Editor: Felicia Wymer, Partner, Pensacola Office
Author: Travis Coleman, Partner, Tampa Office
Author: Katie Valley, Associate, Jacksonville Office
Victor Santiago v. Kraft Heinz and Gallagher Bassett Services, Inc.
JCC Weiss: Ft. Myers District Order date: 4/9/2026
OJCC Case: 22-012670JAW Date of Accident: 1/12/2022
JCC Order: Click Here
Briefly: Fees & Costs
Summary: The claimant asserted entitlement to costs on two PFBs, as well as attorney fees for proving entitlement to costs. The E/C disputed entitlement to costs and attorney fees. On November 13, 2024, at 9:09 AM, the claimant’s attorney contacted the attorney for the E/C asking for a follow up appointment for Claimant with his treating doctor for his right knee injury. On November 14, 2024, at 11:27 AM, the attorney for the E/C replied stating: “This is not in dispute. The carrier agrees to schedule a follow-up appointment. The employer has been in communication with the claimant and previously confirmed authorization for continued care. It is my understanding the employer has requested NCM to facilitate.” The claimant filed a PFB 3.5 hours later. The JCC concluded that, since the E/C had already confirmed there was no dispute before the PFB was filed, there was no unresolved dispute at the time of filing, and therefore no basis for costs under 440.192(4). Separately from that, the JCC found that the PFB was not properly served, as it had only been served on defense counsel, and not on the carrier itself. Per 440.192(7), the claimant’s attorney was not entitled to a carrier paid fee or costs. Regarding the February 20, 2025, PFB, the Claimant’s attorney’s office contacted the attorney for the E/C on February 19, 2025, requesting a follow-up appointment with Dr. Gomez. Eight minutes later, the attorney for the E/C responded: “This is not a dispute. Your client remains in active care with Dr. Gomez. He is free to schedule his own follow ups, but I will have the adjuster contact the doctor’s office, as well. Again, there is NO dispute.” A PFB was filed the following day. Additionally, at the time of the email correspondence, the claimant was already scheduled for a follow up with Dr. Gomez on March 11, 2025. The claimant’s attorney argued that while the claimant had an appointment, he did not know if it was an authorized appointment. The JCC rejected this argument and stated that it was clear that the claimant’s attorney did not know the claimant already had an appointment scheduled with Dr. Gomez when he filed the PFB. As with the earlier PFB, there was no evidence that this PFB was served via certified mail to the Employer. The claimant was denied fees and costs.
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Brian Bacchus v. DNL Logistics, Inc. and NorGUARD Insurance Company
JCC Newman: Tallahassee District Order date: 5/2/25; 4/24/26 (appeal)
OJCC Case: 21-017737JLN Date of Accident: 4/20/2021
JCC Order: Click Here
DCA Order: Click Here
Briefly: Authorization of Medical Care
Summary: On April 20, 2021, the claimant sustained an injury after landing on his back. The E/C accepted the claim as compensable and authorized medical care for the IW’s neck, back, and right hip. Following the accident, the claimant underwent significant medical treatment including a right-sided microdiscectomy in June 2023. Later that year, an MRI continued to show a disc herniation at L5-S1 with a right-sided annular tear. IW’s authorized pain management specialist, Dr. Berlioz, diagnosed the IW with multiple conditions and recommended a spinal cord stimulator trial with possible permanent implantation if the trial proved successful. The claimant filed a petition for benefits on August 1, 2024, seeking authorization of the spinal cord stimulator. The E/C denied the request and obtained an IME with Dr. Salahi, who found that the procedure was not medically necessary and argued that the request was premature. The JCC accepted Dr. Berlioz’s opinion over Dr. Salahi regarding medical necessity but did agree with Dr. Salahi that the request was premature. The claimant underwent cervical surgery in December 2024, and per Dr. Berlioz’s testimony, the earliest time he would initiate a spinal cord stimulator trial would be six months after the cervical surgery. Thus, although Dr. Berlioz would be likely to recommend the Claimant undergo the spinal cord stimulator in the future, the JCC noted that he also made it clear that the Claimant would require more time to recover from his recent cervical surgery and further consultation is needed before the spinal cord stimulator trial will be performed. Therefore, the claimant’s request for authorization of a spinal cord stimulator was denied without prejudice to request such authorization in the future. The request for attorney fees and costs was also denied. Claimant appealed and the First DCA dismissed the appeal per curiam.
