Appeals court dismisses doctor’s fee strike effort

A Florida appeals court overturned a claims judge’s decision dismissing a duly licensed attending physician whose initial assessment and treatment costs exceeded base fee schedule rates.

“We are reversing because the Workers’ Compensation Code does not allow a (compensation claims judge) to disbar a duly licensed attending physician because of a fee-related issue,” the court said in its decision to wednesday in Palm Beach County School District v. Smithfiled with the Tallahassee First District Court of Appeals.

Frances Smith requested a one-time change of doctor, which her employer granted. The employer appointed a new treating physician, scheduled an appointment and withdrew authorization from the original treating provider. The employer and new doctor completed a fee agreement form authorizing an advance payment of $800 for the initial assessment and treatment, an amount that exceeded the base fee schedule rate, according to the decision.

Smith argued that the higher payment changed the authorized treating provider to an independent medical examiner, voided the provider’s authorization, and entitled him to another change of doctor.

The employer refused to allow a change and instead revised the wording of the fee agreement with the doctor to bring the $800 payment into line with a statutory provision allowing fees above the fee schedule.

After a hearing, a compensation claims judge concluded that a doctor “is not a licensed attending physician when the doctor charges more than the maximum amount allowed by law”. The judge fired the doctor provided by the employer and ordered that Smith be given a one-time change of his choice.

The appeals court said it had already recognized that a compensation claims judge cannot order an employer to pay an approved provider above the fee schedule rate.

WorkCompCentral is a sister publication of Business Insurance. More stories here.

About Yvonne Lozier

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