Workers’ Compensation Benefits Denied Because Florida Man’s Need for Treatment was Caused by a Preexisting Condition

ROADWORKERS 72 morguefile quicksandalaIn Ceristaff, Inc. v. Owen, a worker who was employed as a gas appliance technician apparently hurt his shoulder when he fell at work in December 2013. Following the man’s workplace accident injury, the worker’s employer accepted compensability for the incident. As a result, the employee was authorized to seek medical treatment. After the worker was examined by a physician, however, the employer denied further workers’ compensation benefits due to the employee’s purported preexisting condition. According to the man’s treating doctor, the worker suffered from both osteoarthritis and rotator cuff arthropathy prior to his workplace accident.

After the man’s employer denied his request for additional medical care, the worker underwent an examination by his own designated medical expert. The expert recommended that the worker undergo additional shoulder surgery. According to the physician, the major contributing cause (“MCC”) for the employee’s need for a surgical procedure was his fall accident at work.

The employee testified before a Judge of Compensation Claims (“JCC”) that he underwent rotator cuff surgery on both shoulders about a decade before his work injury occurred. Despite this, the man stated that he was able to perform his work duties and was not taking any prescription medications for his shoulder pain when he fell. In addition, the man offered testimony at the workers’ compensation hearing that his schedule would typically be adjusted by his employer if he experienced shoulder pain.

Since the two treating doctors disagreed regarding the MCC of the worker’s need for surgery, the man underwent an additional medical examination that was performed by a medical expert designated by the JCC. The expert stated the MCC for the employee’s need for surgery was his preexisting condition.

The JCC declined to adopt the designated expert’s opinion and found that the worker’s compensable accident caused his preexisting condition to worsen, which ultimately led to the man’s need for surgery. According to the JCC’s findings, the man’s preexisting condition may have remained asymptomatic for the duration of his life if he were not injured at work. Since the employee did not require shoulder surgery prior to his work injury, the JCC ruled that the MCC of the worker’s need for medical treatment was his workplace fall.

On appeal to Florida’s First District, the man’s employer argued the JCC committed error when she rejected the designated medical expert’s opinion that the worker’s need for surgery was caused by his preexisting shoulder condition. The court stated Section 440.09(1)(b) of the Florida Statutes requires that a workplace injury be at least 50 percent responsible for an employee’s need for medical treatment when it is combined with a preexisting injury. In such situations, the appellate court said it was appropriate for a JCC to ascertain whether a workplace accident was the MCC of the worker’s need for medical care.

Next, the court stated a workers’ compensation judge’s factual findings will typically be upheld if they are supported by the evidence. After examining the hearing record, however, the appellate court concluded that the JCC failed to adequately articulate why she believed there was sufficiently clear evidence to contradict the designated medical expert’s presumptively correct opinion. As a result, Florida’s First District Court of Appeal reversed the JCC’s order and remanded the case with instructions to deny the employee’s request for workers’ compensation benefits related to his shoulder harm.

If you or someone close to you was hurt at work in South Florida, you are advised to contact a knowledgeable work injury attorney as soon as possible.   To discuss your right to recover workers’ workers’ compensation benefits with an experienced Miami personal injury lawyer today, do not hesitate to call the caring advocates at Friedman, Rodman & Frank, P.A. at (305) 448-8585 or contact us through our website.

Additional Resources:

Ceristaff, Inc. v. Owen, Fla: Dist. Court of Appeals, 1st Dist. 2015

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Appeals Court Overturns Denial of Compensation Advance in Broward County Workers’ Compensation Case, January 11, 2016, South Florida Personal Injury Lawyers Blog

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