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Morgan’s Tip of the Week: 104 Cap on Temporary Benefits

Morgan Indek's majestic headstand on a surf board

Before the holiday, the 1st DCA addressed the status of the 104 week cap on temporary benefits in Gomez-Lujano v. Palm Beach Grill, 1D15-670.

The issue is still pending before the Florida Supreme Court in the Westphal case.   In the first 1st DCA Westphal decision, the court found the 104 week cap to be unconstitutional, and reverted back to a 260 week cap.  However, when the 1st DCA reheard the case en banc, the decision was much more narrow.  The decision that was appealed to the Fla Sct was that if a claimant remained TTD after week 104, their claim for PTD was ripe to be filed even if they were not at MMI.

In the Gomez-Lujano case, the claimant was paid 104 weeks of temporary benefits.  He returned to work for over 2 years, and then required another shoulder surgery.  He was on a no-work status then for around 6 weeks, followed by around 13 weeks of light duty.  The claimant filed a PFB for the additional TTD and TPD beyond the 104.  The JCC agreed with the denied temporary benefits.

The 1st DCA upheld the JCC decision, stating that that is the correct interpretation of their en banc decision in Westphal regarding no temporary benefits beyond the 104 week cap.  As for PTD, the claimant was eligible to assert a claim for PTD, but it did not automatically entitle him to those benefits.  The claimant would still need to prove the other elements of PTD, which in this case he did not.

So, for now, pending the Fla Sct decision, that is the law.  No TTD/TPD beyond 104.  The claimant can file for PTD even if not at MMI after 104, but has the burden to prove all the elements.