Greetings, we often use the terms “accident” and “injury” interchangeably.  In the Florida WC statute, these are treated very differently, and the burdens of proof are vastly different.  Thinking about them as separate things will help you determine whether it is a compensable claim.

Think about it this way, the accident is the event, the injury is the result.   The fall is the accident, the injury is the boo-boo (medical term).

Accident is defined in 440.02(1) as:

440.02(1) “Accident” means only an unexpected or unusual event or result that happens suddenly.

That’s it.   Not much meat on those bones.   (Repetitive trauma is compensable as a series of small accidents in Florida).  To have a compensable accident, the claimant simply has to report to the Employer within 30 days that an accident happened in the course and scope of employment.

Some examples of defenses to the event/accident being compensable would be not in the course and scope of employment, deviation, horseplay, intoxication, aggressor doctrine and idiopathic/does not arise out of employment.  Clumsiness and stupidity are compensable.

The result of the accident, the “Injury” actually has much more of a burden of proof on the claimant.

440.09(1) The injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause of any resulting injuries. For purposes of this section, “major contributing cause” means the cause which is more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought. In cases involving occupational disease or repetitive exposure, both causation and sufficient exposure to support causation must be proven by clear and convincing evidence. Pain or other subjective complaints alone, in the absence of objective relevant medical findings, are not compensable. For purposes of this section, “objective relevant medical findings” are those objective findings that correlate to the subjective complaints of the injured employee and are confirmed by physical examination findings or diagnostic testing. Establishment of the causal relationship between a compensable accident and injuries for conditions that are not readily observable must be by medical evidence only, as demonstrated by physical examination findings or diagnostic testing. Major contributing cause must be demonstrated by medical evidence only.

Proving an Accident didn’t happen may be difficult, but you can fight the injury as it does require medical evidence of major contributing cause through objective findings, etc… And that is not even going in to the preexisting sections of the statute.

Thinking about accident and injury separately will help you think through compensability decisions.  Can you say the claimant did NOT fall?   Or can we just say there is no compensable injury as a result of the fall?

Our firm is always available for compensability opinions at no charge to help you wade through the decision.

Sincerely,

Morgan Indek | Managing Partner