Finally - something self-executing!

It seems like a lot of the decisions we've been getting out of the First District Court of Appeal lately have been engineered to increase litigation, rather than reduce it (the so-called self-executing nature of the statute being one of Chapter 440's stated goals). It's refreshing to get an opinion that actually benefits both sides of the table and simplifies dispute resolution.

When the opinion in Avalon Center v. Hardaway, 967 So. 2d 268, 271 (Fla. 1st DCA 2007) was handed down about 5 years ago, it caused a fair amount of gnashing of teeth, and for good reason. In Hardaway the Court held that a Judge of Compensation Claims does not have jurisdiction to enter rulings over disputes concerning medical bills. While a JCC can find that the TREATMENT is medically necessary, the JCC can't order the Employer/Carrier to pay specific bills which are outstanding - juridiction for resolving those sorts of disputes resides exclusively with the Florida Agency for Health Care Administration (AHCA). This had the feel of a well-meaining decision. JCC"s are ill-equipped to be wrangling with fee schedules or to order an Employer/Carrier to pay a bill in a specific amount, when that amount could very well be in legitimate dipsute - a dispute which the JCC can't resolve.

Unfortunately, non-payment of medical bills is the reason a lot of injured workers seek out legal representation in the first place. Because of the divergent nature of Florida's workers' compensation system, which vests different administrative bodies with different responsibilities in the oversight of the system, there are a lot of rough "seams" where some of those responsibilities meet. Payment of medical providers has always been one of those areas. An injured worker receiving undisputed treatment for a compensable injury rightly does not want to receive threatening notices in the mail or harassing phone calls about medical bills. On the other hand, employer/carriers do not want to find themselves in litigation every time an injured worker receives treatment and they choose to exercise their rights to argue or reduce the amount charged by the provider.

The Court's decision in Bergstein v. Palm Beach County School Board, 37 Fla. L. Weekly D 1978 (Fla. 1st DCA 2012) is a common sense opinion which strikes a compromise between these competing interests and should (At least, in theory) make everyone happy. Simply put, if an Employer/Carrier takes the position in the course of a dispute that it is responbile for a given medical bill, that effectively stops litigation over the dispute immediately. It is a deemed a binding stipulation on the Employer/Carrier but, more importantly, it serves as a representation that if any entity is responsible for payment of the bill it is the carrier, not the Claimant. The Claimant should then be able to present this stipulation, along with a reference to this decision, if necessary, to stop any entity from harassing him or her further.

It's refreshing to get an opinion which actually DOES enhance the self-executing nature of the system. That seems like a rarity these days.

Brian D.


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