No Genuine Dispute of Material Fact with Doctors' Bills

Thursday, January 20, 2011 | 0

By Michael Rabinowitz
Banker Lopez Gassler

Sorry for the absence, loyal readers.  The holiday season, more appellate work, and the entrance of my first child into the world kept me away.  But, I am back with a brand new 1st District Court of Appeal case summary. Once again, we return to a medical vendor dispute and whether a claimant even has the right to file a petition for unpaid authorized medical bills.

I think we know where this is going. . .

In Cook v. Palm Beach County School Board, claimant filed a petition seeking payment of past medical bills of an authorized treating doctor. The employer carrier (E/C) responded that the doctor remains authorized, they never denied treatment, and the doctor never submitted the bills to the E/C for payment.  Upon receiving the bills with the petition, the E/C processed and paid the doctor’s bills.

The E/C then moved the judge of compensation claims (JCC) for a summary order to dismiss the petition since the JCC lacked jurisdiction to hear medical vendor disputes between the E/C and a doctor.  The JCC granted the E/C’s motion and found there was no “genuine dispute of material fact” and dismissed the pending petition. Claimant appealed.

As you recall, back in November 2008, the 1st DCA ruled in Orange County v. Willis that the JCC lacks said jurisdiction. In a previous blog post about the Willis decision, I wrote the following:

“Section 440.13(11)(c) dictates that the Agency for Health Care Administration (“AHCA”) has 'exclusive jurisdiction' to decide any matters regarding provider reimbursement. As long as the carrier authorizes care with the doctor, the dispute about the doctor’s bills is outside the jurisdiction of the Judges of Compensation Claims.”

In other words, the claimant does not have a dog in this fight. This is a suit only the doctor can bring against the E/C, and then only through AHCA.

In Cook, the 1st DCA found the same as in Willis: that since the JCC lacked jurisdiction a summary order is appropriate. Summary orders are a valuable tool under Workers’ Compensation Rule of Procedure 60Q-6.120 where the pending petition has no “genuine dispute of material fact,” in other words: “there is nothing here, move along.”  There is no need for a trial.

For claims professionals: the petition for unpaid bills is the oldest trick in claimant’s attorney’s books. As long as you continue to authorize the care, there is no dispute between the parties. And, you owe no fee if you pay these bills 30 days past reciept of the petition.

<i>Michael Rabinowitz is an attorney for the Banker Lopez Gassler workers' compensation defense firm in Tampa, Fla. This column was reprinted with his permission from his Workers' Comp Corner blog, which can be found here: http://www.http://workerscompblog.wordpress.com/</i>