Westry v. YRC / Sedgwick CMS
JCC Hedler (West Palm Beach) – (Brian Ricotta/Scott Miller)(10-19-21) – Awarded Fee Entitlement and determined amount. The JCC found entitlement for payment of a medical bill where the Carrier’s Response to the PFB stated “[t]he statement received attached to the Petition was returned to the provider to bill Sedgwick on the proper form and supply medical records for consideration.” The JCC found this statement to be ambiguous noting the wording “for consideration” implied that there would be an investigation or contingency. As the language was not clear on its face, the parol evidence rule was applied. The adjuster testified that there was not an outright agreement to pay the bill once received on proper form and the JCC held the Carrier did not accept financial responsibility of the bill until the bill was paid over three months after the PFB was filed. Another PFB sought indemnity in part which was resolved by way of a Joint Stipulation wherein no additional TTD/TPD was paid but the claimant was reinstated almost $1,250 in sick/vacation time which had been used as an offset towards TPD. The E/C argued no fees were due as no TTD/TPD was paid in response to the PFB and alternatively that the JCC had no jurisdiction to reinstate sick/vacation time and thus no jurisdiction to award fees in conjunction with such. The JCC held he did retain jurisdiction and that fees were due. Claimant’s counsel sought a fee based on 52.4 hours and E/C conceded only 21.70 hours. The JCC found 34.6 hours were expended to secure benefits obtained. Claimant’s counsel sought $450.00 per hour and the E/C argued $300 to $350 per hour was customary and appropriate. The JCC awarded a fee of $16,965 based on 52.20 hours (which included 17.6 hours in proving entitlement) at an hourly rate of $325. Click here to view Order |