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Fla. L. Weekly D1643bTop of Form
Fla. L. Weekly D1643bTop of Form
Workers’
compensation — Forfeiture of benefits — Misrepresentation — Judge of
compensation claims erred in rejecting employer/carrier’s misrepresentation
defense — Because of his multiple false and misleading statements made for
purpose of obtaining workers’ compensation benefits, claimant is not entitled
to benefits
compensation — Forfeiture of benefits — Misrepresentation — Judge of
compensation claims erred in rejecting employer/carrier’s misrepresentation
defense — Because of his multiple false and misleading statements made for
purpose of obtaining workers’ compensation benefits, claimant is not entitled
to benefits
CAL-MAINE FOODS/BROADSPIRE,
Appellant, v. ROBERT HOWARD, Appellee. 1st District. Case No. 1D16-1789.
Opinion filed July 26, 2017. An appeal from an order of the Judge of
Compensation Claims. Marjorie Renee Hill, Judge. Date of Accident: November 2,
2014. Counsel: Christopher A. Thorne and Jennifer P. Killen of Thorne &
Associates, P.A., Orlando, for Appellant. Nicolette E. Tsambis of Smith,
Feddeler, Smith, P.A., for Appellee.
Appellant, v. ROBERT HOWARD, Appellee. 1st District. Case No. 1D16-1789.
Opinion filed July 26, 2017. An appeal from an order of the Judge of
Compensation Claims. Marjorie Renee Hill, Judge. Date of Accident: November 2,
2014. Counsel: Christopher A. Thorne and Jennifer P. Killen of Thorne &
Associates, P.A., Orlando, for Appellant. Nicolette E. Tsambis of Smith,
Feddeler, Smith, P.A., for Appellee.
(M.K. THOMAS, J.) In this workers’
compensation case, the Employer/Carrier (E/C) appeals an order of the Judge of
Compensation Claims (JCC) rejecting multiple defenses to compensability of a
work accident and related benefits. As to the E/C’s argument that the JCC erred
in rejecting misrepresentation defenses, we agree and reverse. Accordingly, it
is unnecessary to address the remaining issues on appeal.
compensation case, the Employer/Carrier (E/C) appeals an order of the Judge of
Compensation Claims (JCC) rejecting multiple defenses to compensability of a
work accident and related benefits. As to the E/C’s argument that the JCC erred
in rejecting misrepresentation defenses, we agree and reverse. Accordingly, it
is unnecessary to address the remaining issues on appeal.
I.
Facts
Facts
On or about November 2, 2014, the
Claimant was operating a front-end loader for the Employer. At a curve in the
road, the brakes failed, and the Claimant jumped from the machine. Conflicting
testimony exists as to whether the Claimant reported any injuries to the
Employer. In August 2015, following termination by the Employer for reasons
unrelated to the accident, the Claimant filed a Petition for Benefits (PFB)
seeking payment of temporary total disability (TTD) or temporary partial
disability (TPD) benefits, and authorization of a neurological/orthopedic
physician to evaluate and treat his lower back symptoms.1 He listed the November 2, 2014, work
accident as the basis for the injuries. In October 2015, the Claimant filed an
Amended PFB requesting determination of compensability of the November 2, 2014,
accident. The PFBs, both signed and attested by the Claimant as to accuracy,
described the accident as follows:
Claimant was operating a front-end loader for the Employer. At a curve in the
road, the brakes failed, and the Claimant jumped from the machine. Conflicting
testimony exists as to whether the Claimant reported any injuries to the
Employer. In August 2015, following termination by the Employer for reasons
unrelated to the accident, the Claimant filed a Petition for Benefits (PFB)
seeking payment of temporary total disability (TTD) or temporary partial
disability (TPD) benefits, and authorization of a neurological/orthopedic
physician to evaluate and treat his lower back symptoms.1 He listed the November 2, 2014, work
accident as the basis for the injuries. In October 2015, the Claimant filed an
Amended PFB requesting determination of compensability of the November 2, 2014,
accident. The PFBs, both signed and attested by the Claimant as to accuracy,
described the accident as follows:
CL WAS
DRIVING A FRONT END LOADER THAT WAS HAVING MECHANICAL ISSUES. AS HE APPROACHED
A BEND IN THE ROAD GOING TO A BRIDGE, HE LET OFF THE ACCELERATOR AND THE
MACHINE STALLED. HIS STEERING AND BRAKES WENT OUT. BEFORE THE MACHINE WENT OVER
THE SIDE OF THE ROAD, HE JUMPED. HE HIT THE TIRE, WHICH PUSHED HIS FACE INTO
THE PAVEMENT AND THEN THE REAR TIRE HIT HIM IN THE HEAD.
DRIVING A FRONT END LOADER THAT WAS HAVING MECHANICAL ISSUES. AS HE APPROACHED
A BEND IN THE ROAD GOING TO A BRIDGE, HE LET OFF THE ACCELERATOR AND THE
MACHINE STALLED. HIS STEERING AND BRAKES WENT OUT. BEFORE THE MACHINE WENT OVER
THE SIDE OF THE ROAD, HE JUMPED. HE HIT THE TIRE, WHICH PUSHED HIS FACE INTO
THE PAVEMENT AND THEN THE REAR TIRE HIT HIM IN THE HEAD.
