Case Law Update – November 21, 2016

WORKERS’ COMPENSATION DEFENSE CLIENTS

Vincent Sansone v. Frank Crum/Frank Winston Crum Insurance, Inc., No. 1D15-5116, Fla 1st DCA (November 2, 2016)

This appeal concerns the potential liability for claimant paid attorney’s fees by an E/C. The specific question addressed is what happens if the carrier or employer accepts responsibility for medical expenses within 30 days but does not actually pay the medical bills until after 30 days. The Court held that as long as the carrier or employer accepts responsibility for medical expenses within 30 days after the Petition for Benefits is filed, it is not liable for claimant attorney fees associated with those benefits under §440.34(3)(b).

In this case, the claimant’s attorney filed a Petition seeking among other things payment of an outstanding hospital bill. Within 30 days of receiving the Petition for Benefits, the E/C indicated its acceptance of responsibility for paying the hospital bill. A few weeks later, and after the 30 days had run from the date the Petition for Benefits was filed, the E/C actually paid the hospital bill.

The First DCA noted that in the past it has indicated in other cases that the timeliness of a payment of benefits is determined not by the date on which the E/C notifies a claimant’s attorney that the claim is accepted and benefits will be paid, but by “the date checks of payment are placed in the mail.” However, the First DCA made an important distinction here and indicated those cases addressed claims for benefits payable directly to claimants. The payment at issue in the Sansone case was to a hospital, not to the claimant himself. The Court went on to state that the actual benefit the claimant received was not the E/C’s payment to the hospital but rather it was his “being relieved of any obligation to pay the hospital itself.” The Court indicated that the claimant became “insulated from financial responsibility” for the hospital bill after the E/C accepted responsibility.

Practical Application:

The Sansone case makes it clear when it comes to medical bills, no attorney fees will be due to the claimant’s attorney so long as the carrier or employer accepts responsibility for a medical bill and agrees to pay it within 30 days after the filing of a PFB, regardless of when the carrier or employer actually pays the medical provider(s). Note that a different situation would apply if the PFB were seeking reimbursement to the claimant himself for a co-payment or medical bill paid out-of-pocket. Under that circumstance, it would appear that the date the check is mailed would be determinative of whether an attorney’s fee is owed.

 
Please feel free to contact any of our workers’ compensation attorneys listed below if you wish to discuss this case and its application to your claims. You may reach us at the telephone numbers or e- mail addresses listed below:

Fort Lauderdale/East Coast Office: (954) 462-4304

Walter C. Wyatt, Partner – ext. 218

wcwyatt@fla-esq.com

Robert M. Potter, III, Partner – ext. 222

rmpotter@fla-esq.com

St. Petersburg/West Coast Office: (727) 322-1739

Joseph A. Bayliss, Partner – ext. 201

jbayliss@fla-esq.com

Jerome B. Blevins, Partner – ext. 205

jblevins@fla-esq.com