Court Finds Employee is Not Entitled to Ongoing Workers’ Compensation Disability Benefits Despite Receiving Medical Referral for a Minor Preexisting Condition

NwkRPUrf morguefile jackietrainsIn Cruz v. State of Florida Dept. of Legal Affairs, a Florida man suffered a compensable workplace injury. While collecting temporary disability for a heart and mental health condition, the worker sought additional temporary total disability or temporary partial disability payments. According to the employee, his work-related harm not only rendered him disabled but also exacerbated his preexisting gastrointestinal condition.

At a hearing before a Judge of Compensation Claims (“JCC”), medical evidence was provided by two cardiologists who treated the worker. Both specialists apparently stated the man would reach his overall maximum medical improvement (“MMI”) for his heart condition before January 1, 2014. Similarly, the worker’s psychiatrists offered testimony that he would reach his overall mental health MMI about six months before that date. As a result, the JCC ruled that the employee was no longer entitled to receive temporary disability benefits as of December 31, 2013.

Although both specialists reportedly stated the worker’s preexisting condition was not related to his heart trouble, the JCC concluded that the worker was entitled to be evaluated in order to determine whether the man’s heart condition somehow exacerbated his acid reflux. After that, the worker appealed the JCC’s order to Florida’s First District Court of Appeal.

On appeal, the worker argued the JCC committed error when he denied his workers’ compensation benefits request after finding the man reached his overall MMI. The appellate court, however, disagreed. Under Florida law, overall MMI is the point at which an injured worker can no longer reasonably expect his or her medical condition to improve. In addition, an employee with more than one medical ailment has not reached MMI until each specialist has deemed the worker to be at overall MMI. Since both of the employee’s treating physicians testified the man reached his overall MMI, the appellate court ruled the worker was no longer entitled to recover disability benefits.

The Court of Appeal also distinguished a proffered case in which a JCC’s finding that a claimant reached his overall MMI was overturned because the decision was not based on the evidence offered to the JCC. According to the court, the worker’s treating specialists each stated he reached his overall MMI. The court said the fact that the employee’s heart condition may have exacerbated his preexisting condition did not change the fact that the man reached his overall MMI with regard to the conditions that caused his disability. Additionally, the appellate court stated the JCC’s order was based on medical testimony that stated that the worker was capable of returning to work whether or not his acid reflux was exacerbated.

The court then ruled that the JCC’s order entitling the employee to be evaluated by a gastroenterologist for acid reflux was not sufficient to demonstrate the man was not at overall MMI. The appeals court stated to rule otherwise would result in an absurd outcome.

After stating the JCC’s order denying the worker’s request for temporary total disability or temporary partial disability benefits was both legally and factually correct, Florida’s First District Court of Appeal affirmed his decision.

If you were hurt at work in South Florida, you should have a knowledgeable workers’ compensation attorney on your side to explain your legal rights and help you protect your interests. To schedule a free confidential consultation with an experienced personal injury lawyer, contact Friedman, Rodman & Frank, P.A. online or give us a call today at (305) 448-8585.

Additional Resources:

Cruz v. State of Florida Dept. of Legal Affairs, Fla: Dist. Court of Appeals, 1st Dist. 2015

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Florida Appeals Court States Evidence Code Applies to Workers’ Compensation Cases, August 10, 2015, South Florida Personal Injury Lawyers Blog

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