12/29/2025
Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
Isidro Vargas v. Ag-Mart Produce, Inc. and Sedgwick CMS
JCC Clark: Ft. Myers District Order date: 11-13-2025
OJCC Case: 22-013936FJC Date of Accident: 02-05-2021
JCC Order: Click Here
Briefly: MCC/Breaking Causal Chain
Summary: On February 5, 2021, the claimant sustained a compensable injury after a slip and fall at work. She treated for three years, primarily with Dr. Sudderth, a neurologist, and was placed at MMI on January 11, 2022. She also saw several orthopedic spine surgeons: Paul Fuchs, D.O. on January 4, 2022; John Kagan, M.D. on August 16, 2022; and Brett Sweitzer, M.D. on June 12, 2023. None of these surgeons recommended anything more than continuation of the conservative treatment Claimant was receiving from Dr. Sudderth. On April 29, 2024, the E/C sent the claimant to Dr. Sale Segal, M.D., another orthopedic spine surgeon, who confirmed the previous diagnosis of multilevel lumbar spondylosis, with no evidence of stenosis. He recommended additional physical therapy and an L4-S1 intra-articular facet injection, which were authorized and provided by EC. Claimant was eventually placed at MMI on July 1, 2024, after endorsing more than 90% improvement. This was confirmed again at a January 3, 2025 follow-up visit. On May 12, 2025, the claimant followed up again with Dr. Segal and reported “worsening low back pain since February 2025 after lifting a heavy object.” He did not rescind MMI, but based on this reported “flare up,” Dr. Segal recommended the physical therapy and facet injection which are the issues in the outstanding PFB. The E/C argued that both treatments were not medically necessary or causally related to the work accident. The claimant argued that the E/C could not deny authorizing the benefits because they did not specifically plead “a break in the chain of causation” defense. The JCC disagreed, and noted that the E/C properly raised the defense in the September 5, 2025 Pre-Trial stipulation, when they stated that the treatment was not “… causally related to the industrial accident of 2-5-21.” Further, the JCC stated that, if the claimant thought these statements were not specific enough, his opportunity for relief could have been found in Rule 60Q-6.113(2)(h), which states: “Objections based upon lack of specificity shall be raised in a separate motion to strike the affirmative defense or avoidance filed within 14 days of the filing of the completed pretrial …” The E/C argued that the self-reporting of a new injury that resulted after “lifting a heavy object” constituted occurrence of a new accident, which the JCC accepted. The requests for benefits, attorney’s fees, and costs were denied. The claimant appealed on December 12, 2025.
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Richard Samuels v. Orange County Government and CCMSI
JCC Sancerni: Orlando District Order date: 11-13-2025
OJCC Case: 24-011378LMS Date of Accident: 03-21-2024
JCC Order: Click Here
Briefly: 120-day, Timely Notice of Intent to Investigate
Summary: On March 21, 2024, the claimant, a corrections officer, sustained injuries to his face after being involved in a physical altercation with an inmate. Based on the original account of the accident, the case was originally accepted as compensable. During an internal investigation, there were conflicting accounts from several witnesses that suggested that the claimant was the initial aggressor. On December 6, 2024, the claimant was terminated. On February 11, 2025, the E/C denied compensability on the claim, citing the aggressor doctrine and lack of a causal relation to employment under Fla. Stat. Section 440.09(3). The JCC found that the E/C could not deny compensability of a work accident after the 120- day period in Section 440.20(4), particularly where it has accepted the employee’s injuries as compensable. Here, the E/C provided benefits immediately after the accident and the Notice of Denial was prepared nearly eleven months after the provision of benefits. The E/C argued that it did not have material facts relevant to the issue of compensability within the 120-day period. However, since a 120-day letter was never sent, and the adjusters did not make any reasonable efforts to obtain the material facts, the JCC held that the E/C waived its right to deny compensability of the claim. The JCC granted the claimant’s claim of compensability as to the accident.
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Nancy Kelly v. The School District of Lee County & Davies Claims of N.A.
JCC Weiss: Ft. Myers District Order date: 11/14/2025
OJCC Case: 24-023844JAW Date of Accident: 8/29/2024; 10/21/2024
JCC Order: Click Here
Briefly: Indemnity Benefits
Summary: Handled by our very own Mary Frances Nelson! The Claimant sought TPD/TTD from February 19, 2025, through March 16, 2025, along with PICA. The Claimant was injured initially when attempting to stop an altercation between two students. She felt a pop in her left hip down to her knee. The claim was accepted as compensable and the Claimant was diagnosed with a complete separation of her left hamstring. She was able to return to work under sedentary restrictions through February 2025, when the school removed the aide from her classroom. The Claimant then saw her personal pain management physician who took the Claimant out of work completely due to an unrelated neck injury. She was out of work from February 19, 2025, through March 24, 2025. She was able to finish her job through the end of the school year and returned in August after the summer break. The Employer/Carrier denied indemnity from February 17, 2025, through March 24, 2025, taking the position that the Claimant was limiting her own income. The denial was rescinded in order to pay the Claimant impairment benefits, only. Dr. Omar Hussamy was questioned regarding work status for the period between February and March, to which he testified that the Claimant would have been on sedentary duty. Accordingly, there was no evidence presented that the Claimant was ever given a TTD status. The only evidence presented was that the Claimant’s personal doctor took her out of work, and in her own words was because she needed a physical and mental heath break. There was no evidence presented that the break had anything to do with the work accident, thus TTD was denied. As for TPD, the evidence presented shows that the Claimant was on sedentary duty, which she remained at through March 16, 2025. It was her personal doctor that imposed more restrictive work restrictions, which the Employer/Carrier honored. As the Employer accommodated the work restrictions, and would have for all periods, TPD was denied.
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Douglas Da Costa Nunes v. Reliance Window Systems, LLC/ICW
JCC Hill: West Palm Beach District Order date: 11/14/2025
OJCC Case: 25-017723KAH Date of Accident: 5/12/2025
JCC Order: Click Here
Briefly: Employer/Employee Relationship – Motion for Summary Final Order
Summary: Handled by our very own David Halpern! The Claimant filed a Petition for Benefits seeking compensability of the accident and right bicep/arm injuries, indemnity, adjustment of AWW, authorization of a PCP, and PICA. The Employer/Carrier responded, indicating that the Claimant was not an employee of Reliance Window, and therefore the Carrier does not have coverage for the claim. Additionally, the Claimant is president of Mardo International, Inc, and was exempt from workers compensation coverage on the date of accident. The Employer/Carrier filed a Motion for Summary Final Order on October 6, 2025. In support of the Motion for Summary Final Order, the Employer/Carrier included affidavits from an insurance specialist and the owner of Reliance Window Systems, showing both the exemption and that the Claimant was not an employee of Reliance. The Claimant timely responded to the Motion but did not include any evidence to support the notion that the Claimant was an employee of Reliance. Accepting the unrefuted affidavits, the Motion for Summary Final Order was granted.
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Erika Faulk v. SRI Management Group, LLC/MEMIC Indemnity Company
JCC Walker: Pensacola District Order date: 12/1/2025
OJCC Case: 25-017723KAH Date of Accident: 6/21/2023
JCC Order: Click Here
Briefly: PTD, TPD
Summary: The Claimant was injured on June 21, 2023, while working as a medical technician. The Claimant underwent treatment, and was recommended for a cervical surgery. Prior to the operation, she learned that she was pregnant. The child was born in August of 2025. The Claimant had been placed at “non-surgical MMI” by authorized surgeon Dr. Cason during the gestational period due to the claimant’s inability to undergo surgery and assigned a 15% PIR. The Claimant subsequently sought TPD and PTD benefits arguing in the alternative. The Claimant asserted that non-surgical MMI is not MMI for PTD purposes such that TPD was payable or, in the alternative, if she was at MMI that PTD benefits were due based upon the non-surgical MMI opinion. At the time of the hearing, the Claimant wished to proceed with the surgery. Dr. Cason indicated that, should the Claimant elect to proceed with surgery, she would need to go through the clearance process again. After reviewing the evidence, the JCC found that the “non-surgical” qualifier is insufficient to successfully allow the Claimant to assert that she is not at MMI. The doctor’s plain language states that the Claimant is at MMI, and that the Claimant would have to start the surgery process over. Further, the JCC found that the assignment of a PIR supported an MMI placement. Based upon placement at MMI, TPD benefits were not due or owing. As for PTD, the Claimant did not present any evidence from a vocational expert to satisfy two of the three prongs under the Blake case. Specifically, the Claimant could not prove that she was unable to find a job at least at a sedentary level within 50 miles of her residence, nor could she show an unsuccessful job search. Finding that the Claimant did not meet her burden to establish PTD, the Judge denied same.