During his first deposition in May
2015, the Claimant testified the injuries resulting from the work accident
included a broken nose, orbital fractures, concussion with brain injury, and
herniated discs of the neck and lower back. He requested surgery for facial
fractures and treatment for his neck and back. The Claimant described that when
he jumped from the machine, he hit his left shoulder on the rear left tire,
which spun him around causing him to strike his face on asphalt. He described
injuries specifically to the right eye and socket, as well as bleeding scrapes
over his left eye. Seven months later, in his second deposition, the Claimant
gave sworn testimony that his injuries from the accident included the eye
socket, nose, neck, middle and lower back. However, he advised that as of the
second deposition, his nose and eye injuries had resolved. He complained of
constant neck pain.
2015, the Claimant testified the injuries resulting from the work accident
included a broken nose, orbital fractures, concussion with brain injury, and
herniated discs of the neck and lower back. He requested surgery for facial
fractures and treatment for his neck and back. The Claimant described that when
he jumped from the machine, he hit his left shoulder on the rear left tire,
which spun him around causing him to strike his face on asphalt. He described
injuries specifically to the right eye and socket, as well as bleeding scrapes
over his left eye. Seven months later, in his second deposition, the Claimant
gave sworn testimony that his injuries from the accident included the eye
socket, nose, neck, middle and lower back. However, he advised that as of the
second deposition, his nose and eye injuries had resolved. He complained of
constant neck pain.
The Claimant did not seek immediate
medical treatment, but rather waited one month after his termination (and two
months after the November 2014 work accident) to see a doctor. Initial medical
treatment was received on January 22, 2015, at Shands Hospital. The Claimant
reported a head injury/pain with frustrated memory and headaches due to being
hit in the head with a baseball bat “eight days prior.” At his initial
deposition, when confronted with the Shands records, the Claimant testified his
description of the baseball bat incident was false and contrived. He asserted
he later “corrected” this false account and told Shands’ staff the injuries
actually occurred from an accident at work. He allegedly made the
misrepresentation due to his belief he would not receive medical treatment if
he reported a work-related accident. No “correction” was documented in the
medical records.
medical treatment, but rather waited one month after his termination (and two
months after the November 2014 work accident) to see a doctor. Initial medical
treatment was received on January 22, 2015, at Shands Hospital. The Claimant
reported a head injury/pain with frustrated memory and headaches due to being
hit in the head with a baseball bat “eight days prior.” At his initial
deposition, when confronted with the Shands records, the Claimant testified his
description of the baseball bat incident was false and contrived. He asserted
he later “corrected” this false account and told Shands’ staff the injuries
actually occurred from an accident at work. He allegedly made the
misrepresentation due to his belief he would not receive medical treatment if
he reported a work-related accident. No “correction” was documented in the
medical records.
On February 4, 2015, Claimant proceeded
to the Wesley Chapel Hospital Emergency Room, where he was seen for left-sided
facial pain, advising he received a facial fracture “one month earlier.” He
requested pain medications and denied back pain or headaches. He did not report
a work accident.
to the Wesley Chapel Hospital Emergency Room, where he was seen for left-sided
facial pain, advising he received a facial fracture “one month earlier.” He
requested pain medications and denied back pain or headaches. He did not report
a work accident.
After the Claimant’s filing of a PFB
in August 2015, the E/C scheduled an IME with Dr. Thomas Delgado, a
neurosurgeon. The Claimant described to Dr. Delgado that he suffered injuries
to his neck, face, and lower back as a result of the November 2, 2014,
accident. The Claimant also completed patient intake/history forms at Dr.
Delgado’s office. On the forms, the Claimant specifically denied any back pain,
injuries, or sciatica before the work accident. The Claimant did not disclose
to Dr. Delgado that he previously reported a “baseball bat” incident to Shands
as the cause of his head and facial injuries. Dr. Delgado, after reviewing the
Shands medical records (provided to him by the E/C), confronted the Claimant
regarding his report of being struck in the head with a baseball bat. Per Dr.
Delgado, the Claimant responded that he “wasn’t sure because he was kind of
foggy when that happened.” At deposition, Dr. Delgado further testified that,
contrary to the Claimant’s responses on the patient intake and history forms,
medical records documented that the Claimant did, in fact, have a prior history
of chronic back pain with treatment in 2006-2007, and lumbar and neck pain
following an automobile accident in 1997.
in August 2015, the E/C scheduled an IME with Dr. Thomas Delgado, a
neurosurgeon. The Claimant described to Dr. Delgado that he suffered injuries
to his neck, face, and lower back as a result of the November 2, 2014,
accident. The Claimant also completed patient intake/history forms at Dr.
Delgado’s office. On the forms, the Claimant specifically denied any back pain,
injuries, or sciatica before the work accident. The Claimant did not disclose
to Dr. Delgado that he previously reported a “baseball bat” incident to Shands
as the cause of his head and facial injuries. Dr. Delgado, after reviewing the
Shands medical records (provided to him by the E/C), confronted the Claimant
regarding his report of being struck in the head with a baseball bat. Per Dr.
