Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Junior Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
David Gottwald v. Carroll Fulmer Logistics Corp. and Protective Insurance Company
JCC Pitts: Orlando District Order date: 1/20/2025
OJCC Case: 22-017885NPP Date of Accident: 5/2/2022
JCC Order: Click Here
Briefly: MCC
Summary: On September 29, 2021, the claimant became employed as a truck driver with the insured. During employment, the claimant asserted he suffered a compensable injury when he was manually lowering landing gear of a trailer in the Home Depot terminal in Lake Park, Georgia. The injury was alleged to have been a hernia, and the date of the injury was determined as May 2, 2022. During his deposition, the claimant voluntarily disclosed a pre-existing hernia that developed while working for a different employer in Oregon. In a November 30, 2023, Final Compensation Order, the accident and injury were determined to be compensable, and the E/C authorized Dr. Timothy Childers to treat the claimant. Dr. Childers ordered a CT of the abdomen and pelvis and testified in his deposition that the claimant had a work-related hernia or exacerbation of symptoms, and should undergo repair. On March 7, 2024, the E/C conferenced with Dr. Childers and provided evidence of the pre-existing hernia from 2017. Dr. Childers, unaware that MCC had already been determined by the JCC, then signed a letter prepared by the E/C, which stated that the major contributing cause of the hernia was not the workplace accident, but a pre-existing injury and a natural progression due to his age and lifestyle. He then amended the office note and DWC-25 from the February 20, 2024, appointment and placed the claimant at MMI. The claimant underwent another IME in June 2024, performed by Dr. Freeland, who conducted the claimant’s prior IME. His diagnosis and plan of care remained essentially the same as the first IME evaluation in 2023. Finally, his opinions as to compensable accident being the MCC of the need for the plan of care remained the same. The JCC determined that Dr. Freeland’s opinion on MCC was more credible than Dr. Childers, and ordered the E/C to authorize and schedule the necessary surgical interventions for the hernia and reinstated the TTD benefits for the claimant, effective from the date they were suspended.
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Kimberly Pagan v. Fedex and Indemnity Insurance Co. of North America, Sedgwick CMS
JCC Massey: Tampa District Order date: 1/21/2025
OJCC Case: 22-017105MAM Date of Accident: 11/12/2020
JCC Order: Click Here
Briefly: TPD/Psych
Summary: On November 12, 2020, the claimant injured her lower back while loading boxes onto a cart. The accident and lower back injury were accepted as compensable and medical and indemnity benefits were provided. The claimant began treating with Dr. David Arango on January 28, 2021. She also treated with another orthopedic surgeon, Dr. Paul Pagano, who placed her at MMI on April 7, 2022. Her treatment included medication, physical therapy, and epidural steroid injections. The claimant returned to work in a light duty capacity in December 2022. Due to continued complaints of severe pain, Dr. Arango referred the claimant to Dr. Alfonso Saa, a psychiatrist, for a psychiatric evaluation on January 6, 2023. She was later put at psychiatric MMI on February 7, 2024. The parties stipulated that all indemnity and impairment benefits had been paid, with the sole exception of the six-month period following overall physical MMI (April 12, 2022, through October 12, 2022). The claimant argued that she was entitled to TPD during this time, since it was prior to her psychiatric MMI. Section 440.093(3) provides that no temporary benefits for a compensable mental or nervous injury be paid for more than 6 months after the date of MMI for the claimant’s physical injury or injuries. The JCC stated that case law holds that the six-month period referred to in the statute is a “window” that opens on the date of overall physical MMI and closes six months later, regardless of when the need for psychiatric care arises or manifests itself. The JCC subsequently held that the claimant was not entitled to benefits for this time period, because her psychiatric symptoms did not “manifest” until more than six months after her physical MMI.
