clock-300x200Florida’s workers’ compensation system has two distinct time bars for filing petitions to seek benefits. Most people are at least vaguely aware of one of the concepts, known as the statute of limitations (SOL). Florida’s workers’ compensation SOL is enunciated in section 440.19, Florida Statutes.

The other time bar is laid out in Florida Statute 440.185(1), reproduced below:

(1) An employee who suffers an injury arising out of and in the course of employment shall advise his or her employer of the injury within 30 days after the date of or initial manifestation of the injury. Failure to so advise the employer shall bar a petition under this chapter unless:

(a) The employer or the employer’s agent had actual knowledge of the injury;

(b) The cause of the injury could not be identified without a medical opinion and the employee advised the employer within 30 days after obtaining a medical opinion indicating that the injury arose out of and in the course of employment;

(c) The employer did not put its employees on notice of the requirements of this section by posting notice pursuant to s. 440.055; or

(d) Exceptional circumstances, outside the scope of paragraph (a) or paragraph (b) justify such failure.

This blog addresses subsection (d).

The statute is often interpreted strictly to the detriment of the injured worker. Accordingly, while there is some room for challenge built into every subsection of the statute, it is nevertheless advisable to err on the side of caution by giving notice [to the employer] whenever practicable within 30 days of  having even the slightest indication a work-related injury may have been sustained.

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caduceus-1219484-m-212x300Individuals receiving Florida workers’ compensation benefits for serious medical conditions must give deep thought and consideration to the role of Medicare in their future medical plans. This is especially so for those who are eligible or soon to be eligible for Medicare.

Because workers’ compensation has primary responsibility [for covering medical care associated with work-related injuries] versus Medicare’s secondary payor status, failing to adequately account for Medicare’s imperatives may keep the Centers for Medicare & Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS), the federal agency that runs the Medicare Programfrom covering much needed future care and services.

Most Florida workers’ compensation cases end up settling. The settlement can take the form of a lump sum (all at once) payment or a structured settlement (which may also include a lump sum component). In consideration for this compensation, claimants must typically forego the right to receive future workers’ compensation medical benefits.

Given its status as a secondary payor, Medicare expects a portion of the lump sum and structured settlement money to be used by the claimant to cover the cost of medical care received in the future in connection with the work-related injuries. Until the amount, which should be pre-established by experts and approved by Medicare — in the absence of pre-approval, we try to get the workers’ compensation insurance carrier to agree to cover the difference between the informal earmarked amount and a later amount Medicare may claim is due — is exhausted and properly accounted for, Medicare will not undertake its role as a secondary payor, i.e., begin making payments for work-related injuries. For example, if $53,000 (a number we used in a recent settlement) were earmarked for this purpose, Medicare would not make any payments until the entire $53,000 (plus interest, if applicable) were exhausted on the claimant’s medical care (for Medicare covered services only — meaning that any money expended for non-covered services does not count against the set-aside amount that must be exhausted before Medicare pays penny one.) See, July 23, 2001 Medicare memo.

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Trump rants that “attorney client privilege is dead.” BS! I’m a lawyer and feel no less confident that as long as my clients and I keep our noses clean, our privileged communications will remain sacrosanct as always. Major hurdles had to be overcome for the federal judge to authorize the raid [in the Cohen matter]. Moreover, additional post-raid safeguards are in place to prevent unauthorized breaches of the privilege. The AC privilege is not absolute; it is not a license to advance or commit crimes. While the measures taken against Cohen are severe, they are not unfair [despite what the Whiner in Chief declares]. The rule of law has been followed to a T.

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Trump is a despicable pig. Period. Anyone who thinks otherwise is right there with him. Period. One day after Passover, the Festival of Liberation, and mere hours after attending church services on Easter Sunday, a supposed day of joy and compassion for Christians, this human smegma dashes all hope for tens of thousands of good and decent and defenseless young people by gleefully declaring in pathologically perverse tweets that DACA is dead.

doctor-267x300Nothing is more important to a workers’ compensation claimant than being under the care of a fair-minded doctor. Unfortunately, realizing this fundamental right under Florida’s workers’ compensation system can be elusive. This is because Florida law offers employers/workers’ compensation insurance companies (E/C) the opportunity to select all of the injured worker’s treating doctors, 440.13, Florida Statutes (2017), and most of these providers, knowing better than to bite the hand that feeds them, willingly render opinions favorable to carriers. Unwilling providers need not apply.

If the opportunity is properly exercised, the E/C can maintain control of the worker’s medical care throughout the duration of the case. The opportunity can be lost.

Section 440.13(f) requires carriers to give employees the opportunity for one change of physician during the course of treatment for any one accident. If the carrier fails to provide the change of physician within 5 days after the request is made in writing (which includes a Petition for Benefits, see Gadol v. Masoret Yehudit, Inc., 132 So.3d 939 (Fla. 1st DCA 939), and email), the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary. 440.13(f) and Zekanovic v. American II, Corp., 208 So. 3d 851 (Fla. 1st DCA 2017).

