11/26/2025
Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
Ashley Marie Machiela v. Flagler County School Board and PMA Insurance Company
JCC Holley: Jacksonville District Order date: 10/08/2025
OJCC Case: 24-027007WRH Date of Accident: 01/24/2024
JCC Order: Click Here
Briefly: MCC
Summary: On January 24, 2024, the claimant sustained a work-related injury to her right hip, right buttock, and lower back after an altercation with a student. She treated with Dr. Simonetta, an orthopedic spine surgeon. Under his care, she received 2 right SI joint injections, a radio frequency ablation to her SI joint, and two rounds of physical therapy. None of the treatment helped improve her subjective complaints. Due to her lack of improvement, Dr. Simonetta ultimately recommended a right SI joint fusion surgery. Claimant had a history of SI joint symptoms and treatment due to a motor vehicle accident that occurred in 2016. There was also evidence of a motor vehicle accident from 2014 that resulted in left sided back pain that had resolved prior to her September 2016 motor vehicle accident. Despite this, the claimant testified that she had gone more than six years without any right sided SI joint pain before January 24, 2024. She testified that she believed her need for the SI joint fusion was related to her 2024 work accident, not the prior car accidents, because she had zero right sided SI joint pain or symptoms for years and sought no medical treatment during that time. At first, Dr. Simonetta opined that the work accident was the MCC of the SI joint complaints. However, after reviewing the medical records from the 2014 and 2016 MVAs, he issued an amended note clarifying that Claimant had a history of SI joint pathology predating the work accident. Based on the prior records and lack of acute findings on Claimant’s 2024 MRI, Dr. Simonetta concluded that her current need for SI joint fusion was primarily related to her pre-existing SI joint condition rather than structural damage caused by the work accident. On February 3, 2025, he placed her at MMI with a 0% impairment rating. The claimant underwent an independent medical evaluation performed by Dr. Richard Smith, who opined that the work accident was the MCC of the Claimant’s condition and need for treatment, due to that fact that she remained symptomatic for more than eighteen months, failed conservative measures, and had two diagnostic injections confirming the SI joint as the source of pain. Dr. Smith further testified that the Claimant had been asymptomatic in her right SI joint for over six years following resolution of injuries from a 2016 motor vehicle accident until the 2024 workplace accident. The JCC agreed with Dr. Smith’s opinion, noting the claimant’s documented prolonged asymptomatic period prior to the accident, and ultimately ruled that the E/C failed to demonstrate a break in the causative chain, affirming that the workplace accident remained the MCC of her need for treatment. The claim for medical authorization for the right SI joint fusion was authorized, as well as the claim for attorney’s fees and costs.
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Kimberly Jefferson v. Ascend Performance Materials, Inc. and Sedgwick CMS
JCC Walker: Pensacola District Order date: 10/08/2025
OJCC Case: 23-028085JW Date of Accident: 01/22/2023
JCC Order: Click Here
Briefly: Repeated Exposure, MCC
Summary: On January 24, 2023, the claimant went to an on-site medical department and told the provider, Jerrell Javier, R.N., that she needed to be off work because of her hands. Javier completed a short-term disability form for the Claimant. She did not return to work. At the time, the Claimant testified that she did not know the problems with her hands were work-related. She sought medical treatment with her personal doctor, and then later underwent a right carpal tunnel release procedure preformed by Dr. Cory Lebowitz. On July 5, 2023, the claimant contacted Javier and informed him that she wanted to file a workers compensation claim, after speaking with her niece, who suggested that her condition could be related to repeated exposure at work. The claimant’s IME physician, Dr. Chen, noted that the claimant had previously seen a rheumatologist, and identified chronic neck pain and cervical spondylosis as a condition. Dr. Chen testified that he could not remember if he reviewed the claimant’s job description when making the determination that the repetitive trauma at work primarily caused the Claimant’s conditions. He could not recall the length of shifts that she worked, or the frequency of breaks she took. The E/C’s IME, Dr. Lurate, opined that the MCC of the claimant’s bilateral upper extremity complaints was due to cervical spondylosis, and that if carpal tunnel syndrome had been the sole cause of her complaints, they would have resolved following her surgery and after she stopped working. Under Matrix Employee Leasing v. Pierce, the Claimant’s evidence supporting her claim under the clear and convincing standard, “must be of sufficient weight to convince the trier of fact without hesitancy.” The JCC found that they could not conclude without hesitation that the Claimant’s employment cumulatively resulted in her bilateral wrist problems and declined to held that the claimant met her causation burden. Thus, all claims were dismissed with prejudice.
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Walter Joseph Hill v. Indian River State College and Davies Claims North America, Inc.
JCC Hedler: WPB District Order date: 10/15/2025
OJCC Case: 24-011156TAH Date of Accident: 05/06/2024
JCC Order: Click Here
Briefly: Attorney’s Fees/Costs
Summary: On February 26, 2025, the claimant filed a petition for benefits seeking authorization of left revision of CTR/CUTR and authorization of left Guyon’s canal release, attorney’s fees, and costs. On March 12, 2025, the Employer/Servicing Agent filed a response, which declared, “Surgery has been approved” and denied attorney’s fees and costs. The Claimant underwent the requested surgery on April 30, 2025. On July 10, 2025, the claimant’s attorney filed a Verified Petition for Attorney’s Fees and costs, asserting fee entitlement for securing the surgery claimed in the February 26, 2025, petition for benefits. The verified motion made no reference to the value of the benefit obtained and did not identify the applicable statutory fee. Rather, the verified motion addressed the factors to determine the reasonableness of the fee. On August 8, 2025, the E/C filed a Response, which asserted that since the E/C authorized the requested surgery within 30 days of the filing of the Petition for Benefits, counsel for the claimant was not entitled to an attorney’s fee pursuant to Section 440.34, Fla. Stat. The claimant asserted that though the surgery was authorized in a timely manner, the timely authorization was incomplete, since he did not undergo surgery until April 30, 2025, resulting a “de facto denial”. The adjuster authorized and faxed authorization for the surgery to the authorized treating provider on March 12, 2025, and after learning that the surgery had not been scheduled, she sent it again on April 9, 2025. The JCC found that the claimant had not met his burden to establish E/C paid attorney’s fees. The E/C authorized the surgery and filed a response to the petition requesting said surgery on the 14th day after the petition was received. Despite the slight delay in the scheduling of the surgery the surgery was not unreasonably delayed or withheld from the Claimant because of the E/C’s actions. Additionally, the JCC stated that there was no evidence of an asserted legal activity performed by Claimant’s counsel that prosecuted the subject claim. The Claimant argued that it was not his burden to follow-up with the E/C to ensure the scheduling of the timely authorized surgery, and that the E/C retained the burden to take all necessary action to confirm the scheduling of the surgery without delay. The JCC further held that the evidence supported that the E/C timely authorized the surgery and, upon learning it was not scheduled, initiated follow-up by sending another authorization to confirm the provision of the benefit, and that scheduling of the surgery was not prompted by any action of the claimant’s counsel. The JCC held that while costs of $43.86 had been agreed upon and stipulated by the E/C, the calculated statutory fee for securing those costs amounted to $8.77. The JCC noted the Claimant had not provided adequate evidence to warrant a deviation from the statutory fee provisions.
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Adalia Edmond v. Marriott Orlando World Center/Marriott International
JCC Pitts: Orlando District Order date: 10/20/2025
OJCC Case: 21-000676NPP Date of Accident: 9/29/2020
JCC Order: Click Here
Briefly: Authorization of Psych Care
Summary: The Claimant requested authorization of a psychiatrist/psychiatric care and treatment, including psychotherapy, which was denied by the E/C based upon the opinion of the appointed EMA physician that it had been more than 6 months since the date of MMI for the physical injuries and conditions and that the physical injuries were not more than 50% responsible for the ongoing pain causing the mental or nervous condition. On September 29, 2020, the Claimant suffered a compensable accident when tucking in a bedsheet, causing pain in her left wrist and shoulder. While walking to the clinic, she was struck from behind by a third-party vendor pushing a cart filled with wet towels, causing low back pain. The Employer/Carrier authorized several doctors for all three injured body parts, all for which the Claimant was ultimately placed at MMI with 0% impairment. Upon reaching MMI, the Claimant selected Dr. Richard Smith as her IME. After his evaluation, Dr. Smith recommended further treatment including pain management, injections, and possible rotator cuff surgery, and assigned work restrictions. Of note, prior MRIs of the Claimant’s shoulder and back revealed chronic conditions including arthritis and a chronic tear in the rotator cuff. Afterwards, Dr. Robert Murrah was appointed as an EMA by Judge Sojourner. After the examination and deposition of the EMA, Dr. Murrah agreed with the MMI for the left shoulder, and agreed with the MMI date for the lumbar spine but assigned a 3% PIR and assigned restrictions. The restrictions, and any ongoing treatment for either body part would not be related to the workplace accident, but her pre-existing conditions. Each side retained a psychiatrist IME. Both diagnosed the Claimant with mental conditions that developed after the compensable accident. The Claimant did not challenge Dr. Murrah’s opinions, accordingly there was no clear and convincing evidence to reject his opinions that any ongoing need for pain management is due to her preexisting condition and not the compensable accident. The JCC found that any pain in the Claimant’s shoulder or lower back are more than 50% due to pre-existing conditions and not the workplace accident. Accordingly, the requested authorizations for psychiatric care were denied, as the major contributing cause of the pain resulting in the mental heal conditions was not the work accident.
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Terren Hicks v. Sysco West Coast Florida & CorVel
JCC Massey: Tampa District Order date: 10/24/2025
OJCC Case: 25-023261MAM Date of Accident: 1/7/2025
JCC Order: Click Here
Briefly: Motion for Summary Final Order
Summary: Handled by our very own Kris Vander Pyl! On September 25, 2025, at 7:23 am, Claimant’s Counsel sent an e-mail to the adjuster indicating her representation of the Claimant, and that they would be filing a Petition for Benefits. Four minutes later, at 7:27 am, a Petition for Benefits was filed requesting numerous benefits. The Employer/Carrier assert that the Petition should be summarily denied or dismissed because no good faith effort was made to resolve the issues prior to filing, in violation of both the letter and spirit of the statute. In making his ruling, the JCC found that the email was sent outside of normal business hours, informing the adjuster that they are in the process of filing a Petition – without telling the adjuster what benefits they are requesting – and filing the Petition four minutes later (still outside of normal business hours) is not a good faith effort. Claimants Counsel argued, unsuccessfully, that they would dismiss the Petition if the Employer/Carrier proved that all benefits were provided, which should satisfy the good faith requirement. The JCC found that the good faith effort must be made first, with sufficient time for the Employer/Carrier to respond to it, before filing the Petition. Accordingly, the JCC granted the Employer/Carrier Motion for Summary Final Order.
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