BY:  

 

 

Thomas G. Portuallo

JCC ORDERS

Daniel Lavine v. S.O.I./Hartford/CCMSI

JCC Sculco; Orlando District; Order Date: January 8, 2016    

OJCC Case: 14-023632TWS; D/A: 6/12/2013

Claimant’s Counsel: Michael J. MacDonald

Employer/Carrier’s Counsel: Gina M. Jacobs

Briefly: MISREPRESENTATION DEFENSE – JCC Sculco denied the Employer/Carrier’s misrepresentation defense and found the claimant did not knowingly or intentionally make false or misleading statements and did not misrepresent his prior medical history.

Summary: The JCC accepted the claimant’s testimony as credible and truthful based on the claimant’s demeanor while testifying. The JCC found that when the claimant was asked about his prior “pain or discomfort” he truthfully identified prior symptoms of treatment and provided the names of the various physicians on whose medical records the Employer/Carrier relied on for its misrepresentation defense.  The JCC also found that when the claimant did respond “none” to pre-existing conditions listed on a patient medical history, all the conditions listed were diseases and not orthopedic problems or injuries, so it is not clear that the claimant knowingly or intentionally made false or misleading statements

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Hedelmiro Diaz v. Barron Development Corp.

JCC Hogan; Ft. Lauderdale District; Order Date: January 8, 2016

OJCC Case: 15-006632GBH; D/A: 8/20/2014

Claimant’s Counsel: Ivette Labied

Employer/Carrier’s Counsel: Alexander O. Soto

Briefly: EMPLOYEE/EMPLOYER RELATIONSHIP – JCC Hogan accepted the testimony of the general contractor and owner of the Employer that he did not have employees working directly for him through his company, but processed all employees through Southeast Personnel Leasing.

Summary: The JCC accepted the testimony of the owner and general contractor that the claimant was hired to work on a project on September 12, 2014, subsequent to the alleged date of accident of August 20, 2014, and that the claimant worked through Southeast Leasing until November of 2014.  The owner testified that on the alleged date of accident, the building was still at the foundation stage with no roof, no walls, and the concrete floor had not been installed.  The claimant testified that on August 20, 2014, he was standing on a 10’ ladder performing tie beam work when he fell off the ladder and injured the left side of his body and broke his nose. According to the claimant, the foundation of the house was already poured and he fell on the concrete floor. 

The JCC noted the claimant’s testimony that he worked using several different names and found that this lessened the claimant’s credibility as a witness.

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Teresa Manucy Naczi v. Lon Manucy Concrete, Inc./Bridgefield Employers Insurance Company

JCC Holley; Jacksonville District; Order Date: January 8, 2016          

OJCC Case: 10-028606WRH; D/A: 1/5/2009

Claimant’s Counsel: Matthew Sosonkin

Employer/Carrier’s Counsel: Kelly Brannon

Briefly: MANAGED CARE DEFENSE – JCC Holley granted the Employer/Carrier’s Motion for Final Summary Order and found the documentary exhibits established the existence of a managed care arrangement and grievance procedure and that the claimant did not respond or provide any facts or exhibits disputing the existence of the managed care arrangement. 

Summary: The JCC found the grievance procedure for the managed care arrangement was not satisfied prior to the filing of the Petition for Benefits and dismissed the Petition without prejudice.  The JCC noted that the Employer/Carrier had a managed care arrangement in effect and the carrier disseminated the required informational brochure along with the required documents to the claimant.  The JCC found that the managed care arrangement documents conveyed that a grievance is a required for each medical issue prior to a Petition being filed.