Workers' Compensation

March 2, 2019

Jeffrey P. Gale, P.A. // Here We Go Again — Florida’s Workers’ Compensation Law Under Assault

Here’s a simple truth: An injured worker (also known as a “claimant”) proceeding “without the aid of competent counsel” is as “helpless as a turtle on its back,” Davis v. Keeto, Inc., 463 So.2d 368, 371 (Fla. 1st DCA 1985) (quoting Neylon v. Ford Motor Co., 27 N.J.Super. 511, 99 A.2d 664, 665 (Ct.App.Div.1953)). Because of this, one of the most important rights presently available to claimants under Florida’s workers’ compensation system, is the ability to hire a lawyer on a contingency fee basis who is able to exact a reasonable attorney’s fee from the workers’ compensation insurance company (collectively, the “E/C”) for making it furnish benefits in accordance with the law. This attorney’s fee provision, contained in section 440.34, Florida Statutes, makes claimants’ attorneys willing and able to invest their time and money to do battle against the unlimited resources of Big Business and the Insurance Industry. Because the fee awarded against the E/C can be substantial, sensible E/C undertake a careful analysis of the pros and cons of denying benefits. This promotes fair and reasonable claims handling.

From 2009 to 2016, E/C operated under a diametrically different system. The 2009 Florida Legislature enacted legislation prohibiting Judges of Workers’ Compensation Claims (“JCC) from awarding “reasonable” attorney’s fees to claimants’ lawyers who successfully forced the E/C to furnish wrongly denied benefits. To accomplish this end, the legislature literally removed the word “reasonable” from the then existing statute. This encouraged indifference and hostility towards the rights of injured workers, with little regard given by E/C to the quick and efficient delivery of workers’ compensation benefits such as medical treatment and lost wages. If an injured worker was somehow able to enlist the services of a lawyer willing to undertake a protracted court battle, and the lawyer managed to win the case, the JCC could only order E/C to furnish the wrongly denied benefits and, because of limits imposed by law, award no more than a nominal fee to the claimant’s attorney, the equivalent of a slap on the wrist.

February 24, 2019

Jeffrey P. Gale, P.A. // The Peculiar Matter of Split Sample (Specimen) Urine Collection in Florida Workers’ Compensation Cases

by Jeffrey P. Gale, P.A.

Employers and their workers’ compensation insurance companies (E/C) relish the opportunity to deny benefits to employees injured on the job. One of the most powerful weapons in their ample arsenal is the section 440.09(3), Florida Statutes drug defense. It reads as follows:

(3) Compensation is not payable if the injury was occasioned primarily by … the influence of any drugs, barbiturates, or other stimulants not prescribed by a physician….

Urine is the specimen of choice for drug testing. It is collected from the donor at a collection site or directly from the injured worker’s urine bag when urinating into a cup cannot be accomplished.

January 26, 2019

Jeffrey P. Gale, P.A. // Key to Defeating Florida Workers’ Compensation Drug Defense is Preventing Presumption of Impairment

by Jeffrey P. Gale, P.A.

A popular defense utilized by Florida employers and their workers’ compensation insurance carriers (E/C) to keep from having to pay workers’ compensation benefits is the drug defense under section 440.09(3), Florida Statutes. In pertinent part, the section provides as follows:

(3) Compensation is not payable if the injury was occasioned primarily by … the influence of any drugs, barbiturates, or other stimulants not prescribed by a physician….

It is routine for specimens to be drawn — typically urine — shortly after an accident, often before medical treatment is provided for the injury. Specimen collectors will even go to hospitals in cases where emergency medical care is required.

A companion to 440.09(3) is 440.09(7)(b), which provides:

… if the employee has a positive confirmation of a drug as defined in this act, it is presumed that the injury was occasioned primarily by the … influence of the drug upon, the employee. If the employer has implemented a drug-free workplace, this presumption may be rebutted only by evidence that there is no reasonable hypothesis that the intoxication or drug influence contributed to the injury. In the absence of a drug-free workplace program, this presumption may be rebutted by clear and convincing evidence that the intoxication or influence of the drug did not contribute to the injury.

Both presumptions are exceedingly difficult to overcome. The trick for the claimant is to keep the presumption from being implemented.

Before addressing this subject, it should be pointed out that, in the case of marijuana and cocaine, two of the most popular recreational drugs in our society, the “positive confirmation of a drug” does not equate to proof positive of being under the influence of either drug at the time of the accident. This is because the confirmation testing employed by labs does not detect the element of the drugs that cause impairment. Rather, the testing detects metabolites, which are merely markers showing that the drug has been ingested at some unknown point in time within days and sometimes even weeks of the specimen draw, while the impairment time from these drugs is typically 4-6 hours maximum. This is a big part, in my editorial opinion, of what makes the drug defense so unfair. Many Claimants are being kept from receiving needed workers’ compensation benefits even though the positive confirmation relates to weekend or after-hours use instead of any connection between impairment and the accident.

Back to the presumption.

January 14, 2019

Jeffrey P. Gale, P.A. // Florida Workers’ Compensation Law Interplay Between Catastrophic Injuries and Maximum Medical Improvement (MMI) and Permanent Total Disability (PTD) Benefits

by Jeffrey P. Gale, P.A.

Permanent Total Disability (PTD) — defined in section 440.15(1), Florida Statutes — is an indemnity (monetary) benefit sometimes available under Florida’s Workers’ Compensation System to the state’s most severely injured workers. Unless the worker has suffered an injury of the type as set forth in 440.15(1)(b), commonly referred to as a “catastrophic injury,” he or she must wait to reach the date of maximum medical improvement (MMI) before becoming eligible for PTD. In some cases, this can take a year or longer. Moreover, where multiple injuries are involved, the worker must first reach MMI from each injury.

For employees who have suffered “catastrophic injuries,” MMI does not have to be reached to qualify for PTD benefits. According to 440.15(1)(b), “an injured employee is presumed to be permanently and totally disabled” upon sustaining a catastrophic injury. The presumption is rebuttable. To overcome the presumption, the employer or carrier must establish “that the employee is physically capable of engaging in at least sedentary employment within a 50-mile radius of the employee’s residence.” 440.15(1)(b).

In Temporary Labor Source v. E.H., 765 So.2d 757 (Fla. 1st DCA 2000), although the claimant had sustained a catastrophic injury, the Judge of Compensation Claims (JCC) refused to adjudicate the issue of PTD when the matter was addressed at trial. Relying upon medical expert testimony “that the use of a prosthetic device may increase Claimant’s ability and capacity for work,” the JCC reasoned that because the claimant had not reached MMI, PTD was not ripe for adjudication. The judgment was reversed on appeal.

November 18, 2018

Jeffrey P. Gale, P.A. // Carrier’s Obligation to Pay Medical Expenses Despite Drug/Alcohol Impairment Defense

by Jeffrey P. Gale, P.A.

Under Florida law, if a workplace injury was occasioned primarily by the influence of alcohol or drugs, workers’ compensation benefits can be denied. Section 440.09(3), Florida Statutes (2018) (Interestingly, while this section provides that “Compensation is not payable,” with section 440.02(7) defining “Compensation” as “the money allowance payable to an employee or to his or her dependents,” the law is used to deny all workers’ compensation benefits, including medical benefits. The issue was addressed in Gustafson’s Dairy, Inc. v. Phillips, where “Compensation” was interpreted to include both medical and indemnity benefits.) It is a popular defense.

Typically, some level of medical care is provided before the workers’ compensation insurance carrier becomes aware of the drug and alcohol test results. For example, our firm is handling a roofing accident resulting in paraplegia for which nearly $200,000 in authorized medical care was provided before a positive test result became known.

We believe that the carrier may be responsible for the medical expenses. Our position is based on section 440.102(5)(p), Florida Statutes, which provides in pertinent part as follows:

“All authorized remedial treatment, care, and attendance provided by a health care provider to an injured employee before medical and indemnity benefits are denied under this section must be paid for by the carrier or self-insurer.”

November 5, 2018

Jeffrey P. Gale, P.A. // Workers’ Compensation Temporary Partial Disability Benefits Following Relocation

by Jeffrey P. Gale, P.A.

Per section 440.15(4), Florida Statues, Temporary Partial Disability (TPD) benefits are due “if the medical conditions resulting from the accident create restrictions on the injured employee’s ability to return to work … or an employee returns to work with the restrictions resulting from the accident and is earning wages less than 80 percent of the preinjury average weekly wage.” Does this provision allow an injured worker who has left a job to relocate to a different city or state, to receive TPD? The answer depends on the motivation of the worker for leaving the job.

