The Issue The issue in this case is whether the allegations of the Administrative Complaint, are correct and, if so, what penalty should be imposed.
Findings Of Fact At all times relevant to this case, Cameron D. Smith (hereafter "Respondent") was certified by the Criminal Justice Standards and Training Commission (hereafter "Petitioner") and was issued certificate numbers 04-86- 222-04 and 14-84-502-02. During the months of August and September, 1987, the Respondent was employed as a correctional officer at the Gainesville Road Prison (now Gainesville Work Camp), a unit of the Department of Corrections (hereafter "DOC"). Each week, the Respondent worked from midnight to 8:00 a.m. Friday through Tuesday, and was off on Wednesday and Thursday. On occasion, the Respondent has suffered recurring pain and incapacity related to a foot injury which occurred in June, 1986. At one time, surgery to correct misalignment of a bone in his foot was scheduled, but was cancelled when the condition improved. The Respondent has obtained medical treatment when such was warranted. The DOC time sheets used by employees to record time worked include a code which identifies one option for leave time as "worker's comp" time. (The evidence does not establish any relationship between the DOC's "worker's comp" time and Chapter 440, Florida Statutes, setting forth the state's worker's compensation system. Therefore, the referenced statute has been disregarded in preparation of this Recommended Order.) The Department of Corrections pay period is a biweekly period ending on the day that time sheets are due. The relevant pay periods are from August 7 to August 20, 1987, and from August 21 to September 3, 1987. Records which specifically identify the days worked by the Respondent at the Road Prison are in evidence. During the period from August 7 through September 1, 1987, the Respondent claimed several days of leave time due to his continuing foot ailment, and marked "worker's comp" leave time on his DOC payroll time sheets. On August 13, 1987, the Respondent became employed as a part-time stock clerk at a newly-opened Walmart store on Archer Road in Gainesville. The Petitioner introduced evidence indicating that the Respondent worked at Walmart on Mondays, Wednesdays, and Fridays from 5:00 p.m. to about 10:00 p.m. The Respondent asserted that worked on other days or at other times as his services were required. The greater weight of evidence, including Walmart payroll records, supports the Respondent. Walmart's payroll records demonstrate that, during some weekly periods, the Respondent worked total hours in excess of the approximate fifteen which would result were the Petitioner's evidence correct. Walmart pays employees on the day following close of the weekly pay period. Pay is computed from employee time cards which are punched by a time clock at the start and finish of each employee's shift. The relevant pay periods are from the Respondent's employment on August 13 to August 14, 1987, from August 15 to August 21, 1987, from August 22 to August 28, 1987 and from August 29 to September 4, 1987. Records which would specifically identify which days the Respondent worked at Walmart are not in evidence. The evidence identifies the number of hours worked during each pay period. On August 17-18, 21-25, and 28-31, 1987, the Respondent claimed worker's compensation leave time from his DOC employment. The Respondent's supervisor refused to approve the time sheets which included the worker's compensation leave time. The supervisor believed that the Respondent was working at Walmart during the periods of time for which worker's compensation leave had been requested. Such claims are approved only when the employee is incapable of working. The Administrative Complaint alleges that the Respondent falsified official records of the Department of Corrections. The apparent falsification of official records relates to the claim of "worker's comp" time on DOC time sheets during periods when the Respondent allegedly worked at his Walmart job. Upon reconciliation and review of payroll records from both employers, the evidence fails to establish that the Respondent worked at Walmart on dates when he was unable to work at the Road Prison. From August 7 through August 14, 1987, the Respondent worked his full DOC shifts. He became employed by Walmart on August 13. For the period ending August 14, 1987, he worked 11.76 hours at Walmart. From August 15 through August 21, 1987, the Respondent worked Saturday and Sunday at the Road Prison, claimed worker's compensation leave on Monday, Tuesday and Friday, and had Wednesday and Thursday off. For the period ending August 21, 1987, he worked 14.76 hours at Walmart. There is no evidence that the Walmart hours were worked on either Monday, Tuesday or Friday. From August 22 through August 28, 1987 the Respondent did not work at the Road Prison, claiming five days worker's compensation leave, with the usual Wednesday and Thursday off. He worked no hours at Walmart during this pay period. From August 29 through September 1, 1987, the Respondent claimed worker's compensation Saturday through Monday and worked his usual shift beginning on Tuesday. There is no evidence that the Respondent worked at Walmart during this period. One witness testified to having seen the Respondent working on a ladder in a "Newberry Road" Walmart while claiming worker's compensation time, the implication being that, were the Respondent suffering a foot ailment, he would not be on a ladder working at Walmart. The witness was unable to identify the date upon which he saw the Respondent working at Walmart and did not document the information, but reported it to his supervisor. The supervisor was likewise unable to identify the date of the incident. There is no evidence that the Respondent was ever employed in a "Newberry Road" Walmart store, if one exists. The Respondent denied having climbed a ladder during his employment with Walmart. The Respondent's testimony related to his employment at Walmart is accepted.
