In our December Case Law Update, we review the following:
City of Ft. Pierce v. Donald Spence
Case No. 1D14-937 (12/30/2014)
In this case the E/C appeals and the Claimant cross-appeals the award of facet injections and denying authorization of an orthopedic surgeon and a cervical discectomy and fusion at C5/6.
The Claimant had a compensable accident on 10/21/2012. The authorized pain management doctor recommended bilateral cervical facet medial branch blocks and attributed 70% of the need for the injections to a non-work related spine condition which had been found by the Claimant’s family doctor.
The JCC accepted the pain management doctor’s percentages but discounted them based upon his reasoning that the degenerative condition was normal aging. The JCC relied on Bysczynski v. United Parcel Services, Inc., 53 So.3d 328 (Fla. 1st DCA 2010).
City of Miami Beach v. Anthony Marten
Case No. 1D14-3109 (12/30/2014)
The Employer/Servicing Agent challenged the late payment of income impairment benefits. IIBs are paid based on the assigned PIR for the work accident. The JCC determined that the IIBs were paid late because they were paid more than 20 days after the date of MMI. The authorized doctors had indicated that the Claimant had no permanent impairment rating as a result of the work accident. It was undisputed that the E/SA paid within 20 days of first having knowledge that the Claimant’s IME had assigned a PIR.
Deborah O’Connor v. North Okaloosa Medical Center
Case No. 1D14-0623 (12/12/2014)
The Claimant challenged the denial of TTD for a finite period based upon res judicata. The Claimant had reflex sympathetic dystrophy of the right hand and wrist as a result of a compensable work accident. Authorized treatment was provided for over six years. After six years of treatment the authorized anesthesiologist placed the Claimant at MMI on 1/14/2011 and opined the Claimant was unable to work.
Based on the MMI the E/C suspended all temporary benefits. The Claimant had not exhausted her entitlement to 104 weeks of temporary benefits when the suspension occurred. By 9/2011, all other authorized doctors had placed the Claimant at MMI. Claimant filed a PFB for PTD based on the 1/14/2011 date of MMI. The parties had stipulated to an MMI date of 1/14/2011.
In this case the JCC had entered a prior Order on 3/1/2012 denying the claim for PTD from 1/14/11 as not ripe for adjudication and was denied without prejudice. This ruling was based on the Claimant not being at MMI. In the prior Order the JCC found the Claimant to be totally disabled from 1/14/2011.
Following the denial of the PTD claim, the Claimant filed a PFB seeking TTD from 1/14/2011 and continuing. The E/C defended on res judicata as to TTD benefits from 1/14/2011 through 2/14/2012 the date of the prior Order.
The JCC agreed with the res judicata defense and reasoned that the Claimant could have pled for TTD as an alternative to PTD. The JCC however awarded TTD from 2/15//12 (the day after the prior Order) to 9/19/2012 when MMI was reached.
John A. Elliott v. Securitas Security Services USA, Inc
OJCC # 11-0038855SLR Judge Rosen Decision date 12/29/2014
This is an evidentiary Order on the Claimant’s objection to the medical composite to be submitted to an expert medical advisor. An EMA was appointed as a result of a conflict in the opinions of two healthcare providers. The issue was MCC of the Claimant’s left knee and right hip. The E/C had accepted the left knee as compensable but denied any causal relationship between the work accident and the right hip.
The Order appointing the EMA directed the parties to compile the medical composite to go to the EMA. The parties could not agree on certain records. The Claimant argued that records from unauthorized physicians that are not IMEs should not be included because the opinions would be inadmissible. The Claimant also objected to records from the first responders on the same basis. The Claimant also took the position that the EMA should not give opinions which usurp the JCC’s authority to resolve factual issues regarding medical claims and defenses.