| History:
1) Any employee may, for any benefit that is ripe, due, and owing, file by certified mail, or by electronic means approved by the Deputy Chief Judge, with the Office of the Judges of Compensation Claims a petition for benefits which meets the requirements of this section and the definition of specificity in s. 440.02. The department shall inform employees of the location of the Office of the Judges of Compensation Claims for purposes of filing a petition for benefits. The employee shall also serve copies of the petition for benefits by certified mail, or by electronic means approved by the Deputy Chief Judge, upon the employer and the employer's carrier. The Chief Judge shall refer the petitions to the judges of compensation claims.
(2) Upon receipt, the Office of the Judges of Compensation Claims shall review each petition and shall dismiss each petition or any portion of such a petition that does not on its face specifically identify or itemize the following:
(a) Name, address, telephone number, and social security number of the employee.
(b) Name, address, and telephone number of the employer.
(c) A detailed description of the injury and cause of the injury, including the location of the occurrence and the date or dates of the accident.
(d) A detailed description of the employee's job, work responsibilities, and work the employee was performing when the injury occurred.
(e) The time period for which compensation and the specific classification of compensation were not timely provided.
(f) Date of maximum medical improvement, character of disability, and specific statement of all benefits or compensation that the employee is seeking.
(g) All specific travel costs to which the employee believes she or he is entitled, including dates of travel and purpose of travel, means of transportation, and mileage and including the date the request for mileage was filed with the carrier and a copy of the request filed with the carrier.
(h) Specific listing of all medical charges alleged unpaid, including the name and address of the medical provider, the amounts due, and the specific dates of treatment.
(i) The type or nature of treatment care or attendance sought and the justification for such treatment. If the employee is under the care of a physician for an injury identified under paragraph (c), a copy of the physician's request, authorization, or recommendation for treatment, care, or attendance must accompany the petition.
(j) Specific explanation of any other disputed issue that a judge of compensation claims will be called to rule upon.
The dismissal of any petition or portion of such a petition under this section is without prejudice and does not require a hearing.
(3) A petition for benefits may contain a claim for past benefits and continuing benefits in any benefit category, but is limited to those in default and ripe, due, and owing on the date the petition is filed. If the employer has elected to satisfy its obligation to provide medical treatment, care, and attendance through a managed care arrangement designated under this chapter, the employee must exhaust all managed care grievance procedures before filing a petition for benefits under this section.
(4) The petition must include a certification by the claimant or, if the claimant is represented by counsel, the claimant's attorney, stating that the claimant, or attorney if the claimant is represented by counsel, has made a good faith effort to resolve the dispute and that the claimant or attorney was unable to resolve the dispute with the carrier.
(5) All motions to dismiss must state with particularity the basis for the motion. The judge of compensation claims shall enter an order upon such motions without hearing, unless good cause for hearing is shown. When any petition or portion of a petition is dismissed for lack of specificity under this subsection, the claimant must be allowed 20 days after the date of the order of dismissal in which to file an amended petition. Any grounds for dismissal for lack of specificity under this section which are not asserted within 30 days after receipt of the petition for benefits are thereby waived.
(6) If the claimant is not represented by counsel, the Office of the Judges of Compensation Claims may request the Employee Assistance and Ombudsman Office to assist the claimant in filing a petition that meets the requirements of this section.
(7) Notwithstanding the provisions of s. 440.34, a judge of compensation claims may not award attorney's fees payable by the carrier for services expended or costs incurred prior to the filing of a petition that does not meet the requirements of this section.
(8) Within 14 days after receipt of a petition for benefits by certified mail, the carrier must either pay the requested benefits without prejudice to its right to deny within 120 days from receipt of the petition or file a response to petition with the Office of the Judges of Compensation Claims. The carrier must list all benefits requested but not paid and explain its justification for nonpayment in the response to petition. A carrier that does not deny compensability in accordance with s. 440.20(4) is deemed to have accepted the employee's injuries as compensable, unless it can establish material facts relevant to the issue of compensability that could not have been discovered through reasonable investigation within the 120-day period. The carrier shall provide copies of the response to the filing party, employer, and claimant by certified mail.
(9) A petition for benefits must contain claims for all benefits that are ripe, due, and owing on the date the petition is filed. Unless stipulated in writing by the parties, only claims which have been properly raised in a petition for benefits and have undergone mediation may be considered for adjudication by a judge of compensation claims.
