Articles Posted in Workers’ Compensation

Workers’ compensation laws can be confusing to navigate. Minor details like choice of doctor can change the validity of your claim even if you believed you were in the right. Working with a workers’ compensation attorney can help you navigate these claims and complex laws before you mistakenly make a decision that gets your claim invalidated or overturned.

In a recent case, a Florida court of appeals judge expanded the definition of “specialty” under Florida’s workers’ compensation laws. Under Florida’s law, injured workers can change their physicians once so long as the new physician is qualified in the same specialty as the original physician. Until now, though, courts had varying opinions on how broad “specialty” really was.

Facts of the Case

The claimant in the case sustained a finger injury while using a food press. She received emergency care and then was evaluated by a doctor who was a general surgeon and plastic surgeon with a specialty in hand surgery. The surgeon recommended surgery for repair of the claimant’s nerve and the placement of a pin. The surgeon did the recommended surgery and follow up for pin removal in his capacity as a hand surgeon. After the second surgery, the claimant requested a new physician and the employer’s insurance carrier authorized a doctor who was an orthopedic surgeon with a specialization in hand surgery. The claimant said that because the second doctor was not also a plastic surgeon, the second doctor did not have the required specialty according to the statute. The judge of compensation claims agreed with the claimant and granted the claimant’s request to name her own physician.

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In a recent case, the First District Court of Appeals in Florida issued an opinion in an appeal involving a benefits dispute between an employer and an employee. The claimant is a former emergency medical technician (EMT) that has post-traumatic stress disorder (PTSD), which the employer does not dispute. Instead, following a judgment in favor of the employer by the Judge of Compensation Claims (JCC), the employee appealed based on a differing interpretation of Florida Statute 112.1815, which refers to specific treatment in awarding benefits for first responders. The court of appeals disagreed with the JCC, ruling in favor of the claimant.

As an EMT, the employer/claimant began working for Polk County Fire Rescue in August 2015. Over the course of her employment, she witnessed multiple horrific incidents in the course of carrying out her official duties. Many of these incidents included deaths or serious injuries to women and children. In 2016, she responded to a domestic violence incident where a woman was badly beaten by her boyfriend and subsequently passed away after arriving at a hospital. Over the course of 2017, she responded to multiple fatal incidents involving very young children, one as young as three months old. Again in 2018, she saw multiple horrific and fatal incidents involving young children, including a child as young as two-years-old. By 2016, the claimant began experiencing nightmares and flashbacks, the first potential signs of PTSD. She sought assistance from her critical incidence stress management team before seeking help from a therapist beginning in early 2017. By 2018, she took a leave of absence under the Family and Medical Leave Act, as she felt that she could no longer do her job due to the trauma. Following the leave, her condition did not improve, and she never returned to work.

While filing for benefits, the JCC denied the employee’s claim for two reasons, stating (1) that as she did not have an accident on the date of her claim, she was not eligible for benefits under section 112.1815, and (2) that her substantive rights for claims were fixed as of the last “qualifying event” she experienced on the job. The appeals court opinion addresses both parts of the JCC argument, disagreeing with the analysis. On the first issue, the appeals court found that due to the nature of the claimant’s disability, the date or dates that she suffered exposure to the disease was not relevant to determine the date of the accidents in the context of this case. On the second issue, the appeals court ruled that the JCC misinterpreted the issue of timing, stating that there was an imputed contractual entitlement to compensation for financial loss as a result of her occupational disease regardless of the date in this case.

In a recent case, the First District Court of Appeals in Florida issued an opinion in an appeal involving a benefits dispute between an employer and an employee. The claimant has hypertension which was previously adjudicated as compensable. Following that adjudication, he filed a petition for benefits seeking payments of impairment benefits for hypertension. The Judge of Compensation Claims (JCC) issued an order granting the claimant’s claims for impairment benefits, attorney’s fees, and costs. The employer appealed the JCC decision.

The claimant’s hypertension was assigned a 10% permanent impairment rating by his authorized treating physician. The claimant’s independent medical examiner assigned a 50% permanent impairment rating. And the employer’s independent medical examiner assigned a 0% permanent impairment rating based on the claimant’s hypertension. Due to the conflicting medical evidence provided, the JCC appointed an expert medical advisor. The employer objected to the use of the expert medical advisor, asserting that no conflict in medical evidence existed. The JCC disagreed, reasoning that even if they accepted the employer’s argument that a conflict existed between the permanent impairment ratings of the claimant’s and the employer’s independent medical examiners. The expert medical advisor concluded that the claimant reached a 42% permanent impairment rating. The employer then appealed the decision.

