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Fla. L. Weekly D205bTop of Form
Fla. L. Weekly D205bTop of Form
Workers’
compensation — Forfeiture of benefits — False, fraudulent, or misleading
statement for purpose of securing workers’ compensation benefits — Judge of
compensation claims erred in rejecting employer/carrier’s affirmative defense
of misrepresentation based on application of civil case law on fraud — Proper
two-part analysis requires JCC to determine whether claimant made false,
fraudulent, or misleading statement and, if so, whether at time statement was
made, it was made with intent to obtain benefits — Remand with instructions to
revisit evidence and make findings under proper standard
compensation — Forfeiture of benefits — False, fraudulent, or misleading
statement for purpose of securing workers’ compensation benefits — Judge of
compensation claims erred in rejecting employer/carrier’s affirmative defense
of misrepresentation based on application of civil case law on fraud — Proper
two-part analysis requires JCC to determine whether claimant made false,
fraudulent, or misleading statement and, if so, whether at time statement was
made, it was made with intent to obtain benefits — Remand with instructions to
revisit evidence and make findings under proper standard
CITY
OF HIALEAH/SEDGWICK CMS, Appellants, v. TONY BONO, Appellee. 1st District. Case
No. 1D16-957. Opinion filed January 19, 2017. An appeal from an order of the
Judge of Compensation Claims. Gerardo Castiello, Judge. Date of Accident:
December 2, 2013. Counsel: David Goehl of Martinez Roman Goehl, P.A., Miami
Lakes, for Appellants. Kimberly A. Hill of Kimberly A. Hill, P.L., Fort
Lauderdale, for Appellee.
OF HIALEAH/SEDGWICK CMS, Appellants, v. TONY BONO, Appellee. 1st District. Case
No. 1D16-957. Opinion filed January 19, 2017. An appeal from an order of the
Judge of Compensation Claims. Gerardo Castiello, Judge. Date of Accident:
December 2, 2013. Counsel: David Goehl of Martinez Roman Goehl, P.A., Miami
Lakes, for Appellants. Kimberly A. Hill of Kimberly A. Hill, P.L., Fort
Lauderdale, for Appellee.
(PER
CURIAM.) In this workers’ compensation case, the Employer/Carrier (E/C) appeal
an order of the Judge of Compensation Claims (JCC) rejecting their affirmative
defense of misrepresentation under sections 440.09(4) and 440.105(4), Florida
Statutes, and awarding benefits to Claimant. Because the JCC applied the wrong
legal analysis, we reverse the order, and remand for findings under the proper
standard.
CURIAM.) In this workers’ compensation case, the Employer/Carrier (E/C) appeal
an order of the Judge of Compensation Claims (JCC) rejecting their affirmative
defense of misrepresentation under sections 440.09(4) and 440.105(4), Florida
Statutes, and awarding benefits to Claimant. Because the JCC applied the wrong
legal analysis, we reverse the order, and remand for findings under the proper
standard.
It
is illegal for any person to “knowingly make, or cause to be made, any false,
fraudulent, or misleading oral or written statement for the purpose of
obtaining or denying any benefit or payment” under the Workers’ Compensation
Law. § 440.105(4)(b)1., Fla. Stat. (2013). And workers’ compensation benefits
are barred for an employee found to have “knowingly or intentionally engaged
in” such acts “for the purpose of securing workers’ compensation benefits.” §
440.09(4), Fla. Stat. (2013). Determining that there has been a violation of
section 440.105(4) requires a two-part inquiry, encompassing first a finding as
to whether a false (or fraudulent or misleading) statement was made by the
claimant, and second a finding as to whether, at the time the statement was
made, it was made with the intent to obtain benefits. See Arreola v.
Admin. Concepts, 17 So. 3d 792, 794 (Fla. 1st DCA 2009) (“In deciding this
issue, the JCC had to answer two questions. The first is whether Claimant made
or caused to be made false, fraudulent or misleading statements. The second is
whether the statement was intended by Claimant to be for the purpose of
obtaining benefits.”); see also Village Apartments v. Hernandez,
856 So. 2d 1140, 1142 (Fla. 1st DCA 2003) (“Regardless of whether the claimant
was under oath, if, at the time he made any of these statements, he knew they
were false . . . then the statements fall within the scope of section
440.105(4)(b)2.”).
is illegal for any person to “knowingly make, or cause to be made, any false,
fraudulent, or misleading oral or written statement for the purpose of
obtaining or denying any benefit or payment” under the Workers’ Compensation
Law. § 440.105(4)(b)1., Fla. Stat. (2013). And workers’ compensation benefits
are barred for an employee found to have “knowingly or intentionally engaged
in” such acts “for the purpose of securing workers’ compensation benefits.” §
440.09(4), Fla. Stat. (2013). Determining that there has been a violation of
section 440.105(4) requires a two-part inquiry, encompassing first a finding as
to whether a false (or fraudulent or misleading) statement was made by the
claimant, and second a finding as to whether, at the time the statement was
made, it was made with the intent to obtain benefits. See Arreola v.
Admin. Concepts, 17 So. 3d 792, 794 (Fla. 1st DCA 2009) (“In deciding this
issue, the JCC had to answer two questions. The first is whether Claimant made
or caused to be made false, fraudulent or misleading statements. The second is
whether the statement was intended by Claimant to be for the purpose of
obtaining benefits.”); see also Village Apartments v. Hernandez,
856 So. 2d 1140, 1142 (Fla. 1st DCA 2003) (“Regardless of whether the claimant
was under oath, if, at the time he made any of these statements, he knew they
were false . . . then the statements fall within the scope of section
440.105(4)(b)2.”).
Instead
of engaging in this two-part analysis, the JCC applied civil case law on fraud,
and the JCC made no mention of whether Claimant actually made specific false or
misleading statements, instead characterizing the “inconsistencies” in
Claimant’s testimony as “impeachment.” Thus, remand is needed for the JCC to
apply the proper standard of law. On remand, the JCC is charged to revisit the
evidence and make findings under the proper standard.
of engaging in this two-part analysis, the JCC applied civil case law on fraud,
and the JCC made no mention of whether Claimant actually made specific false or
misleading statements, instead characterizing the “inconsistencies” in
Claimant’s testimony as “impeachment.” Thus, remand is needed for the JCC to
apply the proper standard of law. On remand, the JCC is charged to revisit the
evidence and make findings under the proper standard.
REVERSED
and REMANDED for further proceedings in accordance with this opinion. (ROBERTS,
C.J., ROWE, and WINOKUR, JJ., CONCUR.)
and REMANDED for further proceedings in accordance with this opinion. (ROBERTS,
C.J., ROWE, and WINOKUR, JJ., CONCUR.)
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