11-0307 GILBERT THEISS, v. CITY OF PANAMA CITY BEACH and FLORIDA LEAGUE OF CITIES, INC.

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State: Florida

Court: Florida First District Court

Docket No: 11-0307

Case Date: 06/30/2011

Preview:IN THE DISTRICT COURT OF APPEAL FIRST DISTRICT, STATE OF FLORIDA GILBERT THEISS, Appellant, v. CITY OF PANAMA CITY BEACH and FLORIDA LEAGUE OF CITIES, INC., Appellees. _____________________________/ Opinion filed June 30, 2011. 11 An appeal from an order of the Judge of Compensation Claims. Laura Roesch, Judge. Date of Accident: August 13, 2008. Kimberly A. Hill of Kimberly A. Hill, P.L., Fort Lauderdale, for Appellant. Douglas F. Miller of Clark, Partington, Hart, Larry, Bond & Stackhouse, Pensacola, for Appellees. NOT FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND DISPOSITION THEREOF IF FILED CASE NO. 1D11-0307

PER CURIAM In this workers' compensation appeal, Claimant challenges an order of the Judge of Compensation Claims (JCC) that denies his claim for a primary care provider under his employer's managed care arrangement. errantly denied this benefit, we reverse. Because the JCC

Claimant suffered compensable injuries, both physical and psychological, for which he was furnished authorized medical care by his employer and its workers' compensation carrier (E/C), under a managed care arrangement. Claimant sought to exercise his right to select or change his primary care provider, as seemingly guaranteed by section 440.134(6)(c)10., Florida Statutes (2008), and Florida Administrative Code Rule 59A-23.003(7)(i) (providing injured employee "shall have the right to select a primary care provider and thereafter, to request one change of primary care provider . . . during the course of treatment"). The JCC denied Claimant the right to select or change his primary care provider on the basis that Claimant failed to introduce the managed care plan or agreement (the contract entered into by the Employer with a third party) into evidence, and thereby failed to persuasively establish such a right. The JCC alternatively concluded that Claimant was required to prove that a primary care provider, or a change in same, was medically necessary. Because every workers' compensation managed care arrangement under section 440.134 "must include" a provision "for the selection of a primary care provider by the employee," and further, because the Florida Administrative Code Rule regulating managed care authorization procedures provides that every "injured employee" receiving medical services under a workers' compensation managed care arrangement "shall have the right to select a primary care provider 2

and, thereafter, to request one change of primary care provider . . . during the course of treatment for each injury," we conclude it was error for the JCC to require Claimant to introduce the managed care plan into evidence to establish such a legal right. The right is established as a matter of legislative decree, to which any contractual rights would be subordinate. See

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