Articles Posted in Workers’ Compensation

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.

Most Florida employers are required to have workers’ compensation insurance to cover the medical expenses of an employee who was injured while working. Workers’ compensation insurance guarantees that all medical treatment for work-related injuries will be paid for on behalf of the employer, following Florida law. Workers’ compensation insurance also can cover additional expenses and accommodations that may need to be addressed as an injured employee returns to work. Although workers’ compensation laws and insurance are designed to insulate workers from the consequences of an injury, many employers and employees do not have a full understanding of what is covered, and how to make a claim. The Florida Division of Workers’ Compensation website has a workers’ compensation section that addresses many of these questions.

Florida workers’ compensation insurance covers all of the medical bills that were incurred from an on-the-job injury. Additionally, employees are entitled to ⅔ of their usual wages if they are unable to work for over 7 days. To start the process of using workers’ compensation coverage for medical care, an injured employee should report the injury to their employer as soon as possible after the injury. Failure to report an injury within 30 days may result in the denial of an otherwise eligible claim. Within 7 days of receiving the report from their employee, your employer should notify their insurance company of the claim. If an employer is refusing to cooperate, the employee also may notify the insurance company themselves.

After a workers’ compensation claim has been opened, the injured worker should be able to receive all medical treatment that was ordered by the doctor. This includes any inpatient or outpatient care, physical therapy, prescriptions, and other ancillary care related to the injury. Compensation for lost work is also available, but may only cover anywhere from one to 104 weeks, depending on the facts of each case. Injured workers may also be eligible for other benefits through the federal government’s social security program, however, coverage limits do apply.

If a worker is injured on the job, there may be many avenues of relief for them to receive treatment and compensation. In the event of a purely accidental injury, the first line of coverage for an injured worker is workers’ compensation insurance. This insurance will pay for treatment and lost work expenses for an injured employee of the policyholder. Workers’ compensation coverage is desirable because it covers injured employees regardless of fault. Workers’ compensation coverage does not generally pay out as much as would a negligent or intentional tort claim.

In Florida, an injured worker may be able to pursue a personal injury claim against their employer or any other negligent party who caused the worker’s injuries. A personal injury claim may include higher amounts of damages for things like disability/disfigurement, pain and suffering, and other special damages. Because personal injury claims allow larger awards than workers’ compensation claims, injured Florida plaintiffs may want to pursue a personal injury claim instead of a worker’s compensation claim when appropriate. The Florida Court of Appeals recently rejected an injured plaintiff’s attempt to recover damages for her workplace injury through a personal injury claim.

The plaintiff in the recently decided case was the project manager for one construction company on a construction site. Employees for the defendant, another subcontractor on the job, moved a staircase from in front of the plaintiff’s trailer and failed to return it before leaving. After the plaintiff arrived at her trailer in the early morning, she didn’t see the missing staircase, fell over 3 feet, and was injured. The plaintiff pursued a worker’s compensation claim with her employer as well as a personal injury claim against the company that employed the workers who moved the staircase.

Recently, the First District Court of Appeals in Florida issued an opinion in an appeal involving a workers’ compensation claim from a correctional officer who suffered a cardiac arrest. According to the record, while the Bradford County Sheriff’s Office (BCSO) initially accepted compensability under Florida’s “pay-and-investigate” law, the BCSO later denied the claim. The correctional officer countered the denial, stating his claim was valid under the so-called “Heart-Lung” statute, which creates a presumption in favor of firefighters, police officers, correctional officers, and others that any “condition or impairment” that is “caused by tuberculosis, heart disease, or hypertension resulting in total or partial disability or death shall be presumed to have been accidental and to have been suffered in the line of duty unless the contrary [is] shown by competent evidence.”

The judge of compensation claims (JCC) denied his claims, reasoning that the correctional officer “must have successfully passed the physical examination required by this subsection upon entering into service as a . . . correctional officer . . . with the employing agency, which examination must have failed to reveal any evidence of tuberculosis, heart disease, or hypertension.” While the JCC found that the correctional officer did not successfully pass a physical examination upon entering service as a correctional officer, that was due to the fact that the BCSO does not require correctional officers that were previously working part-time to take a physical examination upon beginning service as full-time correctional officers. The plaintiff passed a physical examination when he initially began work as a part-time correctional officer.

In fact, in a dissenting opinion, it is highlighted that the employer, BCSO, failed to require and affirmatively disavowed the need for a renewed physical examination for the plaintiff or any part-time correctional officer who is promoted to full-time employment. BCSO’s policy affirmatively prevents the physical examination required by statute. The dissenting opinion states that, by failing to either require an additional test when part-time correctional officers begin service as full-time correctional officers or by disavowing the need for a renewed physical examination, the BCSO forfeits the ability to contest the statutory presumption that would otherwise arise in this matter.