Articles Posted in Workers’ Compensation

applicationUntil six years ago, it was a crime in Florida for an attorney to accept a fee from a claimant in a workers’ compensation case that was not approved by a Judge of Compensation Claims (JCC) in accordance with the fee formula contained in section 440.34(1), Florida Statutes. Section 440.105(3)(c), Florida Statutes. The crime was punishable by up to one year in prison (s. 775.082) and a fine (s. 775.082). Any lawyer violating 440.105(3)(c) could also expect to be suspended or disbarred.

In Miles v. City of Edgewater Police Dept/Preferred Governmental Claims Solutions, 190 So. 3d 171 (Fla. 1st DCA 2016), the JCC rejected an attorney/client contract wherein the client, an injured worker, and her union agreed to pay a workers’ compensation lawyer a fee in excess of the amount allowed under 440.34. Because it would be a financial hardship for the lawyer to handle the case under the formula set forth in 440.34, she withdrew from the case. Unable to find a lawyer to take her case, the injured worker proceeded Pro Se. Her claims were denied by the JCC.

Claimant argueed on appeal that Florida Statutes 440.105 and 440.34 violated the First Amendment of the Constitution of the United States and the fundamental right to contract. The First District Court of Appeal agreed.

At its heart, Miles is about freedom of speech and the right of individuals to contract freely for legal services. The Court found that 440.105 and 440.34 violated both rights:

In conclusion, the restrictions in sections 440.105 and 440.34, when applied to a claimant’s ability to retain counsel under a contract that calls for the payment of a reasonable fee by a claimant (or someone on his or her behalf), are unconstitutional violations of a claimant’s rights to free speech, free association, and petition — and are not permissible time, place, or manner restrictions on those rights. Likewise, those provisions also represent unconstitutional violations of a claimant’s right to form contracts — and are not permissible police power restrictions on those rights. Miles at 184.

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Think of an injury case like navigating a ship from one port to another. Signing up the case is the equivalent of throwing off the ropes and pulling safely away from the dock. Being at sea is analogous to litigation. Some days you will eat the bear and some days the bear will eat you. Stay your course. Invariably, chart adjustments will be necessary, but the final destination always remains the same: favorable resolution of the case. Settling the case equates to pulling into port. However, it is not the last act. The ship must be successfully docked and secured. The Settlement Release is part of this final act. It must be done properly to avoid damaging the ship.

Our law firm handles both workers’ compensation and personal injury/wrongful death cases. It is not uncommon to have both types of cases arising out of one accident. For example, we represent a gentleman who suffered numerous catastrophic injuries in a motor vehicle crash. Since the accident happened in the course and scope of his employment, he was covered under workers’ compensation. We recently settled the workers’ compensation case. The common law liability case, against the second vehicle’s owner and our client’s co-worker [brought under a theory of gross negligence to overcome workers’ compensation immunity], remains ongoing.

As part of the workers’ compensation mediated settlement, the workers’ compensation carrier agreed that the settlement did not affect the liability case against the third party or the co-worker. Nevertheless, the General Release it submitted to us contained wording that could be construed as preventing our client from proceeding against the co-worker. We have reworded it to avoid this outcome.

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maze1-300x225Some wrongs present the aggrieved party with more than one legal remedy. A common example is when an injured person has the option of seeking a recovery under common law or workers’ compensation pursuant to Chapter 440, Florida Statutes. Once the choice is made and pursued beyond a certain point, the alternate option cannot be pursued. This is the legal principle known as Election of Remedies.

Typically, the injured person receives or seeks workers’ compensation benefits before deciding to pursue civil damages. There is no shortage of Florida appellate case law addressing how far one may go in the pursuit before the choice becomes binding. There is very little case law addressing the opposite scenario, namely, how far one may go in pursuing a civil remedy before being foreclosed from seeking workers’ compensation benefits.

The legal analysis is the same for both types of cases:

An election is matured “when the rights of the parties have been materially affected to the advantage of one or the disadvantage of the other,” and “[i]t is generally conceded that to be conclusive it must be efficacious to some extent.” Williams v. Robineau, 124 Fla. 422, 168 So. 644 (1936)Williams v. Duggan, 153 So.2d 726 (Fla. 1963).

It is usually much easier to determine whether an election has been made in a civil case than it is in a workers’ compensation case. In civil cases, damages are not paid unless and until a determination has been made on the legal issue of whether common law is the proper vehicle for pursuing a remedy. Until this final determination is made, the election has not matured.