Recommendation Based on the foregoing, it is hereby RECCOMMENDED that the Department of Law Enforcement, Criminal Justice Standards and Training Commission, enter a Final Order dismissing the Administrative Complaint against Cameron D. Smith. DONE and RECOMMENDED this 10th day of April, 1990, in Tallahassee, Florida. WILLIAM F. QUATTLEBAUM Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 10th day of April, 1990. COPIES FURNISHED: Joseph S. White Assistant General Counsel Department of Law Enforcement Post Office Box 1489 Tallahassee, Florida 32302 Cameron D. Smith 1138 Northeast Second Avenue Williston, Florida 32696 James T. Moore Commissioner Post Office Box 1489 Tallahassee, Florida 32302 Jeffery Long, Director Criminal Justice Standards Training Commission Post Office Box 1489 Tallahassee, Florida 32302
The Issue Whether Gio & Sons, Inc. (Respondent) violated Sections and 440.38, Florida Statutes, and if so, what penalty should be imposed. References to sections are to the Florida Statutes (2004).
Findings Of Fact Petitioner is the state agency responsible for enforcing provisions of Florida law, specifically Chapter 440, Florida Statutes, which require that employers secure workers’ compensation coverage for their employees. Respondent, whose principal is Giovanny Martinez, Jr. (Mr. Martinez), is in the business of providing drywall installation services. At all times material to this case, Respondent is an employer within the meaning of Section 440.02(16)(a), Florida Statutes. At all times material to this case, Respondent was legally obligated to provide workers' compensation insurance in accordance with the provisions of Chapter 440, Florida Statutes, for all persons employed by Respondent to provide drywall installation services within Florida. In particular, Chapter 440 requires that the premium rates for such coverage be set pursuant to Florida law. At all times material to this case, Respondent failed to obtain workers' compensation coverage on behalf of over 150 employees. It is undisputed that Respondent had not furnished the required coverage, and that there was no valid exemption from this requirement. Accordingly, on February 26, 2004, the Stop Work Order was properly entered. Thereafter, Petitioner reviewed Respondent's payroll records, which revealed that Respondent employed the individuals referred to in paragraph 5, whose identities are not in dispute, under circumstances which obliged Respondent to provide workers' compensation coverage for their benefit. Based upon Respondent’s payroll records, Petitioner correctly calculated the penalty amount imposed by law under all the circumstances of the case, and issued the Amended Order imposing a penalty assessment in the amount of $107,885.71. Mr. Martinez does not dispute the factual or legal merits of Petitioner's case.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Department of Financial Services, Division of Workers’ Compensation, enter a final order that affirms the Amended Order in the amount of $107,885.71. DONE AND ENTERED this 15th day of December, 2004, in Tallahassee, Leon County, Florida. S FLORENCE SNYDER RIVAS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 15th day of December, 2004. COPIES FURNISHED: Joe Thompson, Esquire Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-4229 Giovanny Martinez, Jr. Gio & Sons, Inc. 6910 Southwest 18th Court Pompano Beach, Florida 33068 Honorable Tom Gallagher Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florid a 32399-0300 Pete Dunbar, General Counsel Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300
The Issue The issue to be decided in this proceeding is whether the Reimbursement Dispute Dismissal issued by Respondent, Department of Financial Services, Division of Workers’ Compensation (the “Department”), should be reversed due to equitable tolling or some other recognized excuse for untimely submission of the reimbursement dispute.
