wheelchair2The defense of Florida workers’ compensation claims by the use of Martin v. Carpenter, 132 So.2d 400 (Fla. 1961) and Florida Statute 440.15(5)(a) are employer and insurance industry favorites. While the defenses are similar and provide a complete defense to a workers’ compensation claim, they are not entirely alike.

The case and the statute deal with pre-employment representations made by prospective employees about their health. Under Martin, applicants who lie about their physical condition when applying for a job can be denied workers’ compensation benefits for an otherwise compensable injury when the evidence shows the following:

  1. Causal relationship between the injury and the false representation;
  2. The employee knew the representation to be false;
  3. The employer relied on the false representation; and
  4. Such reliance resulted in consequent damage to the employer.

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Can a worker injured outside the state of Florida be eligible for Florida workers’ compensation benefits? The answer lies in § 440.09(1)(d), Fla. Stat.:

If an accident happens while the employee is employed elsewhere than in this state, which would entitle the employee or his or her dependents to compensation if it had happened in this state, the employee or his or her dependents are entitled to compensation if the contract of employment was made in this state, or the employment was principally localized in this state. However, if an employee receives compensation or damages under the laws of any other state, the total compensation for the injury may not be greater than is provided in this chapter.

Key elements for Florida jurisdiction:

  1. The contract of employment was made in Florida; or
  2. The employment was principally localized in Florida.

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dollarsAn employee injured or killed in the course of his or her employment by the negligence or wrongful act of a third-party tortfeasor may receive workers’ compensation benefits and pursue a remedy by action at law against such third-party tortfeasor. (Where the employee has been killed, the third-party action will be handled through the decedent’s estate by a court appointed Personal Representative.)

Pursuant to Florida Statute 440.39, if the employee or his or her dependents accept workers’ compensation benefits, the employer or its workers’ compensation insurance company shall be subrogated to the rights of the employee or his or her dependents against such third-party tortfeasor, to the extent of the amount of compensation benefits paid or to be paid. This is known as the workers’ compensation lien.

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crushed vehicleThe main object of a vehicle (e.g., car, truck, motorcycle, van) crash claim or lawsuit is to obtain full compensation for the person harmed by the negligence of another. The standard damage elements are pain & suffering, loss of income (past and future), past and future medical expenses, and vehicle damage repair or replacement.

A crash damaged vehicle, even if repaired, has a diminished resale value. The diminished value is a measure of damages that can, under the right circumstances, be claimed as compensation from the at-fault party. (Typically, this means the at-fault party’s insurance company. Whether such a claim can be made against one’s own insurance policy in a first-party claim is a matter of contract law. Since Florida law does not require insurers to provide this coverage to their own insureds, whether or not it is available depends on the terms of the insurance contract. The coverage is usually not provided.)

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hospitalThe life of a personal injury lawyer is precarious. Serious pitfalls lurk around every corner. One of the scariest dangers is the unknown medical lien. Of this breed, the Medicare lien can have the biggest bite.

In 1965, Congress enacted the Medicare Act by adding Title XVIII to the Social Security Act, with the purpose of establishing a “federally funded health insurance program for the elderly and the disabled.” Thomas Jefferson Univ. v. Shalala, 512 U.S. 504, 506 (1993). It is taxpayer funded.

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worker2Florida’s workers’ compensation system is stacked against injured workers in every way imaginable. It more closely resembles what would be expected in Vladamir Putin’s Russia.

An especially egregious arrangement is the one which allows employers and their workers’ compensation insurance carriers to hand-select the injured worker’s treating doctors. See Section 440.13(2) Florida Statutes. Not surprisingly, E/Cs select the same doctors again and again. The doctors know what is expected of them and deliver. The money is good and steady, so there won’t be any biting of the hand, so to speak, from this cadre of medical providers. To make matters worse, the law allows the E/C and their representatives to engage in ex-parte communications with treating doctors, see Section 440.13(4)(c) Florida Statutes, and “[n]o medical opinion other than the opinion of a medical advisor …, an independent medical examiner, or an authorized treating provider is admissible in proceedings before the judges of compensation claims.” Section 440.15(5)(e) Florida Statutes.

What all of this amounts to is that injured workers mostly have little control over the outcome of their medical care and work status. The doctor’s word is gold, even when the doctor is in E/C’s pocket.

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gavel-952313-mFlorida Statute §627.737(2) provides that a plaintiff may recover tort damages for pain, suffering, mental anguish, and inconvenience because of injury arising out of the use of a motor vehicle only if that injury or disease consists in whole, or in part of: (a) significant and permanent loss of an important bodily function; (b) permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; (c) significant and permanent scarring disfigurement; or (d) death.* A plaintiff failing to meet any of these thresholds may recover only economic damages, such as medical expenses or lost wages

Florida law allows lawsuits against insurers whose denial of meritorious claims is in bad faith. Two types of bad faith claims are recognized: Common law, in the third party context only, and statutory (§625.155 Florida Statutes). Reasonable diligence and ordinary care are material in determining bad faith. See Campbell v. Gov’t Employees Ins. Co., 306 So.2d 525, 530-31 (Fla.1974).

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truck2Regarding recovery based on fault, present-day Florida tort law is governed by the standard established by the Florida Supreme Court in Hoffman v. Jones, 280 So.2d 431 (Fla., 1973). Hoffman replaced Florida’s contributory negligence rule (West v. Caterpillar Tractor Co., Inc., 336 So.2d 80, 90 (Fla.1976): the “gist of the doctrine of contributory negligence is that the person injured should not recover when it appears that the injury would have been avoided if the injured person had exercised reasonable care”) with a system of tort recovery based on a “pure form” of comparative negligence:

“If plaintiff and defendant are both at fault, the former may recover, but the amount of his recovery may be only such proportion of the entire damages plaintiff sustained as the defendant’s negligence bears to the combined negligence of both the plaintiff and the defendant.” Hoffman, 280 So.2d at 438.

Following the opinion in Hoffman, the Florida Legislature in 1986 codified the Court’s adoption of a system of comparative negligence, and its concomitant abolishment of the rule of contributory negligence, by enacting section 768.81 Florida Statutes (2015 version).

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funeralWe have blogged at length regarding the decision-making role of estate Personal Representatives with regard to the allocation of monetary proceeds recovered from at-fault parties and under/uninsured motorist insurance. Where the amount recovered is less than the full measure of damages, disputes often arise between creditors and the decedent’s survivors over the PR’s allocation decisions. When those disputes cannot be resolved by agreement, the courts must decide. While Florida’s Wrongful Death Act does not articulate preferences, our experience shows that courts tend to side with survivors in close cases.

In re Estate of Wiggins, 720 So. 2d 523 (Fla. 4th DCA 1999) is the seminal allocation case. It involved six adult surviving children and various creditors (owed a total of $26,000), including Indian River Memorial Hospital, vying over a $100,000 settlement. The matter was forced to trial, where the trial court agreed with the PR’s allocation which left creditors with nothing. The lower court’s ruling was upheld on appeal.

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DisabledPTD, the acronym for Permanent Total Disability, is the only post-MMI (maximum medical improvement; § 440.02(10) Florida Statutes) workers’ compensation wage loss benefit available to Florida’s injured workers. A Claimant has four ways of qualifying for PTD.

The first way is by proving at least one of the injuries listed in § 440.15(1)(b) (2015). Doing so establishes a rebuttable presumption of PTD. (The burden is on the employee to prove the injury.) Since the presumption is rebuttable, the employer or carrier can overcome the PTD presumption by establishing that the employee is physically capable of engaging in at least sedentary employment within a 50-mile radius of the employee’s residence.

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