Articles Posted in Workers’ Compensation

A recent Florida workers’ compensation case sheds light on the challenges injured workers face when seeking benefits for ongoing care. The case involved a cashier who suffered an electrical shock while plugging in a cash register at work. Although her initial injury was accepted as compensable, her employer and insurer later denied her claims for additional treatment, arguing that a preexisting genetic condition was the major contributing cause (MCC) of her medical needs. This case highlights the importance of understanding your rights and options when facing a denial in Florida’s workers’ compensation system.

Injured Worker’s Fight for Ongoing Care

The worker initially reached maximum medical improvement in 2020 after treatment for her workplace injury. However, in 2022, her symptoms worsened significantly, leading to issues such as balance problems, hand weakness, and bladder dysfunction. Further evaluation revealed a genetic condition, neurofibromatosis type I, which had caused tumors compressing her spinal cord. She underwent surgery to remove the most problematic tumor, but her doctor noted that additional tumors would require ongoing care.

Despite the severity of her symptoms and the connection to the initial work injury, her employer and insurer denied her claims for continued treatment. They argued that the genetic condition, not the work injury, was the MCC of her medical needs. The worker filed a petition for benefits to secure the necessary care, but the employer disputed her claim, relying on earlier medical opinions.

Florida’s Major Contributing Cause Standard

Under Florida Statutes § 440.09(1)(b), workers’ compensation benefits are only awarded if the workplace accident is the major contributing cause of the injury or need for treatment. This standard requires showing that the work injury is more than 50% responsible for the condition compared to any preexisting conditions.

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Workers’ compensation insurance is a crucial safety net for employees in Florida who are injured on the job. It provides essential benefits, including coverage for medical expenses and compensation for lost wages, to help injured workers recover and get back on their feet. However, while this system is designed to support workers, it also represents a significant cost to employers, who often look for ways to minimize their payouts. Recently, a Florida court decision highlighted the ongoing struggle workers face in securing these benefits, as it denied continued benefits to an employee following an accident.

In Florida, workers’ compensation insurance is intended to provide comprehensive support to employees injured in the course of their employment. This includes coverage for immediate medical treatment, ongoing care, and financial compensation for lost wages. The goal is to ensure that injured workers do not bear the financial burden of their recovery. However, obtaining these benefits can be challenging. Employers and their insurance companies often scrutinize claims to avoid paying out benefits whenever possible. This was shown in a recent court ruling that reversed a decision granting continued benefits to an injured worker, illustrating the obstacles employees may face in accessing the support they need.

The case involved an employee who sustained injuries to her right hand and wrist when a door slammed shut at her workplace. Initially, the employer and their insurance carrier accepted the injury as compensable and provided benefits for several months, including pain management and physical therapy. The worker, experiencing persistent pain more than a year after the accident, sought further medical treatment. The Judge of Compensation Claims (JCC) initially ruled in favor of the worker, approving the continuation of her medical treatment. However, the employer appealed this decision, arguing that the injury no longer required additional care.

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Seasonal employment is a major component of Florida’s economy, drawing thousands of workers each year to a variety of industries. From the bustling tourism sector, where theme parks and resorts require additional staff during peak travel times, to the construction industry, which often ramps up projects to take advantage of favorable weather, seasonal jobs are plentiful. Additionally, Florida’s professional and semi-professional sports teams, including baseball and football, rely heavily on seasonal workers to support their operations. These jobs, while offering valuable opportunities and income, come with risks. Many seasonal roles, especially those in physically demanding fields like construction and sports, can be hazardous, exposing workers to potential injuries.

In Florida, employers are mandated to carry workers’ compensation insurance to protect employees who get injured on the job, and this includes seasonal workers. Workers’ compensation provides essential benefits, such as medical care and wage replacement, to help injured employees recover and support themselves during their time off work. However, the amount of compensation a worker is entitled to can vary significantly. This calculation is often based on “full-time weekly wages,” but this baseline can be adjusted, and the interpretation of this amount can be contentious. Recently, a Florida district court addressed such an issue when an employer challenged the amount awarded to a seasonal professional baseball pitcher who was injured and unable to complete his employment contract.

The pitcher in question was under a contract with a minor league baseball team and earned a salary during the five-month championship season. However, his contract also required him to be available year-round for other activities, such as exhibition games and training. Unfortunately, during one of the championship games, the pitcher sustained a serious shoulder injury, which led him to file a workers’ compensation claim. Initially, the Judge of Compensation Claims (JCC) calculated his average weekly wage (AWW) based on a full-year salary, attributing his monthly earnings over 12 months, even though his contractual salary only covered the five months of the championship season.