Findings Of Fact Petitioner is a business operating in Daytona Beach, Florida. The nature of Petitioner’s business was not made part of the record. In approximately June 2017, Petitioner submitted a claim to the Department, claiming payment for certain (undisclosed) services or expenditures. The Department issued an Explanation of Bill Review (“EOBR”) in response to Petitioner’s claim. The EOBR set forth the amount of reimbursement the Department would allow for Petitioner’s claim. The EOBR was received by Petitioner on July 10, 2017. Upon receipt of the EOBR, Petitioner had 45 days, i.e., until August 24, 2017, to challenge the Department’s determination of the reimbursement amount. Not satisfied that the amount allowed by the Department was correct, Petitioner challenged the determination by submitting a Petition for Resolution of Reimbursement Dispute (the “Petition”) on DFS Form 3160-0023. The Petition was signed on August 8, 2017. However, Petitioner did not immediately submit the Petition on that date, despite being aware of the 45-day time limit for submitting such forms for relief. Petitioner did not mail the Petition until August 25, 2017, one day after the deadline for doing so. The Certified Mail Receipt for Petitioner’s mailing is clear and unambiguous, clearly showing the date. Petitioner did not present any evidence as to factors which might excuse the late filing of its Petition. The only reasons cited were that Petitioner was awaiting information from two claims management services, Sedgwick and Foresight, before submitting its Petition. Petitioner, through its witness at final hearing, admitted its error in failing to timely file the Petition.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that Respondent, Department of Financial Services, Division of Workers’ Compensation, enter a Final Order upholding its Reimbursement Dispute Dismissal. DONE AND ENTERED this 11th day of January, 2018, in Tallahassee, Leon County, Florida. S R. BRUCE MCKIBBEN Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 11th day of January, 2018. COPIES FURNISHED: Taylor Anderson, Esquire Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399 (eServed) Barbara T. Hernandez East Coast Surgery Center 1871 LPGA Boulevard Daytona Beach, Florida 32117 (eServed) Thomas Nemecek, Esquire Department of Financial Services Division of Workers' Compensation 200 East Gaines Street Tallahassee, Florida 32399 (eServed) Julie Jones, CP, FRP, Agency Clerk Division of Legal Services Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-0390 (eServed)
Findings Of Fact 7. The factual allegations contained in the Stop- Work Order and Order of Penalty Assessment issued on April 9, 2010, the Amended Order of Penalty Assessment issued on April 26, 2010, and the Order Cancelling Hearing, Closing File and Relinquishing Jurisdiction issued on January 6, 2011, which are fully incorporated herein by reference, are hereby adopted as the Department’s Findings of Fact in this case.
Conclusions THIS PROCEEDING came on for final agency action and Jeff Atwater, Chief Financial Officer of the State of Florida, or his designee, having considered the record in this case, including the Stop-Work Order and Order of Penalty Assessment, the Amended Order of Penalty Assessment, the Petition for Review, and the Order Cancelling Hearing, Closing File and Relinquishing Jurisdiction served in Division of Workers’ Compensation Case No. 10-152-1A, and being otherwise fully advised Order in the premises, hereby finds that: 1. On April 9, 2010, the Department issued a Stop-Work Order and Order of Penalty Assessment to MIKE CANADY, in case no. 10-152-1A. 2. On April 9, 2010, the Stop-Work Order and Order of Penalty Assessment was personally served on MIKE CANADY. A copy of the Stop-Work Order and Order of Penalty Assessment is attached hereto as “Exhibit A” and incorporated herein by reference. 3. On April 26, 2010, the Department issued an Amended Order of Penalty Assessment to MIKE CANADY. The Amended Order of Penalty Assessment assessed a total penalty of $137,562.68 against MIKE CANADY. 4. On May 27, 2010, the Amended Order of Penalty Assessment was served via Process Server on MIKE CANADY. A copy of the Amended Order of Penalty Assessment is attached hereto as “Exhibit B” and incorporated herein by reference. 5. On June 17, 2010, MIKE CANADY filed a request for Administrative Review (“Petition”), requesting review of the Stop-Work Order and Order of Penalty Assessment, and the Amended Order of Penalty Assessment. The petition for administrative review was forwarded to the Division of Administrative Hearings on July 16, 2010, and the matter was assigned DOAH Case No. 10-5819. A copy of the Petition is attached hereto as “Exhibit C” and incorporated herein by reference. 6. On January 6, 2011, the Administrative Law Judge issued an Order Cancelling Hearing, Closing File and Relinquishing Jurisdiction ruling that, “Accordingly, the facts stated in Petitioner’s First Request for Admissions are deemed to be true and the documents which are attached to the discovery requests are deemed to be genuine. That being the case, a dispute of material fact no longer exists.” A copy of the Order Cancelling Hearing, Closing File and Relinquishing Jurisdiction is attached hereto as “Exhibit D” and incorporated herein by reference.
