JCC Orders

Stella Vickers v. Florida Dept. of Business and Professional Regulations/Division of Risk Management

JCC Lazzara; Tallahassee District; Order Date: September 28, 2015

OJCC Case: 15-004435JJL; D/A: 05/01/2012

Claimant’s Counsel: Paul Anderson

Employer/Carrier Counsel: Kimberly Fernandes

Briefly: JCC Lazzara denied the Statute of Limitations defense and entered an abbreviated final compensation order awarding re-authorization of Dr. Hector Mejia for continued care of the claimant’s upper right extremities and made factual findings in the contents of the order.

Summary: The JCC noted there is no dispute as to the issue of compensability of the accident or injuries and entered an abbreviated final compensation order. The Employer/Carrier defended on the grounds that the date of accident in this claim is 5/1/12 and the statute of limitations would have run when the claimant failed to seek authorized treatment by 5/1/14, two years following the date of the last authorized treatment for that condition. However, the JCC found the medical reports clearly indicate that the claimant received treatment for a compensable injury within two years of the last authorized treatment, but that the Employer/Carrier were not initially aware of the date of treatment due to an error in billing and coding by the office for the authorized physician.

The JCC also accepted the claimant’s testimony, as unrebutted by the Employer/Carrier, that the claimant never received actual notice of the statute of limitations or workers’ compensation information or brochure as required under Florida Statutes Sec. 440.19(4).

******************************************

Melissa B. Loeffelholz v. St. Vincent’s Health Care Foundation/Sedgwick CMS

JCC Humphries; Jacksonville District; Order Date: September 28, 2015

OJCC Case: 13-012624RJH; D/A: 09/14/2012

Claimant’s Counsel: Jonathan Israel

Employer/Carrier Counsel: Richard Stoudemire

Briefly: JCC Humphries appointed Dr. Stephanie Henley as an Expert Medical Advisor even though Dr. Henley is not on the Florida Workers’ Compensation Expert Medical Advisor list. The JCC noted there are no dentists or oral maxillofacial surgeons on the list.

Summary: The JCC found there was a disagreement in the opinions regarding causal relationship of the claimant’s TMJ condition to the industrial accident. The claimant’s IME physician was Dr. Mark Piper and he opined that the work place accident exacerbated the claimant’s pre-existing TMJ condition. Dr. Piper’s opinion conflicted with the opinions of Dr. Harold Menchel and Dr. Mark Hoffman who both opined the claimant’s condition pre-existing the accident and is the cause of her symptoms.

The JCC overruled the Employer/Carrier’s objection and appointed Dr. Henley as an EMA even though Dr. Henley is not on the Florida Division of Workers’ Compensation Expert and Medical Advisor list. However, the JCC reviewed Dr. Henley’s credentials and found her appointment to be appropriate.

******************************************

Holly Bennett v. Time Warner/ESIS WC Claims

JCC Rosen; St. Petersburg District; Order Date: September 28, 2015

OJCC Case: 11-011625SLR; D/A: 03/08/2011

Claimant’s Counsel: Pro se

Employer/Carrier Counsel: Juan Carlos Garcia

Briefly: JCC Rosen entered an evidentiary order denying claimant’s Motion for Sanctions and denying Employer/Carrier’s Motion for Fees and Costs and noted that there is considerable animosity between the claimant and the attorney for the Employer/Carrier. The JCC noted there are no Petitions for Benefits pending, rather the parties used their time to pursue penalties and sanctions against each other.

Summary: The JCC heard argument of the parties, reviewed documentary evidence and found that all claims pending by both parties for sanctions, attorney’s fees and costs were filed without sound evidentiary basis. The JCC admonished both parties and stated the JCC will not tolerate frivolity, vindictiveness, or retribution that is requested by either party without a firm evidentiary basis. The JCC warned that further pleadings filed by either party that proved to be baseless or without evidentiary support would result in severe sanctions.

On the other hand, the JCC stated that valid claims for benefits and defenses will be swiftly determined. .

