Disability Law

Claim for Past Due Medical Bills Was a "Reimbursement Dispute"

By David A. McCranie, Esq.

Although I failed to discuss it earlier, one of the First DCA's more interesting decisions from 2007 was the case of Avalon Center v. Hardaway.  In that case, the court held that pursuant to §440.13(11)(c), Fla. Stat., the Agency for Health Care Administration ("AHCA"), not the judge of compensation claims, has jurisdiction over "reimbursement disputes" concerning the payment of medical bills.  And under §440.13(1)(r), Fla. Stat., a "reimbursement dispute" is "any disagreement between a health care provider or health care facility and carrier concerning payment for medical treatment."

Now, in Orange County, Florida v. Willis, decided on 9/26/2008, the court has held that a "reimbursement dispute" includes a situation where, due to a "mix-up," the carrier simply "fell behind" in paying the bills from the claimant's authorized treating physician.  Therefore, because he lacked jurisdiction over the dispute, and because the claimant lacked standing to bring the claim in the first place, the JCC erred in ordering the E/C to pay the claimant's attorney's fees.

Full post as published by Florida Workers’ Compensation Law Blog on October 23, 2008 (boomark / email).