Editor: Felicia Wymer, Partner, Pensacola Office

Author: Travis Coleman, Junior Partner, Tampa Office

Author: Libby Nelson, Associate, Orlando Office

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Beaubrun v. American Airlines Inc., Sedgwick CMS

JCC Jacobs:   Miami District                                               Order date:   9/9/2024

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

JCC Order: Click Here

Briefly:  Wages in Lieu of Workers Compensation

Summary: The claimant left work on 12/19/2023 and noticed swelling in the left groin area. He was later diagnosed with a left inguinal hernia at the ER and assigned work restrictions. The claimant did not return to work the following day, requested sick leave, and did not relate the work accident to work nor report the injury until January 4, 2024. The Claimant was paid regular sick leave from December 20, 2023, until December 28, 2023, and a half day on December 31, 2023, at which time the Claimant’s sick time expired and he was placed on unpaid sick leave until January 30, 2024. Starting January 31, 2024, the employer paid salary/wages in lieu of compensation until February 19, 2024. The Claimant returned to work with accommodated restrictions on February 20, 2024. The employer testified that they offered him light duty on January 5, 2024, based on an email stating “we are accommodating effective 1/4/24.” Claimant reached MMI on March 4, 2024, with no PIR or restrictions. The Claimant filed a Petition for TTD/TPD benefits from December 20, 2023, through February 25, 2024. The JCC found that the E/C did not offer suitable employment from December 20, 2023, to January 30, 2024, noting that the email was not persuasive of an actual offer of light duty being extended. Finally, the JCC found that there was no evidence establishing that the claimant and employer came to an understanding that the payment would be in lieu of workers compensation benefits, as payment of wages in lieu of compensation “must be an act clearly understood between the employer and the employee.” The JCC therefore awarded the claimant indemnity benefits from December 20, 2023, through February 19, 2024. 

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Leighton v. Kratos Logistics, LLC/Ascendant Commercial Insurance

JCC Forte:   Ft. Lauderdale District                                               Order date:   9/10/2024

OJCC Case:   22-004803IF                                                  Date of Accident:    2/9/2022

JCC Order: Click Here

Briefly:  Statute Of Limitations

Summary: The Claimant was injured on February 9, 2022, when he went to the back of his van to retrieve a package and hit his head on a piece of extended metal. The Carrier received notice of the claim on February 17, 2022, and authorized Concentra on February 22, 2022. The claimant was last paid indemnity on June 29, 2022. The last provision of medical care was August 1, 2022. On May 10, 2023, the E/C issued a reimbursement payment to the claimant for a February 12, 2022, PT visit. A Petition for Benefits was filed on March 1, 2024, which the E/C responded by raising a Statute of Limitations defense. The claimant contended that the Carrier’s reimbursement tolled the statute for a period of one year, which would make the PFB timely filed under Creed case precedent. The JCC found that reimbursement to the Claimant for expenditures was not “furnishing” of medical care. The JCC found that the E/C never denied care that was subject of the reimbursement as it was with an unknown physician of the Claimant’s choosing, a claim for payment of the doctor’s bill was never made, and the first notice that the E/C had about the bill was on May 9, 2023, and chose to reimburse the claimant the following day without question. For these reasons, the JCC granted the Statute of Limitations defense.

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Holmes v. City of Miami Beach/Corvel Corporation

JCC Havers:   Miami District                                                          Order date:   9/10/2024

OJCC Case:   24- 003917WJH                                             Date of Accident:    11/7/23, 2/20/24, 4/1/24