The Issue The issue in this case is whether Respondent violated the provisions of chapter 440, Florida Statutes, by failing to secure the payment of workers’ compensation, as alleged in the Stop-Work Order and 3rd Amended Order of Penalty Assessment, and, if so, what penalty is appropriate.
Findings Of Fact Petitioner, Department of Financial Services, Division of Workers' Compensation (Department), is the state agency responsible for enforcing the requirement that employers in the State of Florida secure the payment of workers' compensation for their employees and corporate officers. Respondent, Po’ Boys, Inc. (Po’ Boys), is a Florida corporation engaged in business operations as a restaurant in the State of Florida from January 31, 2010, through January 30, 2013. Respondent employed more than four non-exempt employees during the periods January 31 through February 24, 2010; June 8 through September 3, 2010; and July 11, 2012, through January 30, 2013. Respondent was an "employer" as defined in chapter 440, Florida Statutes, throughout the penalty period. All of the individuals listed on the Penalty Worksheet of the 2nd Amended Order of Penalty Assessment were "employees" (as that term is defined in section 440.02(l5)(a), Florida Statutes) of Respondent during the periods of noncompliance listed on the penalty worksheets. None of the employees listed on the Penalty Worksheet can be classified as independent contractors, as defined in section 440.02, Florida Statutes. Mr. Jonas Hall is a workers’ compensation compliance officer who has worked for Petitioner for about four years. He has been involved with between 200 and 300 cases. On the morning of January 30, 2013, Mr. Hall received a “referral” report that Po’ Boys was not securing the payment of workers’ compensation for its employees. Po’ Boys operates three “traditional” restaurants in Tallahassee, which provide wait-service to their customers. Mr. Hall checked the Florida Department of State’s “Sunbiz” website, which gave him information on Po’ Boys’ legal structure, corporate officers, and principal location. He also checked workers’ compensation information for Po’ Boys, Inc., by accessing the Coverage and Compliance Automated System (CCAS) maintained by the Department. It indicated that Po’ Boys’ last coverage, which had become effective on February 6, 2012, had ended on July 11, 2012. He determined that active workers’ compensation exemptions were on file for four individuals, including Mr. Carmen Calabrese and Mr. Jon Sweede, co-owners of Po’ Boys. Information in the CCAS is submitted by insurance companies and the National Council on Compensation Insurance (NCCI). Mr. Hall drove to the College Avenue location of Po’ Boys to conduct a site visit, but it did not appear open because there were no vehicles present and the lights were off. Mr. Hall proceeded to the West Pensacola Street location. There were vehicles present and he saw an individual who appeared to be arranging chairs on the patio. Mr. Hall introduced himself and explained what he was doing there, and was then referred to Mr. Carmen Calabrese, the manager. It was about 10:00 a.m. Payroll records indicate that employees reported for work between 10:00 and 11:00 and that the restaurant was open to serve lunch and dinner. Mr. Calabrese took Mr. Hall to a “Broken Arm” poster which had a workers’ compensation sticker on the bottom. The sticker contained a workers’ compensation policy number and periods of coverage, as well as contact information for Zenith Insurance Company. Mr. Hall contacted Zenith Insurance Company, and they confirmed that coverage had not been in effect since July 11, 2012. In response to Mr. Hall’s questions, Mr. Calabrese indicated that Po’ Boys had between 50 and 60 employees working at its three locations. Mr. Calabrese told Mr. Hall that he had no knowledge that coverage was not in effect and that Mr. Hall would have to talk to Mr. Sweede, who handled the workers’ compensation for the business. Mr. Calabrese was a credible witness. Mr. Hall called Mr. Sweede, who in turn told Mr. Hall to contact Mr. Wade Shapiro, his insurance agent for providing workers’ compensation coverage. Mr. Sweede then called Mr. Shapiro as soon as he completed his telephone call with Mr. Hall. When Mr. Hall later telephoned Mr. Shapiro, Mr. Shapiro confirmed that Po’ Boys had no policy in effect, but said that he was in the process of obtaining coverage for them. Mr. Hall contacted his supervisor, Ms. Michelle Newcomer, who provided him with a Stop-Work Order Number. Mr. Hall served the Stop-Work Order and Order of Penalty Assessment on Mr. Calabrese, along with a Request for Production of Business Records for Penalty