The employer argued that the JCC was not correct to appoint an expert medical advisor in the first place and even if they were, whether the opinion offered by the expert medical advisor was proper. The employer states that the JCC erred in appointing the expert medical advisor as there was no initial disagreement in the opinions of the health care providers. Additionally, they contended that the JCC failed to address the employer’s objections to the expert medical advisor’s opinion. Finally, they object to the manner in which the expert medical advisor performed his assessment.

Recently, the First District Court of Appeals in Florida issued an opinion in an appeal involving a workers’ compensation claim dispute. The claimant initially filed a Petition for Benefits (PFB) with the Division of Administrative Hearings (DOAH) in the Office of the Judges of Compensation Claims (JCC) requesting medical and indemnity benefits. The employer responded that the JCC had no jurisdiction over the PFB filed because both parties were bound by a collective bargaining agreement (CBA) that compelled a resolution of claims via arbitration.

Subsequently, the claimant voluntarily dismissed the PFB and filed a request for arbitration as required under the CBA binding the two parties. The arbitration hearing denied all benefits sought by the claimant. Shortly thereafter the claimant filed a motion for a rehearing with the arbitrator that was promptly denied. The claimant then filed a motion with the DOAH to dismiss the arbitration determination. The employer responded that the JCC lacked jurisdiction in this matter. Ultimately, the JCC determined that there was jurisdiction and vacated the arbitrator’s determination, and ordered a rehearing with the same arbitrator subject to the arbitrator’s willingness and availability. The employer then appealed the decision by the JCC.

The court of appeals found that there was no PFB pending before the JCC when the claimant filed the motion to vacate. While the claimant initially filed a PFB, he voluntarily dismissed it and proceeded to arbitration as required by the binding CBA. The dismissal of the PFB removes the jurisdiction of the JCC in this case. The appeals court notes that it had previously held that JCC does not have general jurisdiction and can only address issues specifically conferred by statute. When all claims asserted through a petition for benefits are dismissed, the JCC loses jurisdiction to address those claims. Here, the appeals court found that the claimant filed his PFB before voluntarily dismissing it and conceded to the CBA-mandated arbitration process. It was only once he was denied benefits through the arbitration hearing and dissatisfied with the results that he filed a motion to vacate the arbitration award with the JCC, which was ultimately an inappropriate forum that lacked jurisdiction. Ultimately, the proper course of action remaining to the claimant was to seek relief through a court with appropriate jurisdiction as defined by section 682.

Recently, the First District Court of Appeals in Florida issued an opinion in an appeal involving a workers’ compensation claim from a worker serving as a laundry attendant at a hotel who claimed to suffer a back injury lifting a mattress. According to the record, the attendant stated that he injured his back on May 22, 2019, while lifting and carrying mattresses to different rooms within the hotel. The attendant made several visits to the emergency room over the next few months, stating that he was experiencing stretching and tingling feeling on his side. His employers claim that the hospital visit records do not show a clear connection to the back or neck injury that the attendant states were due to his job. Additionally, the employer states that the attendant failed to file the claim in time.

The judge of compensation claims (JCC) denied the attendant’s claim and dismissed the petition, reasoning that the attendant’s evidence was insufficient for the claim. Both the attendant and the employer appealed the decision, with the attendant contending that the denial should be set aside for various reasons and the employer claiming that the merits of the claim should not have been heard in the first place due to the fact that the attendant did not give notice to the employer in a timely manner.

The Facts of the Case

According to the record, after the attendant claimed to be injured on May 22, 2019, he visited the emergency room on five separate occasions due to potential dehydration, tingling, and a stretching feeling on his side. In the first four of these instances, no mention of potential back or neck issues was noted in the official visit notes, and the attendant himself frequently mentioned dehydration as a potential cause for his issues, noting he was sleeping without an air conditioner. In the final visit on July 17, 2019, the attendant complained of “body aches” and in his discharge instructions, there is a mention of the phrase “cervical sprain.” A few days later, the attendant contacts the employer to file a claim.

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In a recent decision, the First District Court of Appeal in Florida addressed a worker’s compensation claim revolving around one individual’s heart disease. On appeal, the court had to decide whether the individual qualified for benefits based on a Florida statute stating that if a plaintiff departs from his doctor’s prescribed course of treatment, he may not be eligible for compensation. According to the court, the individual here did not significantly depart from his doctor’s prescribed course of treatment, and thus he was entitled to the benefits he requested.

The court began by examining the facts of the case: the plaintiff here was a deputy sheriff who suffered shortness of breath and chest pain on an overnight shift in February 2019. He was admitted to the hospital for a heart attack and immediately underwent an arterial stent implant procedure.

