With the changes in the Florida workers’ compensation law post Castellanos, attorney’s fees continue to be at the forefront of every single workers’ compensation case with claimant attorneys hoping to secure a back attorney’s fee in addition to a fee on the settlement of every claim. Multiple Petitions for Benefits are being filed in every single case in hopes that the employer/carrier will fail to respond to a Petition for Benefits timely or fail to use the correct wording which will allow for attorney fee entitlement.
Claims for medical bills are perhaps the easiest way for a claimant’s attorney to secure a fee. Often, Petitions for Benefits are filed with the accompanying “bills” which we all know are not bills but instead are just billing statements or even collection letters. The Petition for Benefits will ask for the bill to be paid, and oftentimes, the employer/carrier is without complete information as to the date of service, with a billing statement date only. Oftentimes too, the employer/carrier is left with information as to the name of the facility only and is left to wonder whether the treatment is causally related to the work injury or not. We typically review these bills to determine if the date of service comports with the initial ER visit or some other ER admission which we are aware of based on review of the claims file materials and medical records from the authorized providers. It is with this information that we have to make a determination as to whether the medical services provided are causally related to the work injury and therefore should be placed in line for payment.
It is noteworthy, that if the employer/carrier is going to pay a medical bill – in responding to the Petition for Benefits – they must state that the bill will be placed in line for payment and of course it is acceptable to state that the bill will be paid once it is received on the proper billing format with the accompanying medical records – to be paid at the Florida workers’ compensation fee schedule. However, responding to a Petition for Benefits that the bill is under review or the employer/carrier will address whether the bill will be placed in line for payment following receipt of accompanying medical records will place the employer/carrier in a position of owing an attorney’s fee if the bill is paid after 30 days from the filing date of the Petition. Absent any response which states anything other than that the bill will be paid provides for attorney fee entitlement. Unfortunately, the statute requires the employer/carrier to make a quick decision – within 30 days in responding to the PFB as to whether or not the bill will or will not be paid. When in doubt, if the bill is consistent with the timeline of events connected with the work injury without any other information which would suggest that causal relationship is not established, consideration should be made for filing a response stating that the bill will be paid.
Keep in mind, too, that emergency room medical care and treatment is compensable provided that the claimant meets the burden of proof of establishing a causal connection and that the need for the care was in fact an emergency. Pursuant to the case of Cespedes v. Yellow Transportation, Inc, 130 So.3d 243 (Fla. 1st DCA 2013) the Court outlined the necessary burden of proof where the claimant established compensability of emergency room medical bills. This is an easy burden of proof for the claimant to establish and often can be elicited through the deposition testimony of the authorized treating provider as to the causal connection of the care to the work injury and the unavailability of the authorized provider as the claimant’s moment’s notice for medical care. For care to be qualified as “emergency care,” the claimant has the burden of proving 1)the service provider is a licensed physician; 2)the evaluation or care was conducted by that physician; and 3)the care was completed by that physician with the intent of determining if an emergency medical condition existed. Cespedes v. Yellow Transportation, Inc, 130 So.3d 243 (Fla. 1st DCA 2013) Once care qualifies as emergency care, pursuant to Church’s Chicken v. Anderson, 112 So.3d 545 (Fla. 1st DCA 2013), the claimant must prove 1)that the care was medically necessary and 2)that the care was causally related to the compensable injury. As such, this is another issue which should be addressed when responding to Petitions for Benefits and in an attempt to avoid an attorney’s fee – the easy fee that the claimant’s attorneys seek.