Date: 03-18-2015

Case Style: Rafael Echevarria v. Luxor Investments, LLC and Associated Industries Insurance Company

Case Number: 1D14-3540

Judge: Thomas

Court: Florida Court of Appeal, First District on appeal from an order of the Judge of Compensation Claims

Plaintiff's Attorney: Kim. Hill for Rafael Eshevarria

Defendant's Attorney: Rayford H. Taylor and Carol K. Shalaby of Quintairos, Prieto, Wood & Boyer, P.A., Fort Lauderdale, for Appellees.

Description: In this workers’ compensation case, Claimant appeals a ruling of the Judge of Compensation Claims (JCC) denying a follow-up appointment with his authorized neurologist for his compensable injuries. The JCC found that the Employer/Carrier
met its burden to prove that the compensable injuries are not the major contributing
cause (MCC) of Claimant’s need for the requested benefit. The JCC further found
that “no further neurological treatment is medically necessary in this cause inasmuch
as the industrial injuries no longer comprise the MCC for the requested follow-up.”
We affirm. We write only to respond to Claimant’s argument that as a matter
of law his permanent impairment rating assigned for his compensable injuries entitle
him to ongoing palliative treatment, even in the absence of any medical testimony
establishing a need for treatment. Neither the relevant statutory provisions within
chapter 440, nor our case law, establish such an entitlement in the absence of
evidence of medical necessity for the treatment, defined in part as “appropriate to
the patient’s diagnosis” – the diagnosis being the compensable injury. See
§ 440.13(2)(a), Fla. Stat. (2006) (requiring employer to furnish medically necessary
care); § 440.13(1)(l), Fla. Stat. (2006) (defining “medical necessity”). Our decision
in Homler v. Family Auto Mart, 914 So. 2d 1071, 1073 (Fla. 1st DCA 2005), states:
“The law is clear that once a claimant establishes a PI [permanent impairment], he
or she is entitled to ongoing palliative care for the condition.” But this court also
recognized that evidence of medical necessity was present in that case, stating that
“the medical testimony and reports reflect that claimant has a continuing need for
palliative care of her compensable neck injury.” Id. Here, there was no such
evidence to establish that Claimant had a medical necessity for palliative treatment.
2
We acknowledge that some permanent injuries do not require ongoing active treatment but may require periodic doctor visits to ensure that the compensable injury is not worsening or in need of further evaluations or treatment. Nevertheless, here, because Claimant did not establish that either periodic visits or further evaluations by his authorized doctor are appropriate for his compensable workplace injury, we affirm the JCC’s ruling. See Smith v. James Pirtle Constr. Co., 405 So. 2d 290, 291 (Fla. 1st DCA 1981) (“Claimant asserts that, as a consequence of having had a compensable permanent impairment, he has an absolute right to a physician's examination to determine if further medical care, either palliative or remedial, is necessary. We are referred to no such precedent and, absent any evidence from claimant or otherwise, we conclude the deputy correctly denied the motion.”).

Outcome: AFFIRMED

Plaintiff's Experts:

Defendant's Experts:

Comments: