Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Junior Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
Shawna Price v. STOA Construction, LLC and Bridgefield Casualty Insurance Company
JCC Walker: Pensacola District Order date: 3/12/2025
OJCC Case: 24-014317JW Date of Accident: 1/26/2023
JCC Order: Click Here
Briefly: Misrepresentation
Summary: On January 26, 2023, the claimant alleged that she felt a “pop” in her back after bending down to pick up a pair of sunglasses she had dropped while leaving an apartment inspection. The claimant sought TTD, TPD, medical treatment, compensability, and PICA. In her deposition, the claimant admitted to two prior motor vehicle accidents and to receiving lower back treatment after the crashes. She testified that she did not suffer from any prolonged discomfort or injuries thereafter. The claimant also denied having back pain in the period immediately preceding the work accident. The E/C denied her claims, stating that her injury was not the MCC of the injury, and that she made misrepresentations to obtain benefits. According to City of Hialeah v. Bono, when addressing a section 440.105(4) violation, a JCC must undertake a two–step inquiry, “encompassing first a finding as to whether a false (or fraudulent or misleading) statement was made by the Claimant, and second a finding as to whether, at the time the statement was made, it was made with the intent to obtain benefits.” The JCC identified two specific instances where the claimant in this case knowingly misled or concealed evidence of her prior low back treatment. First, when she denied/downplayed any prior back issues or MRIs during her deposition on August 13, 2024. These statements contradicted the medical records from Dr. Brannon, who treated her after the two MVAs. Second, when she denied any pre-existing low back issues or treatment prior to her work injury to the IME physician. Additionally, the JCC also referenced testimony from the claimant’s former supervisor, who stated that she reported pre-existing back issues to him prior to the alleged accident. Based on this evidence, the JCC upheld the E/C’s misrepresentation defense and denied all of the Claimant’s claims with prejudice.
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Doris Moreno v. American Airlines Inc and Sedgwick CMS
JCC Medina-Shore: Miami District Order date: 4/18/2025
OJCC Case: 24-023896SMS Date of Accident: 12/24/2023
JCC Order: Click Here
Briefly: Misrepresentation
Summary: On December 24, 2023, the claimant injured her right knee and low back. The E/C accepted the accident and injuries of lower back strain and right knee meniscus tear as compensable. The Claimant was placed at overall MMI on August 16, 2024, with lifting restrictions of 15lbs. At Final Hearing, Claimant sought, among other benefits, payment of PTD benefits. E/C asserted an affirmative defense of misrepresentation, among others, regarding the claimant’s job search logs. The claimant testified that she had not worked for the employer since the date of her accident, and that no one had reached out to offer her employment. She testified that she looked for work daily and noted a total of 74 job searches. The claimant gave inconsistent testimony regarding her job searches that contradicted the information she wrote on her job search log or with information from witnesses at the place of business at which she applied. Specifically, the Claimant noted on 39 separate application entries that the employer did not hire her because of her physical restrictions, when only 3 providers were shown to have given her this response. Others had failed to respond. The claimant later stated that she assumed the remaining 36 employers did not get back to her because of her restrictions. When confronted with these discrepancies, the Claimant indicated that this was “how she chose to express herself” and would have done so differently had she known she was going to be made to look poorly. The JCC found the Claimant’s assumption to be “a self-serving fabrication”. The JCC also found that the false statements would have a material impact on the case, and that the claimant made them with the intent to secure benefits, especially since there was a pending PTD claim. Subsequently, the JCC held that the claimant’s entitlement to benefits under chapter 440 for this date of accident were terminated for violating Section 440.105(4)(b)1-3.
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Roy Bouie v. JC Penney Corp and Sedgwick CMS
JCC Newman: Tallahassee District Order date: 4/25/2025
OJCC Case: 23-026790JLN Date of Accident: 8/26/2023
JCC Order: Click Here
Briefly: Misrepresentation
Summary: The claimant sustained an injury following an altercation with a suspected shoplifter after engaging in a “tug of war” with a shopping cart. The claimant sustained injuries to his right shoulder, upper back, and lower back. The E/C referred the claimant to Patients First for an evaluation of his work injuries. The claimant told his authorized treating physician that, after the accident, his primary care provider had ordered an MRI of his right shoulder, which revealed a rotator cuff tear. During the claimant’s deposition, he admitted to being involved in a prior motor vehicle accident that resulted in an injury and subsequent treatment for upper back pain and neck pain. He testified that he could not recall any prior treatment for his mid-back, thoracic, or trapezius areas of his body and he denied any prior treatment to either his right or left shoulder or low back. The claimant returned to the authorized treating physician, who opined that the work accident was the MCC of the claimant’s right shoulder and low back injuries and need for additional treatment. The claimant sought payment of TPD benefits and authorization of orthopedic care as a result of his work accident. The E/C argued that the claimant knowingly made false, fraudulent, or misleading statements about material facts relevant to his claim to obtain workers’ compensation benefits, in violation of sections 440.09(4) and 440.105(4)(b). The E/C stated that the claimant intentionally gave false statements under oath when he denied receiving prior medical care for his claimed work injuries, and that he gave false statements to the authorized treating physician when he denied any prior back or right shoulder problems during his initial evaluation. The E/C stated that the prior emergency room record for a 2012 visit after a shower fall with head and right arm injury established that the Claimant did receive prior treatment for neck, shoulder, and back problems. The JCC noted that the ER records that the E/C relied on reveal diagnoses for cervical spinal stenosis and cervical radiculopathy, as well as a right upper arm and head contusion from a fall in 2012. During Final Hearing, the Claimant testified that he did not recall this ER visit at the time of his deposition or during medical treatment. After reviewing the records, the JCC found that the E/C failed to demonstrate with additional records that the Claimant received any significant or ongoing treatment for the back or shoulder injuries. Further, she did not find that the claimant attempted to mislead the E/C during his deposition or mislead his doctors, specifically noting that the Claimant did report prior neck treatment to providers and during his deposition. The JCC granted the Claimant’s requests for benefits and rejected the E/C’s defenses.
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Myla Morris v. Landrum HR Workforce Solutions & PMA
JCC Walker: Pensacola District Order date: 5/5/2025
OJCC Case: 24-010239JW Date of Accident: 4/6/2023
JCC Order: Click Here
Briefly: Misrepresentation
Summary: The Claimant sought compensability of the work accident at Final Hearing. E/C responded that the Claimant had a compensable accident but denied the entirety of the claim on the basis of misrepresentation. At issue were statements made during the Claimant’s deposition. Mainly, failing to mention concurrent earnings from another job in an effort to continue to receive workers’ compensation benefits. The Claimant disputed this as unintended – either based on the stressful nature of the deposition or misunderstanding the questions being asked. First, the Claimant alleged that her deposition testimony became “stressful” as during a break Counsel for the Employer/Carrier mentioned an MRI showing something on the Claimant’s uterus that should be checked out. At a subsequent deposition, the Claimant testified that the spots were non-cancerous. When reading the first deposition transcript, the JCC found that the Claimant was able to answer questions in a clear and coherent manner. The transcript also did not show that the Claimant asked for breaks or wanting to reschedule for being upset. Over three months passed between the first deposition and the denial being issued, and during this time the Claimant did not ask for an errata sheet to clarify any problematic answers. Second, the Claimant explained that she thought Counsel for the Employer/Carrier was only asking about her concurrent job as a hospital clinical instructor and not her job as a campus instructor. The JCC, again upon reviewing the deposition transcript, found that the Attorneys questions were clear regarding any earnings and not specifically for one job or another. The JCC also reviewed wages from her second job, totaling $19,165.80, from February 2024 to June 2024, which includes the May 2024 deposition date. When asked what the Claimant was doing on a daily basis, she failed to mention working almost 35 hours per week leading up to her deposition. Additionally, the Claimant denied currently being paid, or having any other sources of income aside from her wife. The JCC found that the Employer/Carrier was paying TPD benefits at the time of the May 2024 deposition, totaling $2,394.00 biweekly. Failing to mention the outside wages allowed the Claimant to continue to receive those indemnity benefits while still being paid from her second job. This did not allow the Employer/Carrier to either reduce or stop paying TPD benefits entirely. Thus, the JCC found that the Claimant met its affirmative burden proving its misrepresentation defense, and denied all claims with prejudice.
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Johanna Zeno v. CGB Express, LLC & Sedgwick
JCC Case: West Palm Beach District Order date: 5/14/2025
OJCC Case: 24-016012BKC Date of Accident: 6/10/2024
JCC Order: Click Here
Briefly: Misrepresentation
Summary: In this lengthy 33-page opinion, the JCC was tasked with determining whether the Claimant made false or misleading statements to secure workers’ compensation benefits. Specifically, the Employer/Carrier alleged that the Claimant lied in her deposition and to her treating physicians when she denied prior back, neck, right shoulder, and right-hand treatment. On June 10, 2024, the Claimant was involved in a motor vehicle accident and reported pain in the neck, left ear, right finger, right knee, and low back. There was mention in the EMS reports and the hospital reports of right shoulder pain, as well. Ultimately, the Claimant was diagnosed with cervical strain, back strain, and a tension headache, being released with medications and to follow-up with her PCP. The Employer/Carrier accepted compensability of the claim, treatment at the hospital, and follow up with Concentra. After the Claimant’s deposition in October 2024, the Employer/Carrier issued several subpoenas related to a motor vehicle accident in 2014. The records were subjected to an in-camera inspection and uploaded in January 2025. Based on the records, the Employer/Carrier asserted a misrepresentation defense as the Claimant denied injuries to her neck, back, and shoulder from the 2014 accident to Concentra, authorized provider. The Claimant was asked, and denied, having chronic injuries, however there was no explanation as to what chronic meant. The Claimant also did not disclose prior injuries when she sought unauthorized treatment with Spine Institute of South Florida. During the physician’s assistant’s deposition, he testified that the Claimant reported a prior MVA 10-15 years ago, but denied injuries or residual issues. Although the Claimant was not terribly clear in her history, the PA did not follow up to clarify or obtain more information. Based on the above, Claimant’s Counsel does not dispute that the Claimant made statements and gave testimony that could be viewed as inconsistent with the past medical records. Focus then turned to whether the Claimant knew the statements were false or misleading and whether they would have a material impact on her claim. The Claimant’s native language is not English, and her 4-hour deposition was taken without a translator. During the Final Hearing, the JCC noted multiple times when the Claimant did not understand the questions posed, or the information being elicited. However, the Claimant testified that she felt fine in the weeks and years after the 2014 accident, despite some minor treatment. After reviewing the deposition, and observing her in person, the JCC found her a credible witness. As the Claimant did not fully comprehend the questions posed about prior injuries, or remember the details of the accident, the JCC found that the Employer/Carrier did not meet their burden for misrepresentation. Ultimately, the JCC found that the Claimant established compensability and entitlement to TPD benefits.