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Katelin Richards v. Agency for Persons with Disabilities/Division of Risk Management
JCC Newman: Tallahassee District Order date: 2/3/2025
OJCC Case: 24-003704JLN Date of Accident: 11/9/2023
JCC Order: Click Here
Briefly: Authorization of Care
Summary: The issue in this case stemmed from the Claimant’s request for authorization of a pain management clinic for an evaluation of saphenous neuritis in the right knee, as well as with a spine clinic. The Employer/Carrier denied these benefits as not related to the work accident. The Carrier argued that Mayo Clinic, who referred to both pain management and the spine clinic, were only authorized as a consultation for the right knee as requested by Dr. Loeb, the authorized provider. The Claimant injured her right knee in November 2023 when a patient aggressively pushed her onto a bed and held her down, and hit her right knee on the bed frame. Subsequently, the Claimant’s right knee was authorized to be evaluated at an urgent care. The Claimant received treatment and eventually was evaluated by Dr. Loeb who diagnosed her with a right knee contusion. He referred the Claimant to the Mayo Clinic for a second opinion on the Claimant’s right knee pain and a genetic disorder called nail-patella syndrome. During the second opinion, the Mayo Clinic physician was alerted to back discomfort which had not previously been mentioned. The Claimant was diagnosed with saphenous neuritis in the right knee and was recommended to be evaluated by the Mayo Clinic pain clinic for treatment. The JCC agreed with the Claimant as for the pain management evaluation for the right knee being medically necessary after reviewing both doctors depositions. The JCC, finding that the Claimant never mentioned back pain as a result of this accident, denied the request for a spine doctor.
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Monserrat Tijerina v. ICI Homes, AP Framing Construction & ICW
JCC Jacobs: Orlando District Order date: 2/6/2025
OJCC Case: 24-015195JEJ Date of Accident: 5/27/2024
JCC Order: Click Here
Briefly: AWW/TPD/TTD
Summary: Handled by our very own Nicole Florentino. The Claimant was injured when he fell from approximately 12 feet while framing. Notably, the Claimant does not have a Social Security Number, but does have a Tax Identification Number. The Claimant testified that he earned about $1,300 per week consisting of a check for either $960 or $980, and the rest in cash. For the first week after the accident, the Claimant was paid $800, the following two weeks he received $600, then the pay stopped. Although the Claimant had filed taxes previously between 2010-2013 and testified that he planned to do so this year, he had never done so with this Employer, never received a tax form or document from them, never set aside funds from his wages to pay for taxes, does not have a bank account, was not sure how much he earned that year nor did he keep track. The Claimant underwent several surgical procedures to the left upper extremity. Based on the medical records and testimony from Dr. White, the claimant was unable to work until around July 3, 2024, when all the surgeries were completed. From then to the date of the Final Hearing, the JCC found that the Claimant would be able to work light duty with no use of the left arm, making the Claimant eligible for TPD benefits. As for average weekly wage, the JCC had a hard time determining what the Claimant’s aww was considering the lack of evidence presented by either side. Ultimately, given the payments of $600 post accident, and seemingly using that as the compensation rate, the JCC awarded an AWW of $900. As for the tax argument, the E/C argued that no money was withheld for taxes, and the claimant did not report his income or pay taxes and thus his aww should be $0. The Claimant argued that wages for 2024, and the taxes therefrom, are not due until April 2025, and thus it may be premature. However, until the Claimant files his taxes, the JCC determined that his aww is currently $0.
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Guillermo Brown v. Charter Communications LLC/ESIS
JCC Stanton: Orlando District Order date: 2/6/2025
OJCC Case: 20-002866TSS Date of Accident: 6/20/2019,
9/2/2020
JCC Order: Click Here
Briefly: One-Time Change
Summary: The Claimant filed a PFB requesting a one-time change from Dr. Reuss. The E/C timely authorized Dr. Emerson, who canceled the appointment on his own. Then the E/C authorized Dr. Gasner, with whom the Claimant refused to treat. The parties then agreed on Dr. Jablonski, who later advised the parties he was no longer taking work comp. The E/C then offered Dr. Hurbanis or Dr. Rust, which Claimant’s Counsel objected to both. The Claimant argued that the E/C initially did not authorize Dr. Emerson to treat all of the claimant’s body parts that Dr. Reuss was authorized to treat, therefore the Claimant was entitled to choose his own doctor. The E/C argued that the one-time change was for the right shoulder only. Reviewing Section 440.13(2)(f), the JCC found the term “authorize” meant to authorize the new doctor for the same body part as the old doctor. As Dr. Reuss was authorized for the bilateral ankles, knees, and right shoulder. The E/C authorized Dr. Emerson for the right shoulder and bilateral hands, and not the bilateral ankles and knees. Noting that Dr. Emerson’s refusal to treat the claimant did not cure the E/C’s failure to authorize an alternate doctor, the JCC found that the E/C thus failed to timely respond to the one-time change.
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