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firefighter2-300x200In City of Jacksonville v. Ratliff, 217 So. 3d 183 (Fla. 1st DCE 2017), a firefighter with a pre-existing history of diabetes, high cholesterol, prior history of smoking, and a family history of early onset CAD – blocked arteries (CAD – coronary artery disease) caused by the build-up of plaque – among other pre-existing factors, suffered a myocardial infarction (another term for heart attack) after a stressful meeting at work. The myocardial infarction resulted from the rupture of the plaque.

The Employer/Carrier (E/C) presented uncontroverted evidence that the CAD was caused by preexisting factors unrelated to work. Nevertheless, the Judge of Compensation Claims (JCC) awarded compensation and related medical treatment for the myocardial infarction under the “heart-lung” statute, section 112.18, Florida Statutes. E/C appealed. The First DCA affirmed the JCC’s decision.

The Claimant asserted compensability of the heart condition on a “presumption only” basis; or in other words, the Claimant had no medical evidence of occupational causation and relied solely on the presumption of the “heart-lung” statute. To rebut the presumption, E/C faced only the threshold rebuttal burden of presenting competent evidence, rather than clear and convincing evidence, that the disease was not work related. This required E/C to provide evidence that a single factor, or multiple factors, wholly combined, causing the CAD were non-industrial in nature.  Punsky v. Clay Cty. Sheriff’s Office, 18 So.3d 577 at 583 (Fla. 1st DCA) (on rehearing en banc)Fuller v. Okaloosa Corr. Inst., 22 So.3d 803, 806 (Fla. 1st DCA 2009).

E/C met its burden. Even still, it was held responsible for Claimant’s heart attack.

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ladder1We currently represent an elderly woman who was knocked down in the hallway of her condominium building by a large, unleashed dog. She fell and struck her head on the ground. In the days following the event, she had headaches and was lightheaded. While taking a shower, she fainted. As a result of this event, she was hospitalized then transferred to a facility for a month of rehabilitation. She is now receiving 24/7 attendant care at home.

Are the injuries sustained from the subsequent fall compensable?

Something similar happened in Eli Witt Cigar & Tobacco Co. v. Matatics, 55 So. 2d 549 (Fla. 1951). The Plaintiff/Appellee had suffered a brain concussion and other injuries in a motorcycle accident. Within weeks of the accident, he climbed a ladder to reach his attic. While descending, he suffered a dizzy spell and fell to the concrete floor. His injuries from this fall were permanent and catastrophic — paralysis in his lower and upper extremities.

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Firefighter-300x225Unless you are a firefighter or any law enforcement officer, correctional officer, or correctional probation officer, in order to receive workers’ compensation benefits under Chapter 440 of the Florida Statutes for any condition or impairment of health caused by tuberculosis, heart disease, or hypertension, the burden will be on you to establish to a reasonable degree of medical certainty, based on objective relevant medical findings, that the workplace was the major contributing cause — meaning more than 50% — of your condition or impairment of health. See section 440.09(1), Florida Statutes. This can be a daunting task.

If, however, you are a firefighter or any law enforcement officer, correctional officer, or correctional probation officer, “[A]ny condition or impairment of health … 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….” See section 112.18(1)(a), Florida Statutes. This is a game changer.

Two conditions apply which keep the presumption from being an absolute:

  1. The “firefighter or law enforcement officer must have successfully passed a physical examination upon entering into any such service as a firefighter or law enforcement officer, which examination failed to reveal any evidence of any such condition.” Section 112.18(1)(a), Florida Statutes.
  2. The presumption can be overcome by a showing that the condition or impairment was not accidental and suffered in the line of duty. Section 112.18(1)(a), Florida Statutes.

The “firefighter or law enforcement officer must have successfully passed a physical examination upon entering into any such service as a firefighter or law enforcement officer, which examination failed to reveal any evidence of any such condition.”

In City of Homestead/Preferred Gov’t Claims Solutions v. Foust, 242 So.3d 1169 (Fla. 1st DCA 2018), even though a law enforcement officer (LEO) had undergone a physical before becoming an auxilary LEO, he was denied compensation for both heart disease and hypertension because he had not undergone a physical examination upon entering into service as a full-time LEO.

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UBER-EATS-167x300We represent a young man who was severely injured in a roadway accident while making a delivery for Uber Eats. He was struck by a phantom motor vehicle (i.e., unidentified vehicle) while riding his bicycle and left to die by the side of the road. He was discovered and transported to Ryder Trauma Center, where he underwent emergency surgery including a craniotomy. Part of his skull has been permanently replaced by a metal plate.

Uber Eats has denied him all benefits.