The plaintiff sought compensation for the injury, and his employer argued that he should not be entitled to compensation because he failed to follow his doctor’s prescribed course of treatment. Under Florida law, if a plaintiff in a worker’s compensation case significantly departs from the physician’s course of prescribed treatment, that plaintiff’s employer may not be responsible for compensating him after an injury.

Florida workers’ compensation law is designed to allow for workplace injuries to be addressed and relieved efficiently and without undue difficulty for the injured employee who seeks treatment. In reality, offering functional workers’ compensation coverage costs employers and providers money, and they will often delay or deny coverage to prop up their bottom line and save money. The Florida Court of Appeals recently addressed a claim by an employee that their employer willfully ignored the legal requirements of state law in order to delay offering the plaintiff the care they were entitled to.

The plaintiff in the recently decided case was an employee of the defendant, a Florida car dealership when she was injured on the job. Under her employment contract, she was directed to seek treatment using her employer’s workers’ compensation coverage. After her initial care, the woman’s doctor prescribed a home health aide to assist her with everyday duties during her recovery. Although the plaintiff was prescribed a home health care assistant, the defendant repeatedly notified her that the prescription was not detailed or accurate enough, and refused to pay for the care.

Pursuant to Florida workers’ compensation claim procedure, the plaintiff brought her request for coverage to a Florida Judge of Compensation Claims (JCC), who agreed with her employer that the prescription was not detailed enough to warrant coverage for the home health assistant. After the procedural rejection, the plaintiff brought the case to the Florida Court of appeals. The plaintiff argued that the doctor prescribing the care to her was clear and specific that she needed home health assistance, and the only ambiguity was the amount of care she would need, which could be determined based on an evaluation by the provider.

Workers’ compensation, sometimes known as workers’ comp, is a type of insurance that provides wage replacement and medical benefits to qualifying Florida employees who suffered injuries or illness in the course of their employment. Employers offer this benefit in exchange for the employee’s relinquishment of their right to sue the employer for civil negligence.

Although the legislative intent of workers’ compensation appears as an employee benefit, in practice, workers’ compensation often benefits employers, specifically those employers who have particularly hazardous work environments. Those who have suffered injuries at the workplace should consult with an attorney to determine the steps to take to preserve their rights to workers’ compensation benefits and potential third-party claims.

Steps to Take After a Workplace Injury

After a workplace injury, employees should report the accident or illness to their employer as soon as possible, but no later than thirty days after the incident. Then, the employer should report the injury to the insurance company no later than seven days after their knowledge. If they fail to do so, the employee has the right to report the injury to their insurance company. Employees should always seek medical treatment authorized by their employer or insurance company.

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In a recent decision, the First District Court of Appeals in Florida issued an opinion in an appeal involving a cancellation fee charged by the Employer/Carrier’s (E/C) independent medical examiner (IME). According to the record, Claimant was required to attend the independent medical examination while wearing a mask by the E/C. The parties did not dispute that Claimant attended the examination while wearing a mask. However, the E/C stated that by bringing a videographer to record the examination without prior notice, causing the IME to refuse to conduct the examination while being filmed, Claimant became responsible for half of the IME cancelation fee under section 440.13(5)(d), Florida Statutes (2019). E/C’s claim states that this is due to the fact that Claimant’s actions amounted to a “constructive no-show” by behaving in a manner that caused the IME to cancel the examination.

The judge of compensation claims (JCC) agreed with the claims made by the E/C, finding the cancellation was entirely of Claimant’s making as she did not provide notice that she would bring a videographer. Subsequently, the JCC granted the E/C an “award of taxable costs of $900.00 for one half of a cancellation fee charged by the E/C’s IME” under section 440.13(5)(d).

The appellate decision acknowledges that Florida Rule of Civil Procedure 1.360(a)(1)(A) “requires that the person to be examined must advise if the examination is to be recorded or observed by others, and shall include, inter alia, the number of people attending and the method or methods of recording,” but points out that “no corollary for this exists in the workers’ compensation rules or statutes.” In fact, the appellate court decision highlights the JCC’s broad discretion to award costs in such cases, and states that “generally, if a claimant can show good cause for the failure to attend an IME, no sanctions are awarded.” The appellate opinion further states that “the JCC must also ensure that the cancellation fee was properly charged, and the amount was appropriate under the circumstances.” Finally, the appellate decision points out that section 440.13(5)(d) “provides that payment of half of the no show fee” attaches if “the employee fails to appear for the independent medical examination,” but makes no mention of the “constructive failure to appear” that the JCC cites to. Ultimately, the appellate opinion finds that Claimant should not be charged with paying half of the IME cancellation fee under the facts presented.