In Stewart v. CRS Rinker Materials Corp., 855 So.2d 1173 (Fla. 1st DCA 2003), the Claimant left a modified duty job following an industrial accident and relocated to Pensacola because he and his wife were having marital problems and he thought he needed “to be with his family, be back home with [his] mom.” (His wife confirmed this testimony.) While in Pensacola he tried without success, due to his industrial injuries, to maintain a job. Two months later he returned to the job he had left. He also filed a claim for workers’ compensation TPD benefits for the period of time he was in Pensacola.

The workers’ compensation carrier denied the claim for TPD, contending that Claimant voluntarily limited his income. The Judge of Compensation Claims (JCC) agreed, finding that Claimant’s loss of earnings after his employment with the city of Pensacola and before returning to work was “not the result of an injury related disability, but rather the result of his voluntary hiatus from the job he ultimately returned to.” Claimant appealed the JCC’s decision.

November 1, 2018

Jeffrey P. Gale, P.A. // Entitlement to Florida Workers’ Compensation Lost Wages Following Job Termination

by Jeffrey P. Gale, P.A.

It is not uncommon for injured workers to be terminated from their jobs post-accident. There was a time when Florida law required employers to make every effort within reason to reemploy their injured workers. While that admirable public policy was scrapped some 15 years ago, section 440.205, Florida Statutes does prohibit employers from terminating employees hurt on the job for claiming workers’ compensation benefits. However, as a firm that handles wrongful termination cases, we know that proving one from the other can be difficult. Compounding the difficulty is the element of good-cause firings, i.e., justified firings based on conduct, such as excessive absences.

Per section 440.15(4) Florida Statutes (2018), temporary partial disability (TPD) wage loss benefits are due “if the medical conditions resulting from the accident create restrictions on the injured employee’s ability to return to work … or an employee returns to work with the restrictions resulting from the accident and is earning wages less than 80 percent of the preinjury average weekly wage.” This language has allowed some employees terminated for cause to be entitled to TPD benefits. (Caveat: Not all good-cause terminations are treated alike. Read this blog: Jeffrey P. Gale, P.A. // Florida Workers’ Compensation 440.15(4)(e) Termination for Misconduct Law Not Well Understood.)

One of the leading cases on the subject is Stewart v. CRS Rinker Materials Corp., 855 So.2d 1173 (Fla. 1st DCA 2003). The Claimant injured his back on the job in a compensable accident — meaning, an accident accepted by the Employer/Carrier. He returned to work for the Employer, in a modified-duty status to conform to the authorized doctor’s recommendations, for approximately three weeks after the accident until the Employer terminated him for excessive absenteeism (most of which occurred before the accident). For nine of the next eleven months he looked for work but remained unemployed. He also continued under the care of workers’ compensation doctors, who imposed work restrictions.

October 11, 2018

Jeffrey P. Gale, P.A. // Florida Workers’ Compensation SOL Tolling, Impairment Rating & Guides

by Jeffrey P. Gale, P.A.

Our firm recently settled a hard fought workers’ compensation case arising from a 1995 industrial accident. We received the initial call from the Claimant in March of this year (2018). He explained that he had not received medical care for his injuries, tibia and fibula fractures, since three months post surgery in 1995, but had for the past ten years been experiencing progressively worsening pain for which he now wished to be examined by a doctor. He claimed to be unaware of the Florida workers’ compensation system’s two year statute of limitations (SOL).

We accepted the case and proceeded to undertake discovery on four critical issues, the answers to which would decide whether or not the carrier would be estopped from relying on the statute of limitations defense.

Did the workers’ compensation carrier send the claimant the section 440.185(4), Florida Statutes informational brochure which sets forth an explanation of his rights, benefits, and procedures for obtaining benefits and assistance under the Florida Workers’ Compensation Law?
If not, did the claimant otherwise gain knowledge of these rights, say, for example, from a lawyer or even a friend?
Did the carrier obtain a date of MMI or a permanent impairment rating from the medical provider it authorized and pay the impairment benefits?
If not, was the claimant otherwise aware of his entitlement to impairment benefits?

In 1995, as today, carriers were instructed by section 440.185(4) to inform claimants of their rights under the workers’ compensation law. While a failure to do this could toll the SOL — i.e., keep it from running — it is not an absolute. The workers’ compensation judge (JCC) is charged with determining “whether the claimant lacked actual knowledge of his rights under the workers’ compensation law, and, if so, whether the absence of such knowledge was the cause of the claimant’s failure to obtain the requested care within the limitation period.” Fontanills v. Hillsborough County School Board, 913 So.2d 28, 30 (Fla. 1st DCA 2005).

