A Florida appeals court overturned the denial of a worker’s request for health care services prescribed by her doctor.
After Kelly Girardin suffered a work-related injury, her licensed attending physician wrote her a prescription for a home health evaluation and care for 12 hours a day, according to Girardin v. AN Fort Myers Imports LLCinto the Court of Appeals for the First District of Florida in Tallahassee.
Girardin attached a copy of the prescription to an application for benefits. Her employer’s insurer responded that the nursing care was approved and then contacted the doctor to ask for more information.
The doctor said he prescribed the home evaluation because he knew nothing about Girardin̵
7;s home situation and could not provide any details about how much and what type of care she would need.Over the next few months, the insurer retained agencies to conduct three home visits and assessments, with the last occurring just days before the final hearing. The insurer did not give the doctor the evaluations.
At the final hearing, the insurer argued that it had not yet received a written prescription that was sufficiently specific.
The tort judge agreed, finding that the carrier was not responsible for providing care until a physician provided a written prescription specifying the time periods for such care, the level of care, and the type of assistance required.
The Court of Appeals reversed and remanded, stating that the law requires a written prescription with certain information before a carrier will be responsible for providing care, but the carrier cannot “attempt to hide behind a wall of willful ignorance” by not giving the physician the results so that he could provide written details.
“This was little more than using the statute as a shield relieving them of their duty to ‘monitor a plaintiff’s injuries and provide necessary benefits,'” the ruling said.
WorkCompCentral is a sister magazine to Business Insurance. More stories here.
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