Assessment Calculation, at about 11:15 a.m. Although some records indicated that the Stop-Work Order was served at 10:30, other records and the testimony of the witnesses that it was served at 11:15 were more credible. Mr. Sweede testified that he was unaware until January 30, 2013, that his workers’ compensation coverage was not in effect. He testified that the Electronic Funds Transfer payment “came back” in July, but that he had been unaware of this. He testified, “I must not have found the paperwork, must not have looked at the envelopes, take all the heat for that in this business.” Mr. Sweede testified that he later learned Mr. Shapiro was not only aware that Po’ Boys’ coverage was not in effect, but that he had already been working to get Po’ Boys new coverage before Mr. Sweede telephoned him on January 30, 2013, all without the knowledge or authorization of Mr. Sweede. Mr. Sweede entered into an agreement to obtain workers’ compensation coverage for Po’ Boys sometime on January 30, 2013. Several documents were required, at least one with a notary’s signature. Mr. Sweede signed a letter stating that there had been no workers’ compensation claims since his previous coverage had been canceled on July 11, 2012, joined the Florida United Businesses Association (FUBA), filled out an application for coverage, and made a down payment from the Po’ Boys bank account to the (FUBA sponsored) Florida Citrus, Business, and Industries Fund. Under the terms of the agreement, coverage was made effective retroactively to 12:01 a.m. on January 30, 2013. Mr. Sweede testified that Mr. Shapiro notified him, although he could not remember exactly how, that workers’ compensation coverage was obtained for Po’ Boys at around 11:00 a.m. on January 30, 2013, about 15 minutes before the Stop-Work Order was served. Mr. Sweede’s testimony as to how he came to be satisfied that his coverage at Zenith was actually not in effect, determined how and why it had been canceled, decided to obtain insurance elsewhere, and arranged for people in at least three different locations to prepare and execute all of the required documents in approximately 45 minutes, from about 10:15 a.m. until 11:00 a.m., was unclear. The transcript reflects the following exchange: Q: Okay. So this is another –- this is something else. Obviously when Wade Shapiro came by you brought this check, right, and then he also had you sign these documents? A: I really couldn’t tell you. I couldn’t tell you which way, you know, I mean, obviously, you know, like I said, I was stressed. I got him the check. Whether he ran the check up, brought this stuff back, I probably couldn’t –- I can’t remember which chronology it was. It was, you know, a pretty stressful morning. But I know it was all fast, fortunately. Although it does not contain a jurat or notarial certificate,1/ the application for insurance does contain the signature and stamp of a notary public beneath the signatures of Mr. Sweede and Mr. Shapiro. All signatures on the document are followed by a handwritten notation of “1-30-13” in the space provided for a date. The signature and seal provide credible evidence that the document was signed sometime on January 30, 2013. Regardless of the time when coverage became effective, there is clear and convincing evidence in this case that Petitioner had no information reasonably available to it indicating that Respondent had obtained workers’ compensation coverage in the last minutes before the Stop-Work Order was issued. Respondent concedes it did not have coverage at the time of Mr. Hall’s site inspection, and does not claim that when coverage was obtained, it notified Petitioner, or even attempted to do so. Mr. Hall wrote a “Narrative” in a Department database on the afternoon of January 30, 2013, describing the events of the morning. Although Respondent demonstrated that the description was “modified” several days later on on February 5, 2013, the Department put on no evidence to explain what was modified, or why. The testimony of witnesses that Mr. Hall served the Stop-Work Order at 11:15 a.m. was deemed more credible under all of the circumstances than the notation in the Narrative that it was served at 10:30 a.m. Respondent executed a Payment Agreement Schedule for Periodic Payment of Penalty and was issued an Order of Conditional Release from the Stop-Work Order on February 6, 2013. Po’ Boys failed to secure the payment of workers’ compensation for its employees from January 31 through February 24, 2010; June 8 through September 3, 2010; and July 11, 2012, through January 29, 2013. It obtained coverage sometime on January 30, 2013. Respondent would have paid an amount less than $11,565.68 in premiums for those periods during which it failed to secure the payment of workers’ compensation, because that figure should be reduced by the premium paid for coverage on January 30, 2013. Payroll records submitted by Po’ Boys indicate several employees were paid for varying hours after 11:15 a.m. on January 30, 2013. The parties stipulated that the Department has assigned the appropriate class code and manual rates to Respondent's employees from the NCCI SCOPES Manual.
