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A Florida appeals court on Wednesday sided with a narcotics officer who was injured in a flash-grenade accident and then suffered a second injury three months later during a 1993 shooting.
Wednesday's ruling in Maggie Avery v. City of Coral Gables and Johns Eastern overturned a workers compensation judge's ruling allowing the city and its claims administrator to “de-authorize” or discontinue psychiatric care Ms. Avery had received from two treating physicians over a period of about 15 years.
The doctors treated her for mood disorder, depression, anxiety, insomnia, and post-traumatic stress disorder. But in 2009, the employer called for an independent medical exam, which found Ms. Avery's treatment under the doctors was excessive and unwarranted.
As a result, the employer advised Ms. Avery that her psychiatric care had been transferred from her doctors to another physician. The employer also issued a notice that it was deauthorizing further treatment from her doctors.
The employer and claims administrator cited a Florida statute allowing an insurer to transfer an injured worker's care when an independent medical exam determines the claimant is not making “appropriate progress in recuperation.”
Ms. Avery, however, had reached maximum medical improvement years before the independent medical exam. Maximum medical improvement is a point after which no improvement in medical condition can be anticipated.
So Ms. Avery's doctors were providing her only palliative care, which is not designed to improve the claimant's condition, but to help with pain or the effects of an injury, according to the opinion handed down Wednesday by Florida's 1st District Court of Appeal.
The appellate court found that as a matter of Florida law, a claimant who has reached maximum medical improvement cannot be “in recuperation.” Therefore the statute cited by the employer as justification for de-authorizing her treatment did not apply to the case at hand.
The court also advised that the proper remedy for an employer concerned about overutilization is to obtain an overutilization determination from Florida's Division of Workers Compensation.
The appellate court reversed the judge's finding and remanded the case for an order consistent with its opinion.
A woman's gastric bypass surgery and subsequent weight loss did not constitute a change in condition that would have allowed her workers compensation claim to be reopened, and her employer shouldn't have to pay for the procedure, the Iowa Court of Appeals ruled this week.