Carlos Tejeda v. City of Hialeah/Sedgwick Claims Management Services, Inc.
CourtDistrict Court of Appeal of Florida
Date FiledDecember 29, 2021
Docket1D21-0704
StatusPublished
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Full Opinion
FIRST DISTRICT COURT OF APPEAL
STATE OF FLORIDA
_____________________________
No. 1D21-704
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CARLOS TEJEDA,
Appellant,
v.
CITY OF HIALEAH/SEDGWICK
CLAIMS MANAGEMENT SERVICES,
INC.,
Appellees.
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On appeal from an order of the Office of the Judges of
Compensation Claims.
Walter J. Havers, Judge.
Date of Accident: December 28, 2013.
December 29, 2021
PER CURIAM.
Claimant appeals the denial of his petitions for benefits.
Claimant contends that the Judge of Compensation Claims (JCC)
did not have jurisdiction to adjudicate the issue of Claimant’s
entitlement to reimbursement for the expenses from spinal fusion
surgery because it was a “reimbursement dispute.” The Claimant
therefore contends that the Department of Financial Services
(DFS) had sole jurisdiction. Claimant also contends that JCC
erred by construing the meaning of the stipulation between the
parties. We reject both arguments as explained below, and all
other issues raised by Claimant in this appeal.
Claimant was involved in a motor vehicle crash while on the
job as a firefighter. He injured his back in the crash, and the
Employer/Carrier (E/C) accepted the injuries as compensable.
Before the petition for benefits at issue, Claimant underwent
various procedures for his back, including surgeries with Dr.
Brusovanik. In 2017, Dr. Vanni was designated as the new
authorized physician, and Dr. Brusovanik was deauthorized. The
parties stipulated, “If Dr. Vanni opines that Claimant does require
further surgical invention, the Employer/Servicing Agent will
authorize same, and the Claimant will decide whether he wants to
undergo such procedure.”
In June 2020, despite Dr. Brusovanik being deauthorized as a
treating physician, and without an opinion from Dr. Vanni,
Claimant underwent spinal fusion surgery with Dr. Brusovanik.
Claimant filed a petition for benefits seeking payment of the
surgery bill and copayments as medically necessary. After a
contested hearing, the JCC determined that the surgery was
medically necessary. But the JCC also determined that the 2017
stipulation was binding on Claimant and denied reimbursement.
On appeal, Claimant contends that although he petitioned for
benefits seeking reimbursement for the expenses of the spinal
surgery, the 2017 stipulation made this a reimbursement dispute
subject to the jurisdiction of DFS. Claimant is correct that subject
matter jurisdiction may be raised at any time, including on appeal.
See Seven Hills, Inc. v. Bentley, 848 So. 2d 345, 350 (Fla. 1st DCA
2003). But Claimant is incorrect that the dispute here meets the
statutory definition of a reimbursement dispute.
A ruling on whether a proceeding is a reimbursement dispute
is a conclusion of law reviewed de novo, to the extent it involves
statutory construction. Avalon Ctr. v. Hardaway, 967 So. 2d 268,
271 (Fla. 1st DCA 2007). Section 440.13(1)(q), Florida Statutes
(2020), defines a reimbursement dispute as “any disagreement
between a health care provider or health care facility and carrier
concerning payment for medical treatment.” DFS “has exclusive
jurisdiction to decide any matters concerning reimbursement. . . .”
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§ 440.13(11)(c), Fla. Stat. The E/C undoubtedly meets the
statutory definition of carrier. See § 440.13(1)(c), Fla. Stat. But
the Claimant does not meet the statutory definition of a health
care facility or health care provider. See § 440.13(1)(f)–(g). A
dispute between Claimant and the E/C therefore does not meet the
statutory definition of a “reimbursement dispute.” Since this was
not a reimbursement dispute as defined by chapter 440, the JCC
had jurisdiction to adjudicate the claim.
As for the JCC interpreting the meaning of the stipulation, we
have held that “a JCC may be required to interpret contracts” to
decide whether workers’ compensation coverage exists. Bend v.
Shamrock Servs., 59 So. 3d 153, 156 (Fla. 1st DCA 2011) (citing
Curtis-Hale, Inc. v. Geltz, 610 So. 2d 558 (Fla. 1st DCA 1992)). We
have further held that “[a] JCC may also be required to interpret
a contract to determine the parties’ rights and responsibilities
under the Workers’ Compensation Law.” Id. (citing Tampa Bay
Area NFL Football, Inc. v. Jarvis, 668 So. 2d 217 (Fla. 1st DCA
1996)).
“A stipulation properly entered into and relating to a matter
upon which it is appropriate to stipulate is binding upon the
parties and upon the Court.” Gunn Plumbing, Inc. v. Dania Bank,
252 So. 2d 1, 4 (Fla. 1971). Recently, we acknowledged that this
holding from Gunn Plumbing applies in workers’ compensation
cases. See Holcombe v. City of Naples/Johns E. Co., Inc., 46 Fla.
L. Weekly D2057, D2059, 2021 WL 4189243, *5 (Fla. 1st DCA
Sept. 15, 2021). There was no error by the JCC in determining
that he could interpret the meaning of the stipulation.
AFFIRMED.
ROWE, C.J., and BILBREY and JAY, JJ., concur.
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Not final until disposition of any timely and
authorized motion under Fla. R. App. P. 9.330 or
9.331.
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Richard A. Sicking and Mark A. Touby of Touby, Chait & Sicking,
P.L, Coral Gables, for Appellant.
Eduardo E. Neret of Law Offices of Eduardo E. Neret, P.A., Miami,
for Appellees.
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