Recommendation Upon consideration of the above findings of fact and conclusions of law, it is RECOMMENDED: That the Department of Financial Services, Division of Workers’ Compensation, enter a final order determining that Respondent, Po’ Boys, Inc., violated the requirement in chapter 440, Florida Statutes, that it secure workers' compensation coverage for its employees, and imposing upon it a total penalty assessment of $17,349.70, reduced by the amount attributable to lack of coverage on January 30, 2013. DONE AND ENTERED this 23rd day of May, 2013, in Tallahassee, Leon County, Florida. S F. SCOTT BOYD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 23rd day of May, 2013.
The Issue Whether the Florida Department of Financial Services, Division of Workers’ Compensation (Respondent) should enter a final order dismissing the Petition for Resolution of Reimbursement (Petition for Resolution) filed by Martin Memorial Health Systems (Petitioner). If the Petition for Resolution should not be dismissed, whether Guarantee Insurance Company (the Carrier) improperly disallowed reimbursement owed to Petitioner for services Petitioner rendered to an injured employee/claimant and the amount thereof.
Findings Of Fact Paragraphs 1–38 of the Agreed Facts and Conclusions of Law set forth in the Joint Pre-Hearing Statement and Filing of Exhibits are hereby incorporated by reference. The Notice of Deficiency issued by Respondent should not have been issued because the Petition for Reimbursement was complete when filed. Respondent has no basis to dismiss the Petition for Reimbursement. Petitioner provided medical services to an employee that had workers' compensation insurance coverage from the Carrier. The usual and customary charges for the services at issue in this proceeding totaled $61,111.09. The Carrier paid Petitioner the sum of $9,135.52 based on the Carrier’s determination that the charges should be based on inpatient treatment on a per diem basis. The greater weight of the evidence establishes that the services to the injured employee should be billed under the category “outpatient surgery” pursuant to the pre-admission authorization provided to Petitioner. Respondent has duly adopted rules that govern billing limitations. The parties agree that outpatient surgery, such as the services at issue in this proceeding should be reimbursed at 60 percent of the usual and customary charges. Petitioner is entitled to reimbursement from the Carrier in the amount of $36,666.65, which is 60 percent of $61,111.09. The Carrier should be credited with having paid the sum of $9,135.52, so the additional amount of the reimbursement due to Petitioner from the Carrier is $27,531.13 ($36,666.65 less $9,135.52) plus any applicable interest.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Department of Financial Services enter a final order ordering the Carrier to reimburse Petitioner, Martin Memorial Hospital, in the additional amount of $27,531.13 plus any applicable interest. DONE AND ENTERED this 20th day of May, 2010, in Tallahassee, Leon County, Florida. CLAUDE B. ARRINGTON Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 20th day of May, 2010. COPIES FURNISHED: Karen Kennedy Martin Memorial Health Systems Post Office Box 9010 Stuart, Florida 34995 Mari H. McCully, Esquire Department of Financial Services Division of Workers` Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Brian F. LaBovick, Esquire LaBovick & LaBovick, P.A. 5220 Hood Road, Second Floor Palm Beach Gardens, Florida 33418 Julie Jones, CP, FRP, Agency Clerk Department of Financial Services Division of Legal Services 200 East Gaines Street Tallahassee, Florida 32399-0390 Honorable Alex Sink Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Benjamin Diamond, General Counsel Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300
Findings Of Fact 15. The factual allegations contained in the Stop-Work Order and Order of Penalty Assessment issued on November 18, 2008, the Amended Order of Penalty Assessment issued on January 16, 2009, and the 2™4 Amended Order of Penalty Assessment issued on May 21, 2009 which are fully incorporated herein by reference, are hereby adopted as the Department’s Findings of Fact in this case.
