A Florida appellate court recently reversed an order by a Judge of Compensation Claims requiring the employer/carrier to provide Claimant with treatment for a renal mass/cancer to the extent that it was a hindrance to treatment of a compensable lumbar spine injury [Sears Outlet v. Brown, 2014 Fla. App. LEXIS 19939 (1st DCA, Dec. 9, 2014)]. Observing that the JCC found the “self-help” medical treatment provision [§ 440.13(2)(c), Fla. Stat.] applicable based solely on the JCC’s determination that the E/C wrongfully denied the medical care, the court indicated § 440.13(2)(c) expressly provides that there must be a specific request for treatment or care, and the employer or carrier must be given a reasonable time period within which to provide the treatment or care, before a claimant is entitled to recover any amount expended for initial treatment or care. Here it was undisputed that there was no such request, nor was the E/C given the opportunity to provide the care. It was error, therefore, for the JCC to require the E/C to pay for the treatment.
Claimant experienced a recurrence of back pain after undergoing low back surgery to treat a compensable injury. During an authorized orthopedic workup for a second back surgery, an MRI revealed a right kidney mass suspicious for renal cancer. The E/C subsequently authorized a urologist to clear Claimant for the proposed back surgery. The urologist referred the worker to a hospital for further diagnostic testing with partial or complete removal of the kidney. Instead of requesting the recommended kidney diagnostics and surgery from the E/C, Claimant had the procedure done at a hospital on an unauthorized, non-emergency basis. Only after the procedure was complete (with Claimant’s kidney being removed resulting in a final diagnosis of renal cancer) did Claimant ask the E/C to pay for such treatment.
It was undisputed that the kidney mass needed to be removed before Claimant could undergo further evaluation of the low back, have the back surgery, or take additional anti-inflammatories. Applying the hindrance-to-recovery doctrine, the JCC determined that the E/C was responsible for treating the unrelated kidney condition to the extent necessary to remove the hindrance it created to treating the compensable back injury. The JCC also ruled that Claimant’s failure to request authorization for the kidney surgery was excused under the self-help provision of § 440.13(2)(c), Fla. Stat. Accordingly, the JCC directed the E/C to pay the hospital for the admission for the kidney surgery and to reimburse Claimant for the related payments he made directly to the hospital. As noted above, the appellate court found the JCC’s decision to be in error.