Tejeda v. City of Hialeah/Sedgwick Claims Mgmt. Servs., Inc.
| Citation | 332 So.3d 13 |
| Decision Date | 29 December 2021 |
| Docket Number | 1D21-704 |
| Parties | Carlos TEJEDA, Appellant, v. CITY OF HIALEAH/SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., Appellees. |
| Court | Court of Appeal of Florida (US) |
Richard A. Sicking and Mark A. Touby of Touby, Chait & Sicking, P.L, Coral Gables, for Appellant.
Eduardo E. Neret of Law Offices of Eduardo E. Neret, P.A., Miami, for Appellees.
Claimant appeals the denial of his petitions for benefits. Claimant contends that the Judge of Compensation Claims (JCC) did not have jurisdiction to adjudicate the issue of Claimant's entitlement to reimbursement for the expenses from spinal fusion surgery because it was a "reimbursement dispute." The Claimant therefore contends that the Department of Financial Services (DFS) had sole jurisdiction. Claimant also contends that JCC erred by construing the meaning of the stipulation between the parties. We reject both arguments as explained below, and all other issues raised by Claimant in this appeal.
Claimant was involved in a motor vehicle crash while on the job as a firefighter. He injured his back in the crash, and the Employer/Carrier (E/C) accepted the injuries as compensable. Before the petition for benefits at issue, Claimant underwent various procedures for his back, including surgeries with Dr. Brusovanik. In 2017, Dr. Vanni was designated as the new authorized physician, and Dr. Brusovanik was deauthorized. The parties stipulated, "If Dr. Vanni opines that Claimant does require further surgical invention, the Employer/Servicing Agent will authorize same, and the Claimant will decide whether he wants to undergo such procedure."
In June 2020, despite Dr. Brusovanik being deauthorized as a treating physician, and without an opinion from Dr. Vanni, Claimant underwent spinal fusion surgery with Dr. Brusovanik. Claimant filed a petition for benefits seeking payment of the surgery bill and copayments as medically necessary. After a contested hearing, the JCC determined that the surgery was medically necessary. But the JCC also determined that the 2017 stipulation was binding on Claimant and denied reimbursement.
On appeal, Claimant contends that although he petitioned for benefits seeking reimbursement for the expenses of the spinal surgery, the 2017 stipulation made this a reimbursement dispute subject to the jurisdiction of DFS. Claimant is correct that subject matter jurisdiction may be raised at any time, including on appeal. See Seven Hills, Inc. v. Bentley , 848 So. 2d 345, 350 (Fla. 1st DCA 2003). But Claimant is incorrect that the dispute here meets the statutory definition of a reimbursement dispute.
A ruling on whether a proceeding is a reimbursement dispute is a conclusion of law reviewed de novo, to the extent it involves statutory construction. Avalon Ctr. v. Hardaway , 967 So. 2d 268, 271 (Fla. 1st DCA 2007). Section 440.13(1)(q), Florida Statutes (2020), defines a reimbursement dispute as "any disagreement between a health care provider or health care facility and carrier concerning payment for medical treatment." DFS "has exclusive jurisdiction to decide any matters concerning reimbursement...." § 440.13(11)(c), Fla. Stat. The E/C undoubtedly meets the statutory definition of carrier. See § 440.13(1)(c), Fla. Stat. But the Claimant does not meet the statutory definition of a health care facility or health care provider. See § 440.13(1)(f)–(g). A dispute between Claimant and the E/C therefore does not meet the statutory definition of a "reimbursement dispute." Since this was not a reimbursement dispute as defined by chapter 440, the JCC had jurisdiction to adjudicate the...
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