By: Michael Arington, Associate, Jacksonville

The First DCA recently made it harder to rebut the statutory presumption of compensability for heart conditions involving congenital conditions. In two cases where the heart disease was congenital, the judges said an employer must also prove that non-work causes triggered the condition resulting in disability. What was formerly a one-step process burden of proof under F.S. 112.18(1) is now a two-step burden of proof.

The two First DCA cases were Thomasena Mitchell v. Miami Dade Public Schools and Gallagher Bassett Services, Case No. 1D15-2153, decided February 23, 2016, and Brian Gonzalez v. St. Lucie County Fire District and Florida Municipal Insurance, Case No. 1D15-3185, decided March 8, 2016. Both cases were remanded to the JCCs to determine what triggered the congenital defect to become a rapid heart rate.

In Mitchell, the claimant suffered a congenital heart defect that on the accident date was triggered into a rapid heart rate. The doctors did not know what condition triggered the defect into a rapid heart rate. The evidence showed possible causes like caffeine, stress, low potassium, and blockage of the heart. The JCC concluded that because the rapid heart rate would not have occurred but for the existence of the congenital defect, the rapid heart rate was also a product of the congenital defect, and found the claim was not compensable. The 1^st DCA disagreed. The Court said it was not enough to say the congenital defect also caused the rapid heart rate – the JCC also had to identify the non-work cause that triggered the congenital defect into a rapid heart rate.

Gonzalez was a similar case involving a congenital defect that was triggered into a rapid heart beat. The JCC said the employer rebutted the presumption by showing a congenital defect. The 1^st DCA disagreed, based on the rule from Mitchell. The covered condition was the rapid heart beat triggered by some cause, not the underlying congenital defect.

These cases mean there are additional steps when considering a defense to heart cases:

• Know the burden of proof has gotten more complicated. Carriers must know that even when there are records supporting a congenital defect, the presumption may still apply if there are no records showing a non-work condition triggered the congenital defect into a disabling condition.
• Know there will be an increase in the scope of discovery. Costs will increase because more medical records may be required.
• Make sure IME examinations and reports address the primary condition and the condition on the date of accident, especially noting what triggered the episode.
• Find out more about the claimant’s medical history and identify the claimant’s health care providers to get as many of the records as possible. This does not eliminate the defense’s ability to defeat the presumption. It just adds one more step in the process. As always, please contact us with any questions about this issue.