Carlos Tejeda v. City of Hialeah/Sedgwick Claims Management Services, Inc., DCA#: 21-0704, Decision date: Dec. 29, 2021

First District Court of Appeals affirms the judge’s decision, finding that the judge had the authority to interpret the meaning of the stipulation and the interpretation was binding on the parties.

The claimant sustained a compensable accident on December 28, 2013, when he was involved in a motor vehicle accident as a firefighter, which resulted in an injury to his back. The claimant underwent various procedures for his back with the authorized provider. The authorized provider was deauthorized, and in 2017 a new provider was authorized. In 2017, the parties stipulated that if the new authorized provider opined the claimant required further surgical intervention, the employer/servicing agent would authorize same. 

In 2020, without an opinion from the new authorized provider, the claimant underwent a spinal fusion surgery with the deauthorized provider. Subsequently, the claimant filed a petition for benefits, seeking payment of the surgery bill and copayments as medical necessary. The Judge of Compensation Claims determined that the surgery was medically necessary. However, the judge also held that the 2017 stipulation was binding and denied the claimant’s petition for payment of surgery.

The claimant appealed the judge’s denial of his petition for payment of surgery. The issue on appeal was whether the judge had improperly construed the parties’ 2017 stipulation and if the judge had jurisdiction over the medical reimbursement dispute. The First District Court of Appeal cited Gunn Plumbing, Inc. v. Dania Bank, 252 So.2d 1, 4 (Fla. 1971), which noted that “a stipulation properly entered into and relating to a matter upon which it is appropriate to stipulate is binding upon the parties and the court.” The court indicated that the Gunn Plumbing holding applies to workers’ compensation cases. Further, the court found that the dispute between the claimant and the employer/carrier does not meet the statutory definition of a “reimbursement dispute.” Therefore, the court affirmed the judge’s decision and held that the judge had the authority to interpret the meaning of the stipulation and the interpretation was binding on the parties. 

 

What’s Hot in Workers’ Comp is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2022 Marshall Dennehey Warner Coleman & Goggin, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.