Articles Posted in Workers’ Compensation

In a recent case, the First District Court of Appeals in Florida issued an opinion in an appeal involving a claim for authorization of a physician in a worker compensation case between an employee, the Claimant, and the Employer/Carrier (E/C). The Claimant sued the E/C following the E/C disregarding his request for a one-time change under section 440.13(2)(f). The Judge of Compensation Claims (JCC), denied his claim for authorization of the physician and found that the E/C’s waiver defense was tried by consent.

The Claimant suffered a compensable accident on August 21, 2018, and benefits were subsequently initiated. On June 20, 2019, the Claimant sent a written request to the E/C exercising his right to a one-time change under section 440.13(2)(f), and the E/C failed to respond. On July 2, 2019, the Claimant filed a Petition for Benefits (PFB), asserting his entitlement to the one-time change and requesting enforcement of that right. The E/C filed a response agreeing to the one-time change and naming Dr. Feiertag as the alternative physician twenty-seven days after the Claimant filed the first PFB. The Claimant did not attend the appointment and subsequently voluntarily dismissed the first PFB, later explaining that he was concerned with avoiding litigation and “rocking the boat” with his employer. On July 28, 2020, the Claimant filed a second PFB requesting authorization, payment, and scheduling of an appointment for evaluation and treatment with Dr. Roush, his chosen alternative physician. Three days after the second PFB, the E/C wrote to the Claimant, denying treatment with Dr. Roush, stating that Dr. Feiertag was the authorized one-time change doctor.

At trial, the Claimant argued that the E/C forfeited its right of selection of the one-time change physician when it failed to respond to his initial one-time change request. He further claimed that the second PFB was merely a requested enforcement of his previously accrued right of selection, and he was exercising that by selecting Dr. Roush. The E/C argued that the Claimant voluntarily dismissed the first PFB and waived his right of selection. The JCC concluded that due to the fact that the Claimant did not attend the appointment with Dr. Feiertag that was scheduled by the E/C, he did not acquiesce to his authorization. Additionally, the JCC rejected the E/C’s argument that the Claimant forfeited his right of selection due to the length of time between the written request and the selection of the doctor. Regardless, the JCC denied the Claimant’s request, finding that (1) the Claimant withdrew his request, (2) the second PFB was a new request that the E/C responded to in a timely manner, and (3) the Claimant failed to satisfy his burden of proof that the treatment he was seeking reimbursement for was both “compensable” and “medically necessary.”

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, with one of the justices concurring in part and dissenting in part. The claimant is an employee of Brevard County Fire and Rescue seeking compensation for treatment for post-traumatic stress disorder (PTSD). The Judge of Compensation Claims (JCC) found that the accident in question did not give rise to any need for treatment due to PTSD or any other compensable mental injury. The claimant argued on appeal that first responder claimants can seek workers’ compensation benefits for PTSD under either § 112.1815(2)(a)3 or paragraph (5), or both.

The majority on the court of appeals affirmed the lower court ruling. While the majority agreed with the claimant’s argument that first responder claimants can seek workers’ compensation benefits for PTSD under either § 112.1815(2)(a)3 or paragraph (5), or both, they found that the availability of these claims did not alter the outcome in this case. However, one member of the appeals panel concurred with the majority in part and dissented in part. The dissent engages with the issue of first impression, in this case, establishing the burden of proof that first responders must meet to establish entitlement to medical benefits only for mental or nervous injuries, such as PTSD, arising from their employment where no physical injury accompanies the injury.

The dissent found that the JCC erred in concluding that the only path for first responders to establish the compensability of a mental or nervous injury such as PTSD was via subsection 112.1815(5), Florida Statutes, which was enacted in 2018 to allow for medical and indemnity benefits for PTSD arising out of employment involving eleven specific events. Instead, the plain language of subsection (5) states that it applies to PTSD claims “notwithstanding sub-subparagraph (2)(a)3.” and related statutes, which is a legislative acknowledgment that both provisions were intended to co-exist. Subsection (5) supplements and complements sub-subparagraph (2)(a)3. For this reason, the claimant was entitled to seek medical benefits (but not indemnity benefits) under sub-subparagraph (2)(a)3. The opinion goes on to state that the JCC erroneously concluded that even if a PTSD claim could be brought under sub-subparagraph (2)(a)3., the claimant failed to present clear and convincing evidence of his claimed injury. However, this standard of proof is specified by statute for only situations where the mental injury arises from a physical injury. In the case here, the default standard is a preponderance of the evidence, meaning the claimant’s claim should be reevaluated on remand under the proper standard.

When employees and officers are injured on the job, sometimes injuries are not readily apparent. It can sometimes take weeks or even months to realize the full impact of emotional and physical injuries. And when injuries like PTSD or emotional trauma arise, it can be difficult to pinpoint the exact date those injuries began.

In a recent case, the court grappled with an incredibly sensitive PTSD issue resulting from a highly publicized school shooting. After the court’s opinion, an officer involved in the aftermath of the shooting will be able to receive PTSD benefits. This case highlights how important workers’ compensation benefits can be in rectifying harms in the workplace.

Facts of the Case

The claimant in the case was a police officer who responded to the shooting at the Marjory Stoneman Douglas High School in Parkland, Florida. In the months afterward, he realized he was experiencing symptoms of post-traumatic stress disorder (PTSD), including anger, nightmares, and anxiety. He was eventually placed on administrative leave in November 2018, with various days of leave for the PTSD symptoms throughout the next year, followed by light duty and then termination in January 2020. He petitioned for benefits after he was terminated, listing dates he was taken out of work as “dates of accident.” Experts testified that his December leave was due to PTSD related to the shooting and that he did not meet all PTSD criteria until December 2018.

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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.