28 Sep Florida Employer/Carriers Should Specifically Identify Each Body Part and the Type of Injury Accepted as Compensable
Written by: Rayford H. Taylor, Esq.
The First District Court of Appeal (1st DCA) issued an opinion in the case of Julio Sanchez v. Yellow Transportation/Gallagher Bassett, which held the Claimant did not have to establish the workplace accident was the major contributing cause (MCC) for requested treatment. The Judge of Compensation Claims (JCC) denied the Claimant’s request for medical care for his lumbar spine because he failed to prove the treatment was work related.
The Claimant was a truck driver who, over the years, sustained several workplace injuries involving various body parts. Those body parts included the shoulders, neck, and low back. The Employer and its insurance carrier accepted compensability of the Claimant’s injuries and initially agreed the Claimant’s cervical injury remained the MCC of the need for treatment for the 2004 accident. The parties also stipulated that the E/C would continue to authorize physicians to treat the left shoulder, right shoulder, cervical spine, and lumbar spine.
In 2018, the Claimant filed a Petition for Benefits requesting authorization of low back pain management previously recommended by his authorized treating physician (ATP). The Claimant subsequently filed a second Petition seeking authorization of an ESI which was also recommended by the authorized physician. In the Pretrial Stipulation, the E/C conceded Claimant sustained a compensable accident, but asserted that the resulting injury was initially a lumbar strain that was no longer accepted.
At the Final Hearing, the Claimant relied on medical records from the ATP to support his claim. There was no expert medical opinion testimony submitted by either party. The JCC rejected the Claimant’s argument that he did not have to establish MCC because the E/C accepted compensability of the lumbar spine injury and had not provided evidence of any intervening or competing cause. The JCC found that the treating physician’s medical records were “unreliable” evidence of MCC, and therefore the Claimant failed to satisfy the burden of proving entitlement to the requested medical benefits.
On appeal, the First DCA found the E/C agreed in the Joint Stipulation to continue medical care for the Claimant’s lumbar spine. If, as the E/C contended, the accepted injury was merely just a strain, the Court noted it was unclear why they did not expressly limit the stipulated treatment to a lumbar strain or why such a minor injury still required authorized medical care almost twelve (12) years later. Since the E/C presented no evidence of the acceptance of a specific diagnosis for the compensable injury, and given the broad stipulation, the Claimant was not required to prove MCC. Instead, the E/C had the burden of proving a break in the causal chain.
In reaching its conclusion, the First DCA cited several prior cases in which broad stipulations regarding a compensable injury was sufficient to establish MCC. The First DCA held that the JCC had committed reversible error when he ruled the Claimant had the burden of proving MCC.
While this specific case involved some unique facts, the moral of the story is that acceptance of stipulated or compensable conditions should be specific and designed to address the particular body part being accepted. Broad general acceptances like the “back”, the “lumbar spine”, and the “shoulder” may shift the burden for proof from the Claimant to the E/C as related to MCC. The second moral of the story is that employer/carriers should insist whenever possible that an authorized treating physician identify the specific body part and injury related to the workplace injury.
For more information on this or other Florida appellate case law, please contact Rayford H. Taylor, Esq., at firstname.lastname@example.org.