Skip to main content

Bergstein v Palm Beach County School Board




This August 7, 2012 1 DCA opinion affirmed Judge D’Amrosio’s ruling.

The 1DCA held that any E/C asserting the jurisdictional defense that the payment of outstanding bills for medical care is a reimbursement is conceding that, if any entity is financially responsible for the disputed bills, it is the carrier and not the claimant.
The 1DCA indicated that raising a 440.13(11)(c) defense is a de facto concession by the Employer/Carrier that the services or products billed were provided by an authorized provider for compensable injuries “in accordance with” or “pursuant to” chapter 440 and that the claimant is insulated from financial liability for such charges.
Furthermore, the E/C’s representation was a binding legal concession, by operation of section 440.32(3), and it waived any challenge to the medical necessity of the care.
 
Click here to see the 1DCA opinion
Labels:

Comments

Post a Comment

Popular posts from this blog

De la Cruz v Able Body Temporary Staffing

This March 6, 2012 1DCA opinion affirmed in part and reversed in part the JCC decision of Judge Sojourner. In this case, the claimant filed several petitions for benefits after injuring his right knee and left wrist in a workplace fall.  Among other things, Claimant sought authorization for a total knee replacement and TPD benefits related to the wrist injury that the Employer/Carrier had accepted as compensable.  The 1DCA held that the  JCC correctly held that the workplace accident was not the major contributing cause of Claimant’s need for knee surgery, and therefore, denied all related claims. The 1DCA affirmed that portion of the order. However, the 1DCA opined that the JCC did not rule on the TPD claim for the claimant's compensable wrist injury.  The 1DCA held that "Failure to rule on a fully tried issue is reversible error". To support their position, the 1 DCA cited the 1997 Betancourt v. Sears Roebuck & Co. Case.  The 1DCA...
Post a Comment
Read more

Is coronavirus compensable under WC?

According to the NCCI, The answer to that question is maybe. While WC laws provide compensation for “occupational diseases” that arise out of and in the course of employment, many state statutes exclude “ordinary diseases of life” (e.g., the common cold or flu). There are occupational groups that arguably would have a higher probability for exposure such as healthcare workers. However, even in those cases, there may be uncertainty as to whether the disease is compensable. Would time away from work during recovery be considered “temporary disability” or is it just normal “sick time”?    https://www.ncci.com/Articles/Pages/Insights-COVID19-WorkersComp.aspx
Post a Comment
Read more