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Paola Webster v. Southwest Airlines Co. Fort Lauderdale-Hollywood Int’l Airport and Sedgwick CMS
JCC Newman: Tallahassee District Order date: 10/31/2023
OJCC Case: 13-017262JLN Mandate date: 4/27/2026
JCC Order: Click Here Date of Accident: 6/28/2011
Briefly: 120 Day
Summary: On June 28, 2011, the claimant was struck on the left shin by the lower metal portion of an aircraft door. The E/C accepted the accident as compensable and authorized medical care for the resulting left leg injury. Over the following months and years, the claimant’s condition continued to worsen, resulting in a 2012 diagnosis for Pyoderma Gangrenosum (“PG”) of the left leg, an autoinflammatory disorder causing large, painful sores to develop on the skin that can be progressive in nature. She eventually began to develop the same condition in her right leg. On March 15, 2022, the claimant’s authorized treating physician, Dr. Jose Maria Paterno, recommended physical therapy for the claimant’s right leg. The E/C denied treatment for the right leg, contending that it was never accepted as compensable. The Claimant argued that she did not need to prove causation, as the E/C was estopped from denying compensability based on the 120-day rule. The E/C denied that the 120-day rule precluded it from contesting the requested medical care for the Claimant’s right leg. The JCC found that the E/C began providing and authorizing medical care specifically for the claimant’s PG diagnosis in 2012. During that time period, the E/C never informed the claimant that it was investigating, nor did it notify the claimant that it was qualifying the acceptance of PG as limited to the left leg only. The E/C argued that it only accepted the compensability of the Claimant’s left leg injury and never accepted the “entire disease process” of PG. The JCC cited Bynum Transport, Inc. v. Snyder, where the Court found that a claimant’s hepatitis C was compensable because the carrier failed to deny compensability of the condition within 120 days after initiating payment of benefits for the required treatment of the condition. The Court held that “[i]f the E/C is not sure whether to provide compensation or benefits, the pay-and-investigate provision offers a limited window of time in which to explore the question of compensability without being locked into a fixed position.” Here, the JCC found that, as was the case in Bynum, the 120-day rule applied and the E/C, by not denying compensability within that timeframe, was estopped from challenging the compensability of the PG condition in the right leg. Consequently, the JCC granted authorization of the requested physical therapy for the right leg. E/C appealed and the First DCA affirmed the decision per curiam on April 8, 2026.
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Daniel Roberto Maldonado v. Delta Air Lines Inc./Indemnity Ins. Co. of North America and Sedgwick CMS
JCC Stanton: Jacksonville District Order date: 5/1/2026
OJCC Case: 22-022848TSS Date of Accident: 7/28/2022
JCC Order: Click Here
Briefly: Statute of Limitations
Summary: In July 2022, the Claimant injured his lower back and right shoulder while working as a ramp agent. Treatment was initially set up with Centra Care and subsequently with Dr. Bauer for the primary back injury. The Claimant testified that he would like to return to Dr. Bauer. However, the Employer/Carrier denied the follow-up due to the Statute of Limitations, as the Claimant last treated for his 2022 accident in February 2024. The Claimant underwent an IME with Dr. Richard Smith, who diagnosed the Claimant with a herniated lumbar disc and lumbar radiculopathy, which would require PT as well as injections. The JCC looked to the recent Estes decision by the First District Court of Appeal for guidance. In Estes, the court determined that there are two statutory clocks, 1) the two-year limitation period clock, and 2) the one-year tolling clock. Despite a mandate not being entered for Estes, the JCC in this case adopted the same rationale. The Claimant first sought treatment on July 28, 2022, received TPD benefits on March 8, 2023, and additional medical treatment on February 20, 2024, all of which extending the date that the SOL would expire. The last benefit provided was February 2024, with the one-year tolling clock expiring on February 19, 2025. The two-year clock would expire in 2027 if no other benefits are provided. The JCC denied the Employer/Carrier’s SOL defense and awarded a follow-up with Dr. Bauer.
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Michael Spivey v. Polk County School Board and Johns Eastern Company, Inc.
JCC Massey: Tampa District Order date: 1/30/2025, 3/12/2025
5/5/2026 (Appeal)
OJCC Case: 10-008463MAM Date of Accident: 6/3/2005
JCC Order: Click Here
DCA Order: Click Here
Briefly: Authorization of Name Brand vs. Generic Medications
Summary: Claimant injured his lower back in June 2005 and underwent extensive treatment including a failed fusion surgery. The Claimant treated with Dr. Sarria for pain management, who provided injections, implanted a spinal cord stimulator, and handled medication management. The current medications at issue in the litigation were name brand drugs Neurontin and Nucynta. Turning to Fla. Stat. 440.13(1)(m), the Carrier fulfills its responsibilities to provide medicine by providing the generic versions of the medicine, unless the authorized physician indicates that the name brand drug is medically necessary. Dr. Sarria testified that Neurontin is the brand name of Gabapentin, which is used to treat lumbar radiculopathy. Dr. Sarria testified that he prescribed a generic version but the Claimant did not get the same amount of relief as the name-brand. During cross-examination, Dr. Sarria testified that he has been made aware of a generic which has similar ingredients and agreed with the Employer/Carrier’s IME physician that this new medication would be reasonable, medically necessary, and appropriate for the Claimant’s condition and complaints. As it relates to Neurontin, no evidence was presented that the use of the name brand medication as opposed to a generic was medically necessary. Nucynta, used for pain control, was prescribed due to allergic reactions to other similar medications. However, the Claimant reported that Nucynta is ineffective in controlling his pain. Dr. Sarria again agreed with the Employer/Carrier’s IME physician that other medications should be considered, specifically Tramadol. Both doctors again agreed that Nucynta is not medically necessary and should be replaced with a trial rotation of other drugs that may provide better pain relief. The JCC determined that Nucynta was not medically necessary based on the above. Ultimately, the JCC denied compensability, medical necessity, and payments related to Neurontin and Nucynta. The First District Court of Appeals affirmed the ruling.
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