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Workers ’ Compensation Section Chairs : AnthonyV . Cortese – AnthonyV . Cortese , AttorneyatLaw , IreneRodriguez – IreneM . Rodriguez , PA & Ya ’ SheakaWilliams – Quintairos , Prieto , Wood & Boyer
The decision in Ortiz v . Winn-Dixie / Travelers and Sedgwick , No . 12021-0885 ( Fla . 1st dCA , dec . 23 , 2024 ), is an excellent source of caselaw on the scope of appellate review , burdens of proof on various issues , and particularly on the statute of limitations . However , it also had unusual facts that may limit its precedential value .
The Claimant Annalie ortiz was injured at work in 2003 . Subsequent authorized care included removal of one of her kidneys with follow-up care through an authorized urologist . She had follow-up visits at least yearly , some being just checkups and others to address urinary tract symptoms , infections , and painful urination . In January 2019 , she saw the doctor and was asymptomatic . Nonetheless , the doctor told her to continue with probiotics . on August 1 , 2019 , she returned to the doctor complaining of burning urination , and the doctor told her to take a medication previously prescribed for urinary tract infections . The doctor billed the August 1 , 2019 , visit as an office visit and urinalysis , but instead of submitting it to the workers compensation carrier as they had before , his office sent the bill to the claimant ’ s personal health insurance . The doctor ’ s office told
the claimant that they had to send it to her health insurance , because workers compensation authorization had not been given by the time of the visit . on August 19 , 2019 , she returned with similar complaints and the appointment was listed as an office visit with urinalysis , but again the bill was sent to the personal health insurance . on April 7 , 2020 , the claimant returned to the doctor to discuss a renal ultrasound and basic metabolic panel that had been ordered . In May of 2020 , Sedgewick noticed it had not heard from the authorized doctor for over a year and contacted them for any notes of recent dates of service . The doctor ’ s office sent the record of April 7 , 2020 . The workers compensation adjuster followed up to ask if there were any other appointments in the interim , and the doctor ’ s office advised that there had been visits on August 1 , 2019 and August 12 , 2019 . The adjuster did not ask for the medical records for those last two visits . on August 7 , 2020 , Sedgewick filed a notice of denial of benefits , asserting the statute of limitations expired on January 29 , 2020 .
Sincetheclaimantfollowedupwithinayear withtheauthorizeddoctor , therefore , the reasoninggoes , thestatutedidnotexpire .
on August 26 , 2020 , the claimant filed a petition for benefits asking for authorization of a follow-up visit with the treating doctor . Sedgwick denied the claim based on the statute of limitations .
The Judge of Compensation Claims held that the statute of limitations expired on August 29 , 2020 , because the claimant knew that the bills were being sent to her health insurance , and over a year passed without a bill or record being sent to Sedgwick . The written opinion of the First district holds that it ’ s not the claimant ’ s fault that the doctor sent the bill to the wrong place . Since the claimant followed up within a year with the authorized doctor , therefore , the reasoning goes , the statute did not expire . The fact-bound nature of the case might be used to distinguish it in the future , and there is a concurrence which is dicta , but raises some interesting questions for the statute in the future . n
Author : Anthony V . Cortese – Anthony V . Cortese , Attorney at Law
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