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dollars-254x300This previous blog — Florida Workers’ Compensation Permanent Total Disability (PTD) and the Social Security Disability (SSD) Offset — explains how workers’ compensation benefits and Social Security Disability benefits can offset each other. Today’s blog explains what happens when the workers’ compensation case settles.

Federal law (42 U.S.C sec. 424a) and Florida law allow workers’ compensation Employers/Carriers to reduce their payments to injured employees who are receiving both Social Security Disability and workers’ compensation indemnity benefits at the same time. Section 440.15(9)(a), Florida Statutes (2018), provides:

Weekly compensation benefits payable under this chapter for disability resulting from injuries to an employee who becomes eligible for benefits under 42 U.S.C. s. 423 shall be reduced to an amount whereby the sum of such compensation benefits payable under this chapter and such total benefits otherwise payable for such period to the employee and her or his dependents, had such employee not been entitled to benefits under this chapter, under 42 U.S.C. ss. 402 and 423, does not exceed 80 percent of the employee’s average weekly wage. (Bold added.)

When a Florida workers’ compensation case settles, the payment of indemnity benefits ends. Hence, the workers’ compensation carrier will no longer be taking an offset. This opens the door to the Social Security Administration to take the offset.

Steps are available to Florida workers’ compensation attorneys to reduce or eliminate the SSA offset. This is accomplished by doing a “Sciarotta Allocation.”

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The following are some of our posts to social media:

Parkland Town Hall

At the Parkland town hall, Rubio says that the NRA gives him money because it supports his agenda rather than the NRA giving him money to support its agenda. Either way, this means that Rubio supports the NRA agenda. Oy vey!

It is not uncommon for minor children to be living with only one of their parents or neither. Since minors do not have the capacity to make various legal decisions, the question often arises as to who, in the above scenarios, does have that authority.

Custody law can be contentious and complicated. While it is beyond the scope of this blog to address the entire subject, the natural starting point is section 744.301, Florida Statutes.

Section 744.301(2) provides that parents, as the natural guardians of their children, have the authority to make legally binding decisions on behalf of their minor children in personal injury cases. However, the authority is not absolute.

When the parents are living together with the children, the decision making is shared jointly. It is a different story when the parents are divorced and living apart. Section 744.301(1) provides that “the natural guardianship belongs to the parent to whom sole parental responsibility has been granted, or if the parents have been granted shared parental responsibility, both continue as natural guardians.” 744.301(1). This makes it sound like the right to make binding decisions is determined solely by the status of “parental responsibility.” Not necessarily.

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The following editorial was published on January 16, 2018, in the Tampa Bay Times newspaper. It is fair and balanced.

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Editorial: Balancing the playing field for workers’ compensation

For the longest time, injured workers in Florida were basically at the mercy of the whims of employers to treat them fairly. A 2003 law aimed at reducing the cost of workers’ compensation coverage for businesses had the desired impact, but it also discouraged attorneys from getting involved in workers’ comp cases and resulted in a drop in the number of claims. Then the Florida Supreme Court ruled in two 2016 cases on behalf of workers’ rights, causing the pendulum to swing back in the direction of employees and resulting in significant rate increases for employers. The Florida Legislature is again proposing reforms, but it needs a more prudent and equitable approach.

Clearly, this is an area that needs to be monitored closely. Between spurious claims and the potential for excessive attorney fees, a poorly run workers’ compensation system could have an adverse impact on the state’s economy. For example, after the state Supreme Court rulings, the premiums for businesses seeking workers’ compensation insurance jumped 14.5 percent in 2016-17.

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Section 440.15(4)(e) of the Florida Statutes provides as follows: “If the employee is terminated from postinjury employment based on the employee’s misconduct, temporary partial disability benefits are not payable as provided for in this section.”

Simple enough, right? Not necessarily.

For starters, 440.15(4)(e) is qualified by section 440.02(18), which provides in pertinent part as follows:

‘“Misconduct”’ includes, but is not limited to, the following, which shall not be construed in pari materia with each other:

(a) Conduct evincing such willful or wanton disregard of an employer’s interests as is found in deliberate violation or disregard of standards of behavior which the employer has the right to expect of the employee; or

(b) Carelessness or negligence of such a degree or recurrence as to manifest culpability, wrongful intent, or evil design, or to show an intentional and substantial disregard of an employer’s interests or of the employee’s duties and obligations to the employer.

This heightens the standard for authorizing the denial of temporary partial disability benefits (TPD) above innocent acts of misconduct. If Mr. Jones is fired for showing up late to work one day because of a flat tire, it is unlikely that TPD benefits will be denied on the basis of 440.15(4)(e). Now, if Mr. Jones makes a habit of showing up late on a regular basis without a darn good excuse — and even then — the story may likely have a different ending.

In the Mr. Jones example, the distinction is between termination for cause and termination for misconduct. See Thorkelson v. NY Pizza & Pasta Inc., 956 So. 2d 542 (Fla. 1st DCA 2007) (“Clearly a claimant is not disqualified from workers’ compensation benefits just because she ‘”was terminated . . . for cause.”‘)

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