FL Case Law Summaries – 3/17/16
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JCC ORDERS
Thomas Blalock v. Southeast Personnel Leasing/Packard Claims Administration
JCC Hill; Gainesville District; Order Date: March 15, 2016
OJCC Case: 13-015363MRH; D/A: 6/29/2011
Claimant’s Counsel: Bradley Smith
Employer/Carrier’s Counsel: Robert Bennett
Briefly: PETITION FOR MODIFICATION – JCC Hill entered a prior order finding the claimant intentionally misrepresented his medical history to obtain workers’ compensation benefits. Here, the JCC denied claimant’s Petition for Modification of the prior order and rejected claimant’s argument that he had a newly discovered psychological condition that prevented him from recalling prior medical treatment and conditions associated with the work accident.
Summary: In May 2014, the JCC entered the final order finding the claimant intentionally misrepresented his medical history to obtain workers’ compensation benefits and the order was not appealed. On March 6, 2016, claimant filed a Petition for Modification and asserted new medical evidence had been discovered in the form of psychiatric testimony establishing that, after the work incident where a metal rod went through his hand, he developed a severe somatic symptom disorder which resulted in his not associating anything in his past with his current condition.
The claimant presented testimony from psychiatrist Dr. Cassidy in support of the Petition for Modification. In response, the Employer/Carrier presented the psychiatric testimony of Dr. Rao who opined that claimant did not have a psychiatric condition that prevented him from telling the truth. Based upon the conflict in medical opinions, the JCC appointed an Expert Medical Advisor, Dr. Pandya.
The JCC accepted Dr. Pandya’s opinion as the EMA that the claimant does not have a psychiatric condition or some type of amnesia that prevents him from recalling prior medical treatment and denied the Petition for Modification.
Morris Harvey v. Burris Logistics/Travelers Insurance
JCC Sculco; Orlando District; Order Date: March 15, 2016
OJCC Case: 15-016857TWS; D/A: 3/30/2015
Claimant’s Counsel: Sean P. McCormack
Employer/Carrier’s Counsel: Justin R. Crum
Briefly: TPD; MISCONDUCT– JCC Sculco denied the claims for temporary partial disability benefits and rejected the claimant’s explanations for his unexcused absences from work as lacking credibility. The JCC found the claimant was terminated from post-injury employment based upon his misconduct and, as such, is not eligible for temporary partial disability.
Summary: The JCC found the claimant’s absenteeism from work was a conscious and willful decision that lacked a compelling justification. The JCC found that when the claimant called the Employer to say he would not be coming to work, he never mentioned pain in his foot or problems walking as a reason.
The JCC distinguished the facts of this case from the case of Tallahassee Primary Care Associates v. Florida Unemployment Appeals Commission, 930 So. 2d 824 (Fla. 1st DCA 2006), which held that “absences that are properly reported to the Employer and are for compelling reasons, such as illness, do not constitute misconduct connected with work”.
Jessica Mendenhall v. Palm Beach County Sheriff’s Office/USIS
JCC D’Ambrosio; West Palm Beach District; Order Date: March 15, 2016
OJCC Case: 15-019811MAD; D/A: 6/24/2015
Claimant’s Counsel: Jeffrey Friedman
Employer/Carrier’s Counsel: Christine Tomasello
Briefly: MOTION TO STRIKE AUTHORIZED TREATING PHYSICIAN – JCC D’Ambrosio granted the claimant’s Motion to Strike Dr. Silversmith as the authorized physician for failure to comply with F.S. §440.13(14)(a) and (b), as the doctor’s fee exceeded the applicable fee schedules adopted under Chapter 440 and the Department Rule.
Summary: The JCC cited F.S. §440.13(14)(b) as allowing deviations from the established fee schedule “…if a physician or healthcare provider specifically agrees in writing to follow identified procedures aimed at providing quality medical care to injured workers at reasonable costs…”.
The JCC found the affidavit of Dr. Silversmith confirmed he had no such written agreement with the carrier. The claimant satisfied his burden of proof that Dr. Silversmith charged and the Employer/Carrier impermissibly pre-paid Dr. Silversmith for his services in excess of the applicable fee schedules.
Consequently, the JCC found the Employer/Carrier failed to provide an evaluation and treatment pursuant to the Petition for Benefits. The JCC granted the claimant’s Motion to Strike Dr. Silversmith as the authorized treating physician and to strike his report and/or testimony from evidence.
Monica Aquino v. PHR Services, Inc. d/b/a PHR Staffing Solutions/Packard Claims Administration
JCC Sojourner; Lakeland District; Order Date: March 15, 2016
OJCC Case: 15-019977MES; D/A: 6/22/2015
Claimant’s Counsel: Nora Leto
Employer/Carrier’s Counsel: Robert Bennett
Briefly: MISREPRESENTATION DEFENSE – JCC Sojourner denied the misrepresentation defense and awarded temporary partial disability benefits and found the Employer/Carrier was provided with the necessary information required to get medical information regarding the claimant’s condition.
Summary: The JCC found the claimant did not make a material misrepresentation for the purposes of obtaining workers’ compensation benefits. Although the claimant did deny a prior back condition in deposition, she explained the condition was due to her “female” problems, and not due to her back. She acknowledged prior upper back pain and provided the Employer/Carrier with the name of the clinic where she treated. The JCC found no material misrepresentations were made.