SPAIN vs. GENERAL CAULKING AND COATINGS

Final Order: Florida employee Hurt at Work Prevail

Claimant's doctor recommended a two level fusion and the E/C disputed the medical necessity and major contributing cause of the procedure based upon their IME. The JCC appointed an EMA which was not favorable to the claimant on the issue of surgery. Notwithstanding, the JCC concluded the E/C had not timely responded to the request for surgery within ten days and therefore had forfeited the right to contest medical necessity. Additionally, the JCC found there was no evidence of any prior injuries or treatment to claimant's lumbar spine and his condition was normal for a person of his age. Consequently, the JCC found the MCC standard did not apply. Surgery GRANTED.

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Reference Info:Decision | State, 11th Circuit, Florida | United States


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