August 16, 2018

Jeffrey P. Gale, P.A. // Issues Related to Positive Alcohol and Drug Test Results in Florida Workers’ Compensation Cases

by Jeffrey P. Gale, P.A.

Employees testing positive for alcohol or drugs in their system at the time of injury face an uphill battle to recover workers’ compensation benefits. Under subsection 440.09(3), Florida Statutes (2018), compensation is not payable if the injury was occasioned primarily by the intoxication of the employee. If the employer has reason to suspect that the injury was occasioned primarily by the intoxication of the employee or by the use of any drug, urine and/or blood testing is authorized. A positive test result may create the presumption “that the injury was occasioned primarily by the intoxication of, or by the influence of the drug upon, the employee.” Section 440.09(7)(b), Florida Statutes (2018). Unless the employee can overcome the presumption, benefits will be denied. Section 440.09(3).

There are two standards for overcoming the presumption. Which one applies depends on whether or not the employer has instituted a drug-free workplace in accordance with Florida Statute 440.102.

“If the employer has implemented a drug-free workplace, this presumption may be rebutted only by evidence that there is no reasonable hypothesis that the intoxication or drug influence contributed to the injury.” Section 440.09(7)(b), Florida Statutes (2018).
“In the absence of a drug-free workplace program, this presumption may be rebutted by clear and convincing evidence that the intoxication or influence of the drug did not contribute to the injury.” Section 440.09(7)(b), Florida Statutes (2018).

Standard number 1 is more difficult for claimants to overcome than number 2. Sometimes, neither applies. In Wright v. DSK Group, 821 So.2d 455 (Fla. 1st DCA 2002), testimony was adduced from witnesses that claimant had ‘”smoked marijuana on the day of his injury.”‘ Relying on this testimony alone, the judge of compensation claims (JCC) applied the presumption and required the claimant to meet standard number 2. The JCC was reversed on appeal, with the court holding that the presumption did not apply and the employer failed to meet its burden that the work-related injury ‘”was occasioned primarily by the … influence of any drugs … not prescribed by a physician.”‘ Section 440.09(3), Fla. Stat. (1999). See generally Temporary Labor Source v. E.H., 765 So.2d 757 (Fla. 1st DCA 2000) (affirming a ruling that the presumption authorized by section 440.09(7)(b) does not arise when confirmation testing did not conform with applicable rules and that, as a result, the employer was required to establish that the injury was caused primarily by the influence of drugs), review denied, 786 So.2d 1189 (Fla.2001). “When the presumption in section 440.09(7)(b) does not apply, employer/carriers must `establish, by the greater weight of the evidence, that the work-related injury was occasioned primarily by the intoxication of the employee.'” See Thomas v. Bircheat, 16 So. 3d 198, 200 (Fla. 1st DCA 2009) (quoting Wright v. DSK Group, 821 So. 2d 455, 456 (Fla. 1st DCA 2002); see also Sterling v. Mike Brown, Inc., 580 So. 2d 832, 835 (Fla. 1st DCA 1991) (affirming JCC’s order finding employee’s injury was primarily caused by his intoxication even without presumption).

August 3, 2018

Jeffrey P. Gale, P.A. // Clarifying Meaning of “Authorized Treating Provider” Under Florida Statute 440.13(5)(e)

by Jeffrey P. Gale, P.A.

Florida statute section 440.13(5)(e) limits who may give medical opinions in workers’ compensation trials to “a medical advisor appointed by the judge of compensation claims or the department, an independent medical examiner, or an authorized treating provider.”

Our office recently accepted a 23 year old workers’ compensation case where the employee has not received any workers’ compensation benefits for 22 years. The workers’ compensation insurance carrier has raised two defenses to the claim: (1) Statute of Limitations and (2) causal relationship between the current complaints (back and leg pain) and the injury suffered in 1995 (a tibial fracture requiring medullary rodding) — see, 440.02(36).

To carry our burden of establishing the necessary causal connection (to defeat defense #2), medical testimony must be presented. The original surgeon, who was then authorized by the workers’ compensation carrier, is still practicing medicine in Miami-Dade County. Our plan is to have him evaluate the claimant to give his opinion on the issue.

The employer/carrier (E/C) claims that the doctor is no longer “an authorized treating provider,” precluding him from being qualified to give the key opinion testimony. We believe that E/C is wrong.