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In a recent case, the Third District Court of Appeals in Florida issued an opinion in an appeal involving a tort lawsuit filed by the appellee-plaintiff, Giovanni Bastien, against the appellant-defendant, Bottling Group, LLC. Bottling Group appealed from a nonfinal order denying its motion for partial summary judgment in the tort lawsuit filed by Bastien. In their appeal, Bottling Group contends that the trial court erred in finding it was equitably estopped from presenting its workers’ compensation immunity defense. The appellate court was unconvinced, rejecting Bottling Group’s argument and affirming the trial court decision.

Bastien was employed by Bottling Group at a Pepsi packaging and distribution facility in Medley, Florida. He was seriously injured when a coworker, purportedly disgruntled over union activities, shot him several times. While Bastien was recovering in the hospital, he notified his manager that he intended to file a workers’ compensation claim. Bastien was informed that he was not entitled to benefits, and Bottling Group subsequently emailed the compensation carrier, Sedgwick, to oppose his claim. Bastien then received a notice of denial of benefits from the Florida Department of Financial Services Division of Workers’ Compensation. The notice stated that his “claim is denied in its entirety, as not a compensable accident or injury. Injury did not occur in the course or scope of employment. Accident/Injury occurred off premises . . .” Bastien then filed a tort lawsuit in the circuit court against Bottling Group’s parent company, PepsiCo, Inc. PepsiCo moved to dismiss, contending it was entitled to workers’ compensation immunity. Bastien argued that PepsiCo was equitably estopped from asserting immunity. Before the court rendered a ruling on the motion, the parties agreed to the filing of an amended complaint substituting PepsiCo with Bottling Group.

At trial, Bottling Group moved for partial summary judgment on the basis it was entitled to workers’ compensation immunity. Bastien opposed the motion, asserting that estoppel and the international tort exception precluded the operation of immunity. At the conclusion of the hearing, the trial court entered a reasoned order denying summary judgment and prohibiting Bottling Group from raising its immunity defense at trial. Bottling Group appealed shortly thereafter.

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 firefighter who suffered a heart attack and subsequently received a heart transplant after being diagnosed with COVID-19. According to the record, the firefighter was hired by Seminole County as a firefighter in 1993 after a clean pre-employment physical. In the early 2000s, he suffered cardiac problems that Seminole County accepted as compensable. Following his diagnosis, he received yearly treatment. In December of 2020, the firefighter tested positive for COVID-19. In January of 2021, he suffered a heart attack. After multiple surgeries, he received a heart transplant. Following his procedures, the firefighter filed a Petition for Benefits seeking indemnity and medical benefits on grounds that his heart attack stemmed from “heart disease” and thus the statutory presumption of work causation under section 112.18 applied to his case. Initially, Seminole County conditionally accepted the heart attack as compensable, but the county later denied compensability.

The Facts of the Case

The firefighter sought compensability under section 112.18.2 while Seminole County asserted as a defense, among others, that the claim was denied in its entirety because the criteria for the presumption were not satisfied. At the merits hearing, it withdrew the defense and stipulated that section 112.18 applied and that the worker was entitled to the statutory presumption of work causation. As a result, the sole issue before the Judge of Compensation Claims (JCC) was whether Seminole County successfully rebutted the presumption of work causation. At the hearing, the JCC accepted Seminole County’s argument that COVID-19 caused the worker’s heart disease, heart attack, and heart transplant. However, the JCC also found that Seminole County failed to rebut the presumption of work caused by proving that the worker contracted the virus outside of work. The JCC summarily denied Seminole County’s motion for rehearing.

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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 a rental car employee (the Employee) and Normandy Insurance Company (Normandy) on behalf of his employer, Value Car Rental, LLC. The Employee filed a petition for benefits after he was shot seven times at close range by an unidentified shooter while at work for Value Car. The parties stipulated that the shooting occurred in the course and scope of the Employee’s employment with Value Car, so the only issue in dispute was whether the injuries he sustained in the shooting arose out of the work he performed for Value Car. At trial, the Judge of Compensation Claims (JCC), found that the injuries sustained by the Employee arose out of the work he performed for Value Car, and subsequently awarded him benefits. Normandy appealed the decision to the appellate court, which disagreed with the JCC decision, setting the JCC order aside.