******************************************

Joseph Camara v. RREMC, LLC d/b/a/ Denny’s Restaurant/Zenith Insurance Company

JCC Massey; Tampa District; Order Date: September 28, 2015

OJCC Case: 15-013486MAM; D/A: 06/09/2015

Claimant’s Counsel: Pro se

Employer/Carrier Counsel: Stephen Berlin

Briefly: The JCC dismissed the outstanding Petition for Benefits without prejudice and noted that the claimant failed to respond to a show cause order for failing to attend mediation.

Summary: At the order to show cause hearing, the Employer/Carrier made an ore tenus Motion to Dismiss the outstanding Petition. Based upon the claimant’s failure to attend the state mediation and failure to attend the show cause hearing, the JCC dismissed without prejudice the outstanding Petition for Benefits.

******************************************

Valecia Benjamin v. Behavioral Health of the Palm Beaches/Patriot Risk Services

JCC D’Ambrosio; West Palm Beach District; Order Date: September 28, 2015

OJCC Case: 15-012429SHP; D/A: 12/21/2011

Claimant’s Counsel: Dominic Celeste

Employer/Carrier Counsel: April Burnette

Briefly: JCC D’Ambrosio ordered a $2,000 advance over the objection of the Employer/Carrier. The Employer/Carrier argued that the claimant has not shown a plausible nexus to medical and related financial needs arising from work place injuries as the claimant was terminated from employment for reasons unrelated to her injury.

Summary: The JCC noted no response to the Motion for Advance was filed by the Employer/Carrier. The JCC reviewed the medical records of Dr. Garvin Yee offered by the claimant. The JCC found that the claimant suffered a substantial loss of earning capacity and, although the claimant was terminated by the employer, she returned to work at two part time jobs which was significantly less than what she was earning while employed full time with the employer. The JCC noted that the claimant went for three months without any income. The JCC found the claimant met her burden of proof under Florida Statutes Sec. 440.20(12)(c).

With regard to whether or not the claimant showed sufficient nexus between her compensable injury and her financial need, the JCC found that a ruling on a misconduct defense is more appropriate for a final hearing on the pending Petition for Benefits seeking indemnity.

******************************************

Tariq Edwards v. Miami Dolphins Limited/Berkeley Specialty Underwriting Managers

JCC Roesch; Panama City District; Order Date: September 28, 2015

OJCC Case: 14-026140LAR & 15-009128LAR; D/A: 05/23/2014 & 07/31/2014

Claimant’s Counsel: Michael Reidhammer

Employer/Carrier Counsel: Sylvia Krainin

Briefly: JCC Roesch denied the claimant’s Motion to Exclude the Employer/Carrier’s IME testimony and rejected the claimant’s argument that the Employer/Carrier elicited pure opinion testimony from the IME physician as to major contributing cause, specifically as it relates to percentages of causation.

Summary: The JCC made no findings regarding the substance or weight of the Employer/Carrier’s IME physician, Dr. Uribe. However, she did find that the doctor’s testimony is sufficient for admissibility purposes and denied the claimant’s Motion in Limine

******************************************

Mario Castellon v. Asplundh Tree Experts/Gallagher Bassett Services

JCC Anderson; Daytona Beach District; Order Date: September 28, 2015

OJCC Case: 10-009839WWA; D/A: 11/09/2009

Claimant’s Counsel: Chad Hastings

Employer/Carrier Counsel: Michelle R. F. Leissle

Briefly: JCC Anderson denied the claim for replacement or repair of the HVAC system in the claimant’s home and noted that, although there was no dispute that it is medically necessary for the claimant to have a functioning cooling system, the parties placed that responsibility on the claimant by prior contractual agreement.

Summary: The JCC noted that the parties voluntarily entered into a stipulation which included that the provision of the HVAC system was “a once in a lifetime benefit to the claimant. The E/C will NOT purchase or procure other housing for the claimant’s benefit during his lifetime.” It was agreed that the claimant would be responsible for maintenance and repair even if such maintenance was medically necessary.

The JCC noted the claimant testified that he did not think the stipulation made him responsible for the entire replacement of the HVAC system. However, the JCC found that one party’s thoughts or unspoken intentions do not determine the meaning of the stipulation that controls. If the claimant had any questions about its meaning, he had the opportunity to ask his lawyer about it before signing the stipulation.