FL Case Law Summaries – 12/21/15
BY:
JCC ORDERS
Charmaine G. Peart v. Memorial Healthcare Systems/Preferred Government Claims Solutions
JCC Hill; Gainesville District; Order Date: December 17, 2015
OJCC Case: 14-026373MRH; D/A: 2/28/2013
Claimant’s Counsel: Steven Wilson and Jeffrey Deutsch
Employer/Carrier’s Counsel: Michael Riedhammer
Briefly: PSYCHIATRIC CONDITION – JCC Hill found the claimant’s psychiatric condition to be compensable and noted F.S. §440.093(1) provides “Nothing in this Section shall be construed to allow for the payment of benefits under this Chapter for mental or nervous injuries without an accompanying physical injury requiring medical treatment.”
Summary: Based upon Dr. Garcia-Granda’s psychiatric Expert Medical Advisor opinion, the JCC found claimant’s contusion resulting from the work accident was the major contributing cause of the claimant’s psychiatric condition and need for treatment.
The JCC did not find clear and convincing evidence to reject the presumptively correct opinion of the EMA.
Jeanne Shabazz v. Duval County School Boards/Johns Eastern Company, Inc.
JCC Humphries; Jacksonville District; Order Date: December 17, 2015
OJCC Case: 15-000087RJH, 15-006502RJH, 15-007285RJH; D/A: 4/1/2010, 8/16/2014, 10/17/2014
Claimant’s Counsel: Jonathan Israel
Employer/Carrier’s Counsel: Monett Brewer
Briefly: MISREPRESENTATION DEFENSE – JCC Humphries granted a misrepresentation defense with regard to the one of the pending workers’ compensation cases, but denied the misrepresentation defense asserted against another case.
Summary: The JCC found the claimant made knowingly false, fraudulent, or misleading written statements or submissions seeking reimbursement of medical mileage. The JCC found the claimant fraudulently sought reimbursement for 35 miles round-trip on five occasions from her home to a Publix pharmacy and noted that the Carrier’s prescription record did not show the claimant filled any prescriptions at this Publix. The JCC also found that the claimant initially claimed 5 miles round trip to obtain prescriptions from CVS, but later modified her submissions to 35 miles. Based on the evidence, the JCC found that the pharmacy is located 1.6 miles from the claimant’s residence. The JCC rejected the testimony of the claimant on these issues as not logical and not worthy of belief.
However, with regard to another case number, the Employer/Carrier failed to establish any false, fraudulent or misleading statements with regard to the mileage claim.
Mona Evetta St. Brice v. School Board of Broward County
JCC Lewis; Ft. Lauderdale District; Order Date: December 17, 2015
OJCC Case: 12-028780DAL; D/A: 9/28/2012
Claimant’s Counsel: D. Robert Wells
Employer/Carrier’s Counsel: Diane Hernandez
Briefly: MISREPRESENTATION DEFENSE – JCC Lewis denied the claim for compensability and determined the claimant knowingly or intentionally made false, fraudulent, incomplete or misleading statements for the purpose of obtaining benefits and found the claimant made statements to her orthopedic surgeon where the claimant failed to report that she was previously evaluated for prior fractures in the same foot and ankle.
Summary: The JCC found that the claimant’s treating physician reviewed the various diagnostic studies and specifically asked the claimant if she had ever had any previous trauma to her left foot or ankle, and the claimant said no. As the MRI and CT scans contradicted the claimant’s statement, the physician researched the computer records of his own medical group and discovered the claimant had been treated by his orthopedic group for prior fractures that had gone on to develop post-traumatic arthritis. The JCC found the doctor clearly testified the claimant provided false information to him and lied about her prior injuries.
The JCC found the claimant to be lacking in credibility and rejected her testimony that she thought her physician remembered her prior history because he had previously evaluated her years prior. The JCC found this does not excuse or explain her failure to inform her doctor of her prior injuries.
James M. Sergent v. Autonation, Inc./Gallagher Bassett Services, Inc.
JCC Rosen; St. Petersburg District; Order Date: December 17, 2015
OJCC Case: 15-000267SLR; D/A: 12/13/2014
Claimant’s Counsel: Joey D. Oquist
Employer/Carrier’s Counsel: Tiffany S. Hawks
Briefly: EMERGENCY TREATMENT – JCC Rosen denied the claims for payment of emergency medical treatment and found the claimant made no attempt to contact the Employer/Carrier for authorization of what the claimant termed as “emergency treatment” and that the claimant had multiple authorized medical providers available on the dates he visited the emergency room.
Summary: The JCC also noted that the claimant’s authorized treating pain management physician could not identify any condition as a result of the industrial accident that would have required the claimant to seek emergency room treatment at any time in the course of his treatment. The JCC found that the records of the emergency room do not in any way reflect an emergency situation. Each report indicated the claimant was seeking medications for pain.
The JCC concluded there is no evidence to show the claimant needed emergency care on the dates he presented to the emergency room and there was no medical evidence of objective findings to support the claimant’s complaints of pain which would have necessitated emergency medical care as a result of the industrial accident. The claimant offered no explanation as to why he did not contact the Employer/Carrier before appearing at the emergency room on three occasions.