JCC Grants Pain Management and Cyclobenzaprine After Carrier Raises Pharmacy Jurisdiction Defense

In Rebecca Miller v. Royal Care of Avon Park/Normandy Insurance Company, OJCC Case No. 24-021012RLY, the claimant sought authorization of a pain management provider, payment for two cyclobenzaprine prescriptions issued during authorized AdventHealth visits, and attorney’s fees and costs after a low-back and shoulder accident. The employer/carrier argued there was no authorized pain-management referral, disputed medical necessity beyond an accepted lumbar strain aggravation, and asserted the JCC lacked jurisdiction to order payment directly to Injured Workers Pharmacy.

Judge Rita L. Young nevertheless granted the pain-management claim. The order credited claimant IME Dr. Nnamdi Nwaogwugwu, who tied the claimant’s ongoing left-sided low-back pain and radicular complaints to the industrial accident and explained that the March 2025 lumbar MRI supported epidural and possible facet-based pain treatment. The judge rejected the carrier’s argument that a February 2025 note created only a contingent referral, finding the claimant still proved medical necessity and major contributing cause for evaluation and treatment by a properly qualified pain-management provider.

The order also grants the cyclobenzaprine claim for the November 5, 2024 and February 17, 2025 prescriptions. Judge Young found the carrier never timely responded to the authorization requests, that both Dr. Jester and Dr. Nwaogwugwu supported the prescriptions as reasonable for that period, and that the carrier’s jurisdiction defense effectively conceded claimant had no financial liability for the bills even though any reimbursement dispute with Injured Workers Pharmacy belongs before the Department of Financial Services. The practical takeaway is that a carrier can lose ground on both medical-necessity and billing defenses when it leaves authorized prescription requests unanswered and then leans on a jurisdiction objection too late in the case.

Source: Compensation Order