Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
Shannon Washington, Jr. v. Cone Distributing Inc. and Zurich American Insurance Company
JCC Newman: Tallahassee District Order date: 12-30-2025
OJCC Case: 25-008722JLN Date of Accident: 01-02-2025
JCC Order: Click Here
Briefly: Misconduct
Summary: On January 2, 2025, the Claimant was working as a route driver for the Employer when he injured his back while making a delivery to a customer. The Claimant was initially authorized to seek medical care with Patients First clinic in Tallahassee, where he reported left lower back pain and pain down his left leg. He was diagnosed with dorsalgia and paresthesia and prescribed medication and physical therapy. He was also assigned light duty work restrictions. The Claimant was later referred to Dr. Spencer Stoetzel (orthopedic surgeon) for continued complaints of back pain. Dr. Stoetzel placed the Claimant at MMI on June 13, 2025, with a 0% permanent impairment rating and full duty work status. On May 22, 2025, the claimant was terminated for his failure to submit a random drug test, which was a requirement of his job as a route driver. The claimant was aware of this requirement. On the day of his random drug test, the claimant told the Employer that he could not take the random drug test because he needed to pick up his children from school. The Employer offered to contact Concentra to provide a quick appointment so that the claimant could do both. He declined the offer. He was advised several times that if he did not comply with the drug test, he would be terminated. The E/C argued that the claimant’s conduct gave rise to a misconduct defense, which would bar any recovery for TPD benefits. The claimant argued that the Employer scheduled the drug test on a day that they were aware the claimant would need to leave early. It was later discovered that the claimant was not referencing his own children, but his “nieces and nephews”. The Employer contradicted the claimant’s statements. The JCC found the Employers’ testimony to be more credible than the claimant’s and found that the claimant’s testimony that he was placed in an untenable choice between his family and his job was not credible. Thus, it was determined that, based on the evidence, the Claimant knowingly violated the Employer’s company policy by refusing to submit to a random drug test on the date that it was assigned, and that such violation constituted “misconduct” as defined by Chapter 440. His petition for TPD benefits was denied.
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Tristan Borkowski v. RV World FL, LLC D/B/A Camping World RV Sales and Gallagher Bassett Services, Inc.
JCC Case: West Palm Beach District Order date: 01-13-2025
OJCC Case: 25-011806BKC Date of Accident: 04-15-2025
JCC Order: Click Here
Briefly: Unexplained Fall/Idiopathic Injury
Summary: On April 15, 2025, the claimant passed out at work, falling and hitting his head, and was rendered unconscious. His prior medical history was negative for any heart related problems, seizure disorders, head injuries, or fainting/passing out. He did confirm a previous diagnosis for vertigo following scuba diving around 2020. He testified that he received treatment, to include two Epley maneuvers, which cleared the condition. He denied any other episodes of vertigo until this accident. The claimant testified that the floor in his bay could get slippery, but did not know for sure if a slip was the cause of his fall. The Employer/Carrier referenced the Claimant’s use of marijuana as a possible cause for the fall. The Claimant testified that he has a marijuana card and that he routinely uses marijuana at night to help him sleep. He typically uses it after his kids go to bed, but generally not after 10:00pm. Dr. Stone, the E/C’s IME doctor, opined that the claimant’s concussion, post-traumatic vertigo, and amnesia were all caused by the Claimant’s fall at work. He recommended the Claimant undergo a brain MRI along with a 4-hour EEG, video recording, a course of physical therapy and an ENT evaluation to evaluate the ongoing vertigo/dizziness. He also stated that the claimant’s 2020 vertigo episode was likely unrelated, and that vertigo did not cause one to pass out. The claimant underwent an IME with Dr. Conidi, who agreed that the prior vertigo episode did not cause the Claimant to fall/pass out and was properly treated and cured. Both doctors agreed that the Claimant’s use of marijuana at night would not cause him to pass out in the morning. Both doctors also opined that the claimant likely fell and hit his head, rather than passed out, but that the cause was unknown.
The E/C contended that the claimant had a pre-existing condition that contributed to or caused his fall. However, the medical evidence did not establish the Claimant had any pre-existing conditions. There was no medical evidence to suggest that the claimant’s marijuana usage the night before would cause him to pass out the following morning. The JCC looked to Soya v. Health First, Inc., which held that “…where an unexplained fall happens while Claimant is ‘actively engaged’ in the duties of employment, and where there is no other established basis for the fall, the causal relationship between the employment and the accident is met.” Therefore, the JCC found that the claimant met his burden to establish “the causal relationship between the employment and the accident” and that his unexplained fall arose from work and is compensable. The JCC found the claimant to be entitled to an evaluation by an ENT and neurologist.
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Kenetra Bradley v. Citrus County School Board/FSBIT
JCC Arthur: Tampa District Order date: 1/16/2026
OJCC Case: 22-013073RAA Date of Accident: 3/21/2022, 9/16/2022
JCC Order: Click Here
Briefly: Medical Necessity for Post-MMI follow-ups
Summary: Handled by our very own Morgan Indek! The Claimant sustained two lower back injuries in 2022 while working as a school bus driver. The Claimant had somewhat minimal treatment to her back, primarily PT. She treated several times with her orthopedic doctor, Dr. Olalov, and was placed at MMI in December 2022 with a 0% PIR and no work restrictions. Dr. Lowell placed the Claimant at MMI 0% in February 2023. She next treated with Dr. Dermarkarian 26 months later in April 2025, admittedly not for treatment, but to keep her workers’ compensation claim open. Dr. Dermarkarian confirmed the December 2022 MMI 0%, as the Claimant had recovered and maintained the lingering back pain with a home exercise program. A follow-up was recommended a year out, with the Doctor testifying that it was not for treatment, but to keep the workers compensation claim open. The JCC rejected the opinions of the Claimants IME, Dr. Richard Smith, as his opinions conflicted with the other orthopedic doctors and were based upon findings that contradict every other doctor. Dr. Smith indicated that the Claimant was not at MMI, despite her returning to work without restrictions for multiple years, and only has intermittent/minimal pain. The JCC agreed with Dr. Dermarkarian that the ongoing treatment was not medically necessary, and that the injuries were a temporary exacerbation of her underlying degenerative disc disease and stenosis conditions. Ultimately, the JCC denied the authorization and scheduling of a follow-up appointment.
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Suzanne Kelin v. Apple, Inc/Sedgwick CMS
JCC Jacobs: Miami District Order date: 1/23/2026
OJCC Case: 17-022968JIJ Date of Accident: 4/16/2016
JCC Order: Click Here
Briefly: TPD, Estoppel, Modifications
Summary: Handled by our very own David Halpern and Michael Kodetsky! At issue for this Final Hearing was the Claimant’s entitlement to TPD benefits from January 19, 2024, through April 10, 2025, with penalties and interest. Prior to the Final Hearing, the Employer/Carrier agreed to pay indemnity benefits from April 11, 2025, through the date of the Final Hearing. The Claimant was injured in 2016 after a trip and fall and suffered a compensable lumbar herniation. The Claimant required two surgeries. The Claimant’s IME opined that MMI was not reached and that she was unable to work. However, the Claimant returned to performing remote work for Apple until July 2023, when the remote work program was terminated. Since that time, she has been unemployed. She received long term disability upon termination with Apple, which she elected over workers’ compensation benefits due to higher valuation. The policy provided that social security and workers’ compensation benefits offset the amount of long-term disability benefits received. The Claimant ultimately received long-term disability from July 2023 through October 2025. In 2025, the Claimant qualified for social security disability, effective January 2024. She received a retroactive payment of over $30,000. Consequently, she was overpaid long-term disability in the amount of $32,152. To remedy, the Claimant agreed to pay $15,000 to Lincoln Financial and lower her benefits to $500 a month to repay the balance. During this time, the Employer/Carrier paid the Claimant $11.47 a week from January 2024 through April 10, 2025, representing the difference between the long-term disability amount and one hundred percent of the Claimants AWW. The Claimant filed two PFBs for TPD and spinal surgery. Counsels for both parties negotiated a resolution of the pending PFBs, with the Claimant accepting $1,043.77 pursuant to the agreement. The Claimant filed a PFB in July 2025 for indemnity benefits covering the period in the agreement. The Employer/Carrier contends that the parties’ agreement and equitable estoppel bars the benefits in the July PFB. Ultimately, the JCC found that the parties reached a binding agreement to resolve the TPD dispute from January 2024 through April 2025, and the Claimant filed a Notice of Resolution. As for the Claimant’s modification request, no order was entered on the stipulation so there was nothing for the JCC to modify. The PFBs were denied and dismissed with prejudice.
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Charles Caulk v. Coastal Forestry Services/Bitco National Insurance Co.
JCC Walker: Pensacola District Order date: 1/23/2026
OJCC Case: 25-009614JW Date of Accident: 5/3/2024
JCC Order: Click Here
Briefly: Major Contributing Cause
Summary: Prior to the accident at issue, the Claimant was involved in a 2020 work accident where he felt a pop in his right shoulder. The Claimant was followed by a doctor for his shoulder and neck and was recommended for neck surgery. Due to COVID and the severity of the surgery recommended, Claimant did not elect to have the surgery. This prior claim settled for $125,000. Afterward, the Claimant started working for Coastal, where the second work accident occurred. As before, the Claimant had right shoulder and neck pain. Dr. Goodwiller was authorized for the shoulder, and Dr. Matthew Lee for the neck, who later recommended neck surgery. Claimant now wishes to proceed with neck surgery. After leaving Coastal, the Claimant worked elsewhere and continued to report pain in his neck. Claimant testified that the settlement money, which accounted for the neck surgery, was depleted, as he used it to buy a new truck and a new shed roof. Based on Dr. Lee’s deposition, 95% of the cause for need for surgery was from the preexisting cervical condition. Turning to MCC, the JCC was tasked with determining whether a single carrier is on-risk for two dates of accident that occurred with two employers in different years. As the Carrier put neck surgery into its evaluation when the $125,000 settlement was agreed upon, the JCC determined that having them pay for the surgery now would be having them pay for the same thing twice and denied the request.