The Employee worked as the general manager of the Value Car in the Orlando International Airport Holiday Inn. The business was near the airport and an industrial park. The premises of the car rental business consisted of a kiosk desk inside the hotel atrium and an office in a separate building next to the hotel swimming pool. One night, the Employee was walking from the kiosk desk to the office building with the last rental agreement of the night, he was shot seven times by an unknown assailant. Video footage captured the incident, and showed the assailant shooting the Employee, beginning to walk away, before shooting him several more times. The assailant did not attempt to rob or take anything from the Employee. Despite his injuries, he made it to the hotel lobby, where a hotel guest came to his aid, he stated that “Robert shot me” and said the police should look for a blue Mustang. The Employee petitioned for workers’ compensation benefits, including indemnity and medical benefits. Value Car and its insurance carrier, Normandy, denied that the Employee was entitled to benefits.

Following the decision to award the Employee benefits by the JCC, Normandy appealed. The Normandy appeal argued that the JCC finding was not supported by competent, substantial evidence. The appellate court opinion stated that a two-pronged analysis dictated whether the Employee could be compensated under the Workers’ Compensation Law. The first prong states that there must be “an accidental compensable injury . . . arising out of the work performed in the course and scope of employment.” The second prong states that “for an injury to arise out of and in the course of one’s employment, there must be some causal connection between the injury and the employment or it must have had its origin in some risk incident to or connected with the employment or that it flowed from it as a natural consequence.

With the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA) to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education, and assistance. OSHA is a federal agency that is part of the larger federal Department of Labor. The administrator for OSHA is the Assistant Secretary of Labor for Occupational Safety and Health. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Most Frequently Cited OSHA Standards

Certain types of workplace injuries attract more attention than others. OSHA estimates that more stringent training policies could prevent approximately 70% of all forklift accidents in the United States. OSHA also projects that in total, between 35,000 and 62,000 forklift injuries occur each year. However, the ten OSHA standards that are cited the most frequently might surprise you.

The following ten OSHA standards were the most frequently cited standards by Federal OSHA in fiscal year 2022 (October 1, 2021, through September 30, 2022): (1) Fall Protection, construction (29 CFR 1926.501); (2) Hazard Communication, general industry (29 CFR 1910.1200); (3) Ladders, construction (29 CFR 1926.1053); (4) Respiratory Protection, general industry (29 CFR 1910.134); (5) Scaffolding, construction (29 CFR 1926.451); (6) Control of Hazardous Energy (lockout/tagout), general industry (29 CFR 1910.147); (7) Powered Industrial Trucks, general industry (29 CFR 1910.178); (8) Fall Protection Training, construction (29 CFR 1926.503); (9) Eye and Face Protection, construction (29 CFR 1926.102); (10) Machinery and Machine Guarding, general industry (29 CFR 1910.212).

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In a recent case, the First District Court of Appeals for the State of Florida issued an opinion in an appeal involving a claim for compensability of hypertension and heart disease brought under section 112.18, Florida Statutes (2019), commonly known as the “heart-lung statute.” The appellant, a law enforcement officer, filed a claim for compensation under the heart-lung statute and was denied by his employer, Florida Highway Patrol, which is the appellee. The Judge of Compensation Claims (JCC) denied the appellant’s claim, finding that he failed to satisfy “disability,” a prerequisite for compensability of occupational disease under the law. After the denial, the appellant appealed the decision.

The appellant was hired by the Florida Highway Patrol in 2001 after undergoing a pre-employment physical. In 2008, he was diagnosed with hypertension after consulting a doctor for headaches and redness in the face he was experiencing. At that point, the appellant was restricted from working for a few days and prescribed medication. He did not file workers’ compensation paperwork and did not pursue a workers’ compensation claim. Then in early 2019, while visiting a hospital to investigate a vehicle crash, the appellant asked a nurse to check his blood pressure. The nurse informed him that his blood pressure was high, and recommended he consult a doctor.

The next day, the appellant met with his personal doctor and alerted his employer. The employer then scheduled an appointment for him with a cardiologist, Dr. Gupta, for evaluation. At his first appointment with Dr. Gupta, his blood pressure was 160/96, and described by the doctor as “uncontrolled.” Dr. Gupta diagnosed him with hypertension and obesity, changing his medication and recommending an echocardiogram (EKG). At that point, Dr. Gupta did not take him out of work, assign work restrictions, or refer him to the hospital. The appellant returned to Dr. Gupta in February for his EKG and planned to report to work immediately after the appointment. Dr. Gupta changed his medication again, counseled him on obesity and lifestyle changes, and recommended a stress test. He also requested that Friesen remain in the waiting room for ten to fifteen minutes for the medication to take effect and lower his blood pressure. The appellant waited fifteen minutes and his blood pressure improved. Again, no work restrictions were assigned. After continuing to work full time, in mid-February, his employer issued a Notice of Denial, asserting that hypertension or heart disease must be accompanied by disability to be compensable. The appellant then filed a Petition for Benefits, requesting workers’ compensation benefits.