JCC Order: Click Here

Briefly:  Major Contributing Cause

Summary: The Claimant has had at least four right shoulder surgeries related to prior work accidents with the same employer. Prior to the November 7, 2023, work accident, the last work accident for the right shoulder was in May 2014. The Claimant testified he had not seen a doctor for his right shoulder between May 2014 and November 2023. After the November 2023 accident, the Claimant noted another incident while on a lunch break and was placed in a sling by Memorial Regional Hospital. The authorized provider recommended right shoulder surgery to address internal derangement. After the prior authorized provider became unavailable to treat patients, the E/C authorized Dr. Paul Meli who diagnosed the claimant with a frozen shoulder due to the labrum tear from November 2023. When questioned regarding prior injuries, Dr. Meli indicated that the claimant had worsened due to the November 2023 accident. The adjuster denied the surgery. On February 20, 2024, the claimant felt another pop in his right shoulder, and felt it again on April 1, 2024. The E/C denied these two accidents, and Dr. Meli reviewed an MRI which did not show a new injury or new acute pathology after these accidents. Dr. Meli testified that, while he originally thought the MCC of the need for any surgery was the work accident, his review of the MRI after the two subsequent accidents confirmed it was something different than he first thought. He placed the claimant at MMI with a 0% PIR and opined that the MCC was due to the degenerative changes. Both the E/C and Claimant then obtained an IME. The JCC agreed with Claimant’s IME, which indicated that the claimant did not have any issues with his right shoulder for nearly a decade while working a strenuous job, and thus the major contributing cause of the need for surgery would be the 11/23 work accident. The Claimant’s IME’s opinions were consistent with Dr. Meli’s before he changed his mind after consulting with E/C’s counsel during a conference. The JCC also found that, as the contributing causes are occupational in nature, the MCC standard does not apply, and awarded the right shoulder arthroscopic surgery.

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Luke Mirabal v. Boucher Brothers Beach Management/Broadspire Services, Inc.

JCC Moneyham: St. Petersburg District                                        Order date: 09/17/2024

OJCC Case: 23-022929JPM                                                            Date of Accident: 06/21/2023

JCC Order: Click Here

Briefly: Temporary Partial Disability, Misconduct, Voluntary Limitation of Income

Summary: The claimant was injured while working as a Beach Operations Manager. Following his accident, he was given work restrictions which the employer was able to accommodate. Within two months following the accident, the claimant was demoted and then fired.  The JCC found that the claimant’s demotion and accompanying reduction in pay was due to dissatisfaction with the Claimant’s job performance, which was unrelated to any limitations that the Claimant had following the workplace accident. The claimant’s poor performance included sleeping on the job on at least one occasion, repeated tardiness, failure to meet performance goals, and concerns about his leadership. Thus, the claimant’s request for TPD was denied. The JCC found that the claimant did not meet his initial burden of showing a causal connection between the compensable injury and the subsequent loss of income and the burden never shifted to the E/C to show voluntary limitation of income or misconduct.

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Tomako Williams v. Publix Super Market’s Inc./Publix Risk Management

JCC Case: West Palm Beach District                                              Order date: 09/26/2024

OJCC Case: 22-030010BKC                                                Date of Accident: 10/22/22,

10/20/21, 02/14/22

JCC Order: Click Here

Briefly: Notice

Summary: The claimant alleged injuries on three separate occasions to her neck/right arm while working. The E/C denied the claims, arguing that the injuries were not compensable, the medical treatment requested was not related to the alleged accidents, and that proper notice of accident/injury was not provided. The JCC believed the claimant’s deposition testimony was inconsistent, and she did not clearly testify what or how she was purportedly injured at work, or if the condition was personal in nature. Claimant’s depositions were inconsistent as to reported injury and vague/lacking detail as to how same occurred. Medical records showed complaints of arm and neck pain but did not link the complaints to her employment or a work accident. The employer representative testified that he had no knowledge of a work-related injury. The claim was first reported to the carrier by way of attorney correspondence and production request in December of 2022, a month after the Claimant was terminated for insubordination. The JCC found that the claimant did not notify the employer of the alleged work accident within 30 days of the alleged injuries.  Accordingly, all claims for compensability, medical treatment, and indemnity benefits were denied.

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