Worker's alteration of CT scan prescription form proves costly

In Florida, the alteration and modification of a CT scan prescription constitutes a knowing and intentional misrepresentation in order to obtain benefits.

Case name: Hunter v. Mercy Hospital, 17 FLWCLB 206 (Fla. JCC, Miami 2010).

Ruling: A Florida judge of compensation claims held that a worker knowingly and intentionally made misrepresentations in order to secure a workers' compensation benefit for which she was not entitled and she forfeited all workers' compensation medical and indemnity benefits past, present, and future.

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What it means: In Florida, the alteration and modification of a CT scan prescription form so that the claimant can get additional CT scans of other parts of her body constitutes a knowing and intentional misrepresentation in order to obtain benefits, resulting in a forfeiture of all workers' compensation benefits.

Summary: A worker slipped at work and sustained several injuries to her hands, knees, neck, and back. The claim was initially accepted as compensable. The authorized treating doctor provided the worker with an order for a CT scan of her right wrist/hand. The worker testified that she altered the CT scan prescription in order to obtain CT scan of her cervical and lumbar spine as well. She further said that while she was engaged in a telephone conversation with the medical provider's receptionist, she heard one of her treating doctors tell the receptionist that it was permissible for her to obtain the additional CT scans. However, the treating doctor denied giving the worker permission to alter the CT scan prescription. The JCC found the worker's testimony not credible and inconsistent with the credible testimony of the authorized treater. The JCC further found that she forfeited all benefits based on her knowing and intentional misrepresentation in order to secure a workers' compensation benefit for which she was not entitled.

Read more at the WorkersComp Forum homepage.

February 28, 2011

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