation...