Editor: Felicia Wymer, Partner, Pensacola

Author: Travis Coleman, Junior Partner, Tampa

Author: Libby Nelson, Associate, Orlando

Nelson Beaubrun v. American Airlines, Inc. and Sedgwick CMS

JCC Jacobs: Miami District                                       Order Date: 05-21-2024

OJCC Case: 24-002852JIJ                                          Date of Accident: 12-19-2023

JCC Order: Click Here

Briefly: Advance

Summary: The claimant sought an advance payment due to his inability to work for over four weeks. He did not receive his pay or compensation benefits for this period. In the Motion for the Advance, the Claimant alleged he required the money to pay bills which he had fallen behind on. In an addendum to the motion, the claimant alleged that he intended to use the advance to pay for an IME. At hearing, the Claimant testified that he needed the advance to pay for the two emergency room visits at Memorial Hospital and an IME. The JCC held that although the claimant satisfied the substantial wage reduction requirement under 440.20(12), he failed to demonstrate adequate justification for the advance. Specifically, the JCC noted that the Claimant failed to enter into evidence any bills or other evidence of sums owed to Memorial Hospital. Further, while an IME is an adequate justification for issuance of advance, the Claimant had not selected an IME provider, nor did he know how much such a provider would charge. Accordingly, the JCC found that the Claimant failed to demonstrate financial need for a $2,000.00 advance.

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American Airlines Group; American Airlines and Sedgwick CMS v. Alejandro Lopez

JCC Almeyda: Miami District                                   Decision Date:   01-19-2023

OJCC Case:   20-016770ERA                                     Date of Accident:    08-08-2019

JCC Order: Click Here                                                 PCA Date:    05-22-2024

Briefly:  Statute of Limitations

Summary: E/C appealed the JCC’s order rejecting their SOL defense. The claimant suffered a compensable accident and the E/C provided medical and indemnity benefits. The E/C last paid a medical bill September 22, 2020, and made its last indemnity payment on November 13, 2020. Following, the JCC approved a stipulation as to fees and costs in a final order dated May 3, 2021, relating to benefits obtained in prior PFBs. The Claimant went on to file two additional PFBs, on 12/1/2021 and 6/6/2022.  The E/C asserted SOL as a defense. The First DCA reviewed the case de novo and determined that the JCC erred in considering the payment of attorney’s fees and costs as a benefit under Section 440.19(2). The Court explained that only indemnity benefits or remedial treatment toll the statute of limitations, and the payment of attorney’s fees does not. The Court also found that the claimant’s December 2021 PFB, which was voluntarily dismissed, did not toll the statute of limitations, and therefore the June 2022 PFB was untimely and barred.

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Allan Howard Jr. v. Walmart Inc. and Sedgwick CMS

JCC Jacobs: Orlando District                                     Decision Date:   05-19-2024

OJCC Case:   22-030203JEJ                                       Date of Accident:    12-08-2022

JCC Order: Click Here                                             

Briefly:  Compensability of Medical Treatment

Summary: The claimant sought authorization of medical treatment as requested by his IME, specifically a shoe insert with metatarsal pad, corticosteroid injections, topical and oral anti-inflammatories, platelet plasma therapy, rex corporal shockwave therapy, and an MRI of the left foot. The claimant was injured when a pallet jack ran over the fourth and fifth toes of his left foot. This resulted in a degloving of the fourth toe necessitating emergency surgery, as well as lacerations and fractures to both toes. Benefits were provided until the claimant’s authorized podiatrist placed the claimant at MMI, and the claimant returned to work with the employer. The claimant underwent an IME who requested the above benefits, which were denied. During the Final Hearing, the claimant conceded that the IME requested progressive treatment starting with the shoe insert, so the additional benefits may not be ripe, due, or owing. During depositions, the claimant’s authorized doctor testified that the requested orthotic is within the appropriate standards of care and practice parameters for a person with the claimant’s injuries, but since the claimant did not report pain in the most recent visit he saw no reason to recommend it. The doctor testified that all of the recommended treatments by the claimant’s IME would be reasonable treatment if the claimant had intermittent problems or discomfort. The JCC found that the opinions of the IME essentially aligned with the authorized doctor, and awarded benefits requested by the IME that were the least invasive, including the shoe insert, topical and/or anti-inflammatories and corticosteroid injections. If those treatments are not successful, the progressive treatment would be awarded.

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Dewayne Jacobs v. FW Services, Inc. d/b/a Pacesetter Personnel Services

JCC Walker:   Pensacola District                                                    Order date:   5/17/2024

OJCC Case:   23-026456JW                                                Date of Accident:    10/12/2023

JCC Order: Click Here

Briefly:  Course and Scope

Summary: The claimant asserted that he had an industrial accident in 2023. At the Final Hearing, the claimant testified that a co-worker threw a heavy bag of concrete at him, striking the claimant’s left shoulder and resulting in an injury. Since the accident, the claimant asserts continued left shoulder pain. During testimony, the JCC did not find the claimant credible for several reasons. The first being that the claimant alleges an injury on a day that he did not work. Second, the claimant testified that a concrete bag was thrown at him, but the PFB and the claimant’s statement of injury indicated a carrying or lifting injury. Third, the claimant agreed, by his signature on a daily time ticket, that no work injury occurred. Fourth, the claimant was a one-day employee. And fifth, the claimant’s testimony did not accord with logic and reason when taken in totality with other evidence presented. Testimony presented by the E/C included a general contractor not employed with the employer who oversaw laborers on the jobsite. The general contractor testified that he was with the claimant the entire day and would have seen this incident occur. Based on the above, the JCC denied the claimant’s request for compensability and denied all pending PFB’s with prejudice.

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Russell Robinson v. City of Orlando/Relation Insurance Services

JCC Pitts:   Orlando District                                                           Order date:   5/16/2024

OJCC Case:   13-024396NPP                                                Date of Accident:    3/11/2009

JCC Order: Click Here

Briefly:  Attorney Fee Entitlement

Summary: This Final Hearing was held solely on the issue of attorney fee entitlement and not amount, stemming from a 7/6/2023 PFB. The claimant had been treating with Dr. George White until July 7, 2023, when a fax was received from the adjuster denying the claim. The doctor’s office was not aware that any subsequent appointment was authorized despite indication from E/C that same occurred, and sent the claimant home at a follow-up in August of 2023. Dr. White’s office was trying to get authorization from the claimant’s personal insurance and was not aware of the workers compensation authorization. After several letters from the claimant’s attorney, an appointment was scheduled for September 7, 2023. A representative from Dr. White’s office testified that the delay would not have occurred but for the initial denial received from the adjuster and would not have been rectified but for the claimant’s attorney’s efforts. Although the initial denial was based on a Statute of Limitations defense, the denial was later rescinded. The JCC found that due to claimant’s counsel’s efforts, the claimant attended the requested appointment with Dr. White in September 2023. Accordingly, the JCC found that claimant’s counsel was entitled to a reasonable attorney’s fee and costs for securing the appointment with Dr. White.

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