History.--s. 25, ch. 93-415; s. 115, ch. 97-103; s. 16, ch. 2001-91; s. 31, ch. 2002-194; s. 22, ch. 2003-412.
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Relevant Case Law
Note: Failure to timely respond to a 440.192(8) petition does not waive carrier's right to later contest entitlement to benefits.
Note: Insurer must comply with managed care procedures or else waive right to claim injured party must exhaust grievance procedures.
Note: Decedent's acceptance of workers comp benefits she didn't file for is not a waiver of a wrongful death claim.
Note: Attorney fees appropriate for pre-petition time if petition not dismissed.
Note: E/C's 120 days to deny a claim will be calculated from the date of an amendment of petition if the request being denied was reqested in the amendment but not the original petition.
Note: E/C is precluded from complaining that they lacked information about the injury because there were "red flags" that were not investigated at the time.
Note: Because the E/C refused to authorize medically necessary emergency care even though the Motion for Emergency Conference was filed, they are liable for attorney's fees.
Note: Absent circumstances beyond the E/C's control, they cannot prevent a 20% penalty for being late on an installment payment simply by filing a notice of denial.
Note: The E/C, in trying to comply with federal law banning discrimination against disabled employers, created a sheltered position for the claimant. They cannot use that employment to deny PTD benefits.
Note: When the E/C has accepted the claimant as PTD within the 14 day period, even after initially denying it, an award of attorneys fees is inappropriate.
Note: An attorney representing a claimant is not authorized to schedule independent medical evaluations.
Note: Appellants' failure to act within fourteen days did not alter the timetable either for giving notice of a mediation conference or for actually holding the conference; both deadlines depend on when the petition for benefits is filed, not when or whether a notice of denial is filed.
Note: A petition cannot be amended except by stipulation of the parties and approval by the judge.
Note: Where a pretrial stipulation states a claim or defense to be presented, even though no formal claim or defense has been filed, and has been accepted and approved by the JCC, the claim or defense is properly at issue in a workers' compensation proceeding.
Note: There is no statutory authority for litigation before the JCC of IME controversies during the informal dispute resolution stage.
Note: A statute of limitations is to be applied prospectively unless legislative intent to the contrary is express, clear and manifest.
Note: a carrier who does nothing after the filing of a petition for benefits is deemed to have accepted it as compensable.
Note: A JCC may hold an emergency conference where there has been no exhaustion of preclaim procedures if there is a bona fide emergency involving the health, safety, or welfare of an employee.
Note: 440.20 does not discuss sanctions for an E/Cs failure to timely file a notice of denial.
Note: A petition must include a justification for the treatment sought.
Note: Within 14 days after receipt of a petition for benefits by certified mail, the carrier must either pay the requested benefits without prejudice to its right to deny within 120 days from receipt of the petition or file a notice of denial with the Division.
Note: The legislative repeal of the 21-day rule set forth in section 440.34(3)(b) is substantive and so in a case involving a 1990 accident the statute as it existed at the time shall be applied to the claim for attorney's fees.
Note: A Request for Assistance does not function as notice of the commencement of litigation, but is an alternate approach for the claimant to seek resolution without beginning the litigation process and acquiring the need for legal services.
Note: Where certain specific medical benefits were not requested as a part of a petition for benefits then such services cannot be awarded an injured worker.
Note: Section 440.192's requirement of a Social Security Number violates the Federal Privacy Act of 1974.
Note: SOL not tolled during the period that an earlier filed petition was pending before it was voluntarily dismissed.
Note: Claimant entitled to costs related to mail expenses, postage, and photocopying charges.
Note: Failure to indicate SSN on Petition for Benefits does not invalidate claim.
Note: Failure to take action following service of a '120-day pay and investigate' letter analogous to a denial of the claim.
Note: Waiver of right to deny compensability under section 440.20 does not preclude the E/C from challenging entitlement to benefits.
Note: Failure to file denial within 14 days of receipt of petition for benefits warrants award for penalties.
Note: More than 120 days had expired from the initial provision of benefits by the carrier, thereby waiving its right to deny compensability of the employee's back injury.
Note: The Agency for Healthcare Administration (AHCA) has exclusive jurisdiction over disputes between the E/C and the claimant's authorized treating psychiatrist, therefore the claimant is without standing.
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