Conclusions THIS PROCEEDING came on for final agency action and Alex Sink, Chief Financial Officer of the State of Florida, or her designee, having considered the record in this case, including the Stop-Work Order and Order of Penalty Assessment and the Amended Orders of Penalty Assessment served in Division of Workers’ Compensation Case No. 08-385-1A, and being otherwise fully advised in the premises, hereby finds that: 1. On November 18, 2008, the Department of Financial Services, Division of Workers’ Compensation (hereinafter “Department”) issued a Stop-Work Order and Order of Penalty Assessment in Division of Workers’ Compensation Case No. 08-385-1A to M & M Roofing, LLC. 2. On December 8, 2008, the Stop-Work Order and Order of Penalty Assessment was served by personal service on M & M Roofing, LLC. A copy of the Stop-Work Order and Order of Penalty Assessment is attached hereto as “Exhibit A” and incorporated herein by reference. 3. On January 16, 2009, the Department issued an Amended Order of Penalty Assessment in Case No. 08-385-1A to M & M Roofing, LLC which assessed a total penalty of $153,187.40 against M & M Roofing, LLC. A copy of the Amended Order of Penalty Assessment is attached hereto as “Exhibit B” and incorporated herein by reference. 4. On May 21, 2009, the Department issued a 2°4 Amended Order of Penalty Assessment in Case No. 08-385-1A to M & M-Roofing, LLC which assessed a total penalty of $153,556.44 against M & M Roofing, LLC. A copy of the 2° Amended Order of Penalty Assessment is attached hereto as “Exhibit C” and incorporated herein by reference. 5. The Employer timely requested a Formal Hearing on or about February 27, 2009. A copy. of the Request for Hearing is attached hereto as “Exhibit D” and incorporated herein by reference. 6. On March 23, 2009, the request for formal hearing was forwarded to the Division of Administrative Hearings for assignment of an administrative law judge for a formal hearing. The matter was assigned to Judge Cleavinger and assigned case number 09-1578. 7. A formal hearing was scheduled for May 27, 2009, in Pensacola, Florida. A copy of the Notice of Hearing is attached hereto as “Exhibit E”. 8. A Motion to Continue Hearing was filed by the Department on April 30, 2009. 9. An Amended Motion to Continue Hearing was filed by the Department on May 5, 2009. The motion stated that Petitioner had been contacted and did not oppose the Motion. 10. An Order Granting Continuance and Re-Scheduling Hearing was entered on May 18, 2009. The hearing was re-scheduled for June 30, 2009, in Pensacola, Florida. A copy of the Order Granting Continuance and Re-Scheduling Hearing is attached as “Exhibit F”. 11.. A Letter of Request for Continuance was filed by M & M Roofing, LLC on June 22, 2009. 12. The Request for Continuance was denied on June 23, 2009. The Order Denying Continuance of Final Hearing is attached as “Exhibit G”. 13. A final hearing was held on June 30, 2009. M & M Roofing, LLC failed to appear at the hearing. 14. An Order Relinquishing Jurisdiction and Closing File was entered on July 2, 2009. A copy of the Order Relinquishing Jurisdiction and Closing File is attached as “Exhibit H”. |
