Florida’s workers’ compensation system has its own unique set of laws. One of these concerns the burden claimants bear in establishing the compensability of injuries. Per section 440.09(1), Florida Statutes, the injury “must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause of any resulting injuries.”
The statute defines objective relevant medical findings as “those objective findings that correlate to the subjective complaints of the injured employee and are confirmed by physical examination findings or diagnostic testing.” The instructions accompanying form DWC-25, which is typically completed by workers’ compensation doctors after each appointment, say this about objective relevant medical findings:
Objective Relevant Medical Findings: Pursuant to Section 440.09(1), F.S., pain or other subjective complaints alone, in the absence of objective relevant medical findings, are not compensable. Further, pursuant to Section 440.13(16)(a), F.S., abnormal anatomical findings alone, in the absence of objective relevant medical findings, shall not be an indicator of an injury or illness, a justification for the provision of remedial medical care, the assignment of restrictions, or a foundation for limitations. Objective relevant medical findings are those objective findings that correlate to the subjective complaints of the injured employee and are confirmed by the physical examination findings or diagnostic testing.
Compensability is but one of many issues in Florida workers’ compensation cases. Even after compensability is resolved, disputes may arise over other issues such as the transfer of medical care and the payment of indemnity (money) benefits. Interestingly, even though medical evidence is needed to resolve almost every workers’ compensation dispute, compensability is the only one in which “objective relevant medical findings” is a mandatory element.
This point has been and remains an area of confusion for lawyers, adjusters, and workers’ compensation judges.
In Perez v. Southeastern Freight Lines, Inc., 159 So.3d 412 (Fla. 1st DCA 2015), the workers’ compensation judge of compensation claims (JCC) denied temporary total disability (TTD) benefits on the basis that claimant had not produced evidence of objective relevant medical findings. In reversing the trial judge, the First District Court of Appeal ruled that since the Employer/Carrier (E/C) had stipulated to compensability, “Claimant was absolved of the need to reestablish objective relevant medical findings….” Id. at 414. The court explained that “once a claimant has established compensability of an injury, for example by a prior ruling or a stipulation, an employer/carrier cannot challenge the causal connection between the work accident and the injury, but only the causal connection between the injury and the requested benefit,” see Engler v. Am. Friends of Hebrew University, 18 So.3d 613, 614 (Fla. 1st DCA 2009). The First also pointed out that the burden of proof regarding the causal connection between the injury and the requested benefit was on the E/C. Jackson v. Merit Electric, 37 So.3d 382, 383 (Fla. 1st DCA 2010).
Just as in Perez, in Morrow v. Sam’s Club, 17 So.3d 763 (Fla. 1st DCA 2009), E/C accepted the workplace injury as compensable. However, it refused to authorize a referral to an orthopedic specialist made by a clinic doctor and nurse to help explain the basis for claimant’s complaints in the absence of objective relevant medical findings. On the ground claimant failed to establish objective relevant findings to support the referral, the JCC sided with E/C. The First DCA reversed.
The court held that once compensability is established, the objective relevant medical findings standard “is inapplicable in determining whether a claimant is entitled to a specialist evaluation recommended by his or her authorized treating physician. Entitlement to such a referral is governed, as is all medical treatment or care, by section 440.13(2)(a), Florida Statutes (2007), which requires a showing of medical necessity.” Id. at 764.
The claimant in Morrow had another path to securing the referral. Here’s how the court saw it:
Claimant’s doctor testified that the compensable accident was the major contributing cause of the need for the evaluation, and that the purpose of the evaluation was to determine whether claimant’s ongoing symptoms were related to his injury—or at least to determine whether there was an objective basis for claimant’s symptoms. In such circumstances, this court has held a claimant is entitled to an evaluation. See Grainger v. Indian River Transport/Zurich U.S., 869 So.2d 1269, 1271 (Fla. 1st DCA 2004) (holding that the judge of compensation claims erred by not requiring the employer and carrier to pay for an evaluation to determine the etiology of claimant’s medical problem, and that it is the purpose of the evaluation, not its result, that determines its compensability).
Even though establishing objective relevant medical findings may not be necessary to prevail on these other issues, I’d recommend using the evidence whenever possible. In opposing the claimed benefit, E/C is likely to present competent substantial evidence. Presenting objective medical evidence makes it easier for the judge to rule in claimant’s favor.
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