Editor: Felicia Wymer, Partner, Pensacola Office

Author: Travis Coleman, Junior Partner, Tampa Office

Author: Libby Nelson, Associate, Orlando Office

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Addison v. Boston Whaler, Inc/Indemnity Insurance Co. of North America

JCC Holley:   Jacksonville District                                     Order date:  6/11/2024

OJCC Case:   23-028636WRH                                            Date of Accident:    6/06/2023

JCC Order: Click Here

Briefly:  One-Time Change, Authorization of Medical Care

Summary: The Claimant was injured in a slip and fall on June 6, 2023, and alleged injuries to her left knee, left hip, lower back, and neck. After treating with an urgent care, the claimant was referred to Dr. James Bryan. The claimant attended one visit, and had a subsequent visit cancelled due to her being late. Afterwards, the claimant made no attempts to reschedule the appointment or ask for the Carrier to reschedule. In deposition, Dr. Bryan testified that the claimant had multiple no show appointments. Due to missed evaluations with Dr. Bryan, missed PT appointments, and non-surgical MRI findings, Dr. Bryan placed the Claimant at MMI. The adjuster then authorized Dr. Joshua Rogozinski, but the claimant did not attend the scheduled appointment as Jacksonville was too far away from the claimant’s job. The PFB at issue sought authorization of orthopedic care in the Claimant’s county of residence as authorized physician refuses to treat. When reviewing the PFB, the JCC determined that a request for a doctor in the claimant’s county of residence is not sufficient for a one-time change request. The JCC also determined that Dr. Bryan did not discharge the claimant and he was not refusing to treat the claimant, and thus the E/C’s “de facto” deauthorization of Dr. Bryan to Dr. Rogozinski was improper. The JCC therefore ordered the E/C to authorize a return visit with Dr. Bryan.

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Lopez-Camara v. UniVida Medical Center, LLC/Travelers Indemnity Company of America

JCC Jacobs:   Miami District                                               Order date:   7/22/2024

OJCC Case:   24-001349JIJ                                                 Date of Accident:    7/05/2023

JCC Order: Click Here

Briefly:  Compensability

Summary: The claimant alleged an injury while driving a van to a patient’s residence. The claimant parked and the van rolled backwards onto the claimant’s right foot causing her to fall on her right side. The E/C accepted compensability of the claimant’s right foot and ankle injury but denied compensability of the right shoulder. The claimant received treatment on the date of accident for a right distal fibula fracture. During examination, the claimant had full painless range of motion of all joints without tenderness or evidence of injury. The claimant returned to the hospital on July 28, 2023, as her leg had become black. She underwent a debridement of necrotic skin and was discharged on July 31, 2023. There was no mention of right shoulder symptoms during that visit. The claimant continued treatment with the authorized physician, Dr. Fongue,  and several records of visits and examinations did not reference any right shoulder issues. Finally, in a February 2024 note, Dr. Fongue recommended the claimant follow-up with a PCP for her right shoulder. The E/C authorized Dr. Orestes Rosabal to evaluate the claimant’s right shoulder, who diagnosed her with right shoulder subacromial bursitis. In deposition, Dr. Rosabal could not determine if the work accident was the major contributing cause of the right shoulder injury. Based on the evidence presented, the JCC found that the Claimant failed to meet her burden to establish compensability of the right shoulder injury. Dr. Rosabal testified that the alleged accident could result in subacromial bursitis, but the JCC found that this did not demonstrate causation to a reasonable degree of medical certainty.

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Gaw v. Marion County Public Schools/Davies Claims North America, Inc.

JCC Holley:   Jacksonville District                                     Order date:   7/24/2024

OJCC Case:   21-017205WRH                                            Date of Accident:    9/2/2020

JCC Order: Click Here

Briefly:  Statute of Limitations

Summary: The claimant’s accident occurred on September 2, 2020, when she slipped on water and injured her left knee and hip. She continued to work for the employer afterward, and sustained another injury on October 15, 2021, involving the right hip, right elbow, and lower back. Following the 2020 accident, the claimant treated with Concentra, Dr. Henry, Dr. Rogers, and Dr. Cannon. During the claimant’s treatment with Dr. Rogers, she was diagnosed with osteoarthritis, which the doctor indicated pre-dated the September 2020 date of accident. The claimant requested her one-time change, and thus Dr. Cannon was authorized. Dr. Cannon recommended three injections, with the last one occurring on January 25, 2022, at which point the claimant was placed at MMI with 2% PIR for the left knee. The MCC for further treatment for the left knee was the pre-existing osteoarthritis. This date of service was the last benefit provided by the E/C for the September 2020 date of accident. Following the second date of accident, the claimant was authorized to treat with Dr. Jason Key. Dr. Key was not authorized to treat the claimant for any injuries sustained in the September 2020 accident, nor was he aware of that accident or treatment provided. The claimant obtained an IME after her second date of loss, who recommended PT, medications, rest, and injections. The IME provider also indicated that the ongoing treatment for the Claimant’s second accident, specifically the anti-inflammatory and analgesic medications, would also provide palliative relief to the injuries sustained in September 2020. The Claimant filed a Petition for Benefits on November 1, 2023, seeking ongoing care for the 2020 date of accident, which was defended by the E/C on the basis of SOL. The claimant argued that the provision of ibuprofen for the 2021 accident was concurrently providing a medical benefits for the 2020 date of accident. The JCC concurred with the E/C, that “these are two separate and independent cases despite being with the same employer, and the provision of medical treatment in one case cannot be deemed to be authorized treatment in the second case especially when different body parts and doctors are involved.” Thus, the JCC dismissed the claim for authorization of continued medical care related to her September 2020 date of accident.

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Jorge Padron v. Presidente Supermarket #7 / Technology Insurance Company

JCC Medina-Shore: Miami-Dade District                                     Order date: 08/02/2024

OJCC Case: 22-010078MGK                                                          Date of Accident: 3/03/2021

JCC Order: Click Here

Briefly: Temporary Partial Disability, Authorization of Medical Care

Summary: The claimant alleged injury to his low back on 3/3/2021, after a shopping cart he was pushing at work became lodged in a hole in the parking lot. The Claimant treated at Concentra on two occasions for this date of loss, attended physical therapy, and missed one week of work, but thereafter returned to his regular job working full-time hours. The Claimant alleged a second injury on 4/20/2022 of the same nature. The Claimant returned to Concentra and was assigned light duty restrictions, which were accommodated by the employer. The Claimant came under the care of orthopedic provider Dr. Waeltz, who recommended physical therapy and injections. The Claimant attended physical therapy but refused the injections. Dr. Waeltz placed the Claimant at MMI with no impairment rating and a full release for the 4/20/2022 accident in November of 2022. The Employer required the Claimant to return to his former position of cart duties based on the Claimant’s release, but the Claimant felt that he could no longer perform this work. The employer terminated the Claimant’s employment. After being released to MMI for the second date of loss, the Claimant pursued additional care under the 2021 injury and was again sent to Dr. Waeltz. The Claimant alleges that Dr. Waeltz diagnosed compression fractures but did not recommend surgery, so the Claimant did not return for treatment due to lack of trust in the provider. The Claimant did not look for work after his termination, arguing that he was unable to work, despite looking after his grandchildren and traveling to Cuba after the accident. Dr. Waeltz’ testimony indicated that the Claimant did not have a compression fracture but a sprain/strain. Dr. Waeltz assigned MMI for the first date of accident as of 11/14/22 with a 0% PIR and no restrictions. The Claimant sought payment of indemnity from his termination ongoing based on the opinion of his IME provider, Dr. Hyde, that the Claimant was not at MMI and had light duty restrictions. The JCC found the Claimant’s testimony to be self-serving and inconsistent throughout and sided with Dr. Waeltz over Dr. Hyde with regard to restrictions. TPD was denied.

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Crystal Wade v. Florida Dept of Juvenile Justice/Division of Risk Management

JCC Newman: Tallahassee District                                     Order date: 08/07/2024

OJCC Case: 14-022039JLN                                                 Date of Accident: 07/30/2014

JCC Order: Click Here

Briefly: Authorization of Medical Care, Medical Necessity

Summary: Claimant requested authorization of a cell phone, a home assessment, and attendant care based on the referral of her authorized treating psychiatrist, asserting they were necessary for her treatment following a work-related accident in 2014 that caused significant psychiatric issues and permanent total disability. The E/C denied these benefits on the grounds that they were not medically necessary. The Claimant alleged that the E/C waived their ability to dispute medical necessity by failing to respond to the requests of the provider pursuant to F.S. 440.13(3)(d) and (i). The E/C argued that the recommended treatment (cell phone, home assessment, and attendant care) were not the type of medical treatment addressed by the statute, as 440.13(3)(d) specifically deals with a provider referral to another treating provider and (i) deals with surgical requests, specialty providers, diagnostics, x-rays, and the like. Accordingly, the JCC found that the E/C did not waive the ability to defend on the basis of medical necessity by failing to respond to the psychiatrists request for the above-listed items. The JCC further found the claimant was able to use a landline phone effectively and had not missed medical appointments due to lack of communication. Additionally, the claimant’s ability to manage her medication and food intake, along with her overall self-care, was deemed adequate by the court based on her own testimony and lack of medical evidence countering same. The JCC concluded that the requested items were not medically necessary, as they were considered more related to improving quality of life rather than addressing specific medical needs.

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