Important Evolving Case Law & Strategy on Excess Fees to Authorized Doctors

Please be aware of a new line of cases, at the Judges of Compensation Claims level, and the quick reaction of the Claimant’s Bar to try to exclude favorable opinions of authorized doctor

Florida Statute 440.13 (13)(d) requires that fees charged for medical care not exceed the fee schedule, unless there is a written agreement that the doctor will do certain extra services.  The Statute mentions, as a reason to depart from the fee schedule, the doctor agrees “to follow identified procedures aimed at providing quality medical care to injured works at reasonable costs.”  The Statute goes on to say that the doctor also agrees to “the timely scheduling of appointments for injured workers, participating in return-to-work programs with injured workers’ employers, expediting the reporting of treatments provided to injured workers, and agreeing to continued education, utilization review, quality assurance, precertification, and case management systems that are designed to provide needed treatment for injured workers.”

Judge Kerr, in Miami, recently ruled (in Padron v Majestic Mirror & Frame & Associated Industries Insurance Company, OJCC #14-004606, 07/07/2015) that the opinions of the authorized doctor were not admissible in evidence since he was paid in excess of the fee schedule and the Employer/Carrier did not present any evidence of why a departure from the fee schedule was warranted under F.S. 440.13(13)(d).

We have seen Claimants’ attorneys throughout the State trying to use this tactic to exclude medical opinions that are not favorable to their clients.

We understand that you often have to agree to pay above the fee schedule to get qualified doctors on a claim and have the following suggestions to avoid having favorable opinions excluded from evidence:

~ Consider notifying the doctor, in writing, that in exchange for agreeing to pay above the fee schedule that she/he is agreeing to follow identified procedures aimed at providing quality medical care to injured workers at reasonable costs and agrees to the timely scheduling of appointments for injured workers, participating in return-to-work programs with injured workers’ employers, expediting the reporting of treatments provided to injured workers, and agreeing to continued education, utilization review, quality assurance, precertification, and case management systems that are designed to provide needed treatment for injured workers.

~ Document in your claims notes and notify your defense attorneys when you have agreed to pay a doctor in excess of the fee schedule so your attorneys can make sure that it is documented that the doctor agrees to do the extra services that warrant a departure from the fee schedule.

We would be happy to help you draft a letter to send to doctors who charge above the fee schedule which explains the Statute and what we need from them to be able to pay the charges they demand.