Uber claims that its Florida operators are independent contractors. Because true independent contractors are not employees, they are not entitled to Florida workers’ compensation benefits (see 440.02(15)(d)). Workers’ compensation would cover medical and indemnity (i.e., wages) benefits. Our young client, who was a senior in high school when this event happened, has received neither through Uber, a multi-billion dollar company. Nothing. Zero. Zilch.

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calculatorIt is not unusual for entities other than the workers’ compensation insurance carrier to pay medical expenses following a work-related accident. The most common payors are health insurance carriers, Medicare, and Medicaid. (PIP (a/k/a “No Fault”) insurance also pays if the accident involves motor vehicles, but since their rights are different than those of the other entities mentioned above for purposes of this blog, PIP will not be addressed in this blog.)

Since workers’ compensation is supposed to be the primary payor — PIP can add a wrinkle to this concept. See section 627.736(4), Florida Statutes — the other entities are entitled to reimbursement for the payments they have made. How the reimbursement is made depends on when, during the life of the workers’ compensation case, the payment is made. If it is made post-settlement, the payment is typically made as part of a negotiated agreement between the entities and the injured worker’s attorney. This is always the situation when the workers’ compensation employer/carrier denies responsibility for the accident and injuries throughout the entire case. Alternatively, when the carrier has accepted compensability of the claim it may agree as part of the negotiated workers’ compensation settlement to satisfy the liens. In this circumstance, hold harmless language should be included in the settlement agreement to protect the claimant in case the carrier fails to be proactive in resolving the liens and the entities come after the claimant for repayment.

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calculatorFlorida workers injured in the course and scope of their employment may end up receiving simultaneously both workers’ compensation indemnity (money) benefits under Florida Statute 440.15 and Social Security Disability benefits under 42 U.S.C. s. 423. When this happens, Federal law and Florida law provide that the combined benefits shall not exceed 80 percent of the claimant’s pre-disability earnings. See 42 U.S.C. s. 424a and s. 440.15(9)(a).

The Federal law authorizes each state to enact legislation permitting employers and their workers’ compensation insurance companies (“E/C”), rather than the Social Security Administration, to take the offset. Regnier v. Department of Labor & Indus. of Wash., 110 Wash.2d 60, 749 P.2d 1299, 1300-01 (1988) (en banc). Florida has enacted such “reverse offset” legislation. See section 440.15(9), Florida Statutes.

Injured workers’ lawyers are entitled to fees for services rendered in obtaining 440.15 indemnity benefits. Where there is no basis for the E/C to pay the fees, the Judge of Compensation Claims (“JCC”) may order that the fees be withdrawn from the claimant’s periodic workers’ compensation indemnity payment.

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calendar-1192688-300x230Workers’ compensation employers and carriers (“E/C”) “shall furnish to the employee … medically necessary remedial treatment, care and attendance….” See s. 440.13(2)(a), Florida Statutes.

440.13(1)(k) defines “medically necessary” as follows:

“Medically necessary” or “medical necessity” means any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to the patient’s diagnosis and status of recovery, and is consistent with the location of service, the level of care provided, and applicable practice parameters. The service should be widely accepted among practicing health care providers, based on scientific criteria, and determined to be reasonably safe. The service must not be of an experimental, investigative, or research nature.

Unless medical necessity is established by operation of law, it is the Claimant’s burden to prove medical necessity. Medical necessity by operation of law arises if E/C fails to respond to a written request from an authorized health care provider for additional medical care or services within the time periods allowed in sections 440.13(3)(d) and (i). See Elmer v. Southland Corp. 17-11, 5 So.3d 754, 756 (Fla. 1st DCA 2009); see also Pearson v. BH Transfer, 163 So. 4d 1280 (Fla. 1st DCA 2015) (The medical provider’s written request can be attached to a Petition for Benefits.)  Section 440.13(3)(d) applies only to requests from doctors for referrals to other doctors and not to requests by employees. Wal Mart Stores, Inc. v. Mann, 690 So.2d 649 (Fla. 1st DCA 1997). When one health care provider refers an employee to another health care provider for treatment, section 440.13(3)(d) applies. See Wuesthoff Mem’l Hosp. v. Schmitt, 694 So.2d 145, 145 (Fla. 1st DCA 1997).

A carrier must respond, by telephone or in writing, to a request for authorization by the close of the third business day after receipt of the request. A carrier who fails to respond to a written request for authorization for referral for medical treatment by the close of the third business day after receipt of the request consents to the medical necessity for such treatment. All such requests must be made to the carrier. Notice to the carrier does not include notice to the employer.

Section 440.13(3)(i) applies to requests “for specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, X-ray examinations, or special diagnostic laboratory tests that cost more than $1,000 and other specialty services that the department identifies by rule….”

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