Delgado, the Claimant responded that he “wasn’t sure because he was kind of
foggy when that happened.” At deposition, Dr. Delgado further testified that,
contrary to the Claimant’s responses on the patient intake and history forms,
medical records documented that the Claimant did, in fact, have a prior history
of chronic back pain with treatment in 2006-2007, and lumbar and neck pain
following an automobile accident in 1997.
The Claimant was evaluated by Dr.
Robert Martinez, a neurologist, in March 2015. He complained of neck, middle
and lower back pain, along with confusion as a result of the work accident.
Likewise, the Claimant denied any history of neck or back pain, or similar
injuries before the work accident. He did not disclose the earlier report of
being struck in the head with a baseball bat.
Robert Martinez, a neurologist, in March 2015. He complained of neck, middle
and lower back pain, along with confusion as a result of the work accident.
Likewise, the Claimant denied any history of neck or back pain, or similar
injuries before the work accident. He did not disclose the earlier report of
being struck in the head with a baseball bat.
The Claimant obtained an Independent
Medical Exam from Dr. Jorge Inga, a neurosurgeon, on November 11, 2015. He
complained of pain radiating down his right leg, lower back, cervical spine,
shoulder and right facial pain. The Claimant described the origin of his
symptoms as the November 2, 2014, work accident. He did not address the
baseball bat incident.
Medical Exam from Dr. Jorge Inga, a neurosurgeon, on November 11, 2015. He
complained of pain radiating down his right leg, lower back, cervical spine,
shoulder and right facial pain. The Claimant described the origin of his
symptoms as the November 2, 2014, work accident. He did not address the
baseball bat incident.
In preparation for hearing, the E/C
filed medical records in compliance with section 440.29(4), Florida Statutes.
The admissible medical records documented the Claimant had a history of similar
medical complaints and treatment prior to the work accident. The records
documented: lower back injuries 1997 after an automobile accident; chronic back
pain in 2006-2007; medical care and diagnostic studies in 2012 for constant
neck pain only relieved by pain medications; injuries from a motorcycle
accident, which required ongoing medical treatment for twelve years; and a
previous recommendation for cervical surgery. In the pretrial stipulations, the
Claimant listed the following physical conditions as related to the work
accident: “face injuries, concussion w/ brain injury, back and neck.” However,
at the final hearing, the Claimant announced he was seeking compensability of
the lower back injuries only, thus dropping other claims relating to facial and
neck injuries, and concussion with brain injury.
filed medical records in compliance with section 440.29(4), Florida Statutes.
The admissible medical records documented the Claimant had a history of similar
medical complaints and treatment prior to the work accident. The records
documented: lower back injuries 1997 after an automobile accident; chronic back
pain in 2006-2007; medical care and diagnostic studies in 2012 for constant
neck pain only relieved by pain medications; injuries from a motorcycle
accident, which required ongoing medical treatment for twelve years; and a
previous recommendation for cervical surgery. In the pretrial stipulations, the
Claimant listed the following physical conditions as related to the work
accident: “face injuries, concussion w/ brain injury, back and neck.” However,
at the final hearing, the Claimant announced he was seeking compensability of
the lower back injuries only, thus dropping other claims relating to facial and
neck injuries, and concussion with brain injury.
During cross-examination at the
merits hearing, the Claimant was questioned regarding his prior deposition
testimony in which he described substantial injuries to his face and head
following the November 2, 2014, work accident. The Claimant admitted that his
prior statement at Shands of being struck in the head and face by a baseball
bat was “not true.” Although the JCC determined the Claimant had committed
multiple misrepresentations, she ultimately declined to terminate the
Claimant’s entitlement to workers’ compensation benefits. Specifically, the JCC
held the misrepresentations were moot and not committed for the “purpose of
obtaining workers’ compensation benefits.” We disagree and reverse.
merits hearing, the Claimant was questioned regarding his prior deposition
testimony in which he described substantial injuries to his face and head
following the November 2, 2014, work accident. The Claimant admitted that his
prior statement at Shands of being struck in the head and face by a baseball
bat was “not true.” Although the JCC determined the Claimant had committed
multiple misrepresentations, she ultimately declined to terminate the
Claimant’s entitlement to workers’ compensation benefits. Specifically, the JCC
held the misrepresentations were moot and not committed for the “purpose of
obtaining workers’ compensation benefits.” We disagree and reverse.
II. Analysis
While this Court is deferential to
the broad fact-finding powers of a JCC, such power is not without constraints. Fritz
v. Courtyard Marriott, 592 So. 2d 1167, 1169 (Fla. 1st DCA 1992). A JCC’s
findings must be in accordance with the requirements of chapter 440 and be
supported by competent, substantial evidence (CSE). Quiroz v. Health Cent.
Hosp., 929 So. 2d 563, 565 (Fla. 1st DCA 2006).
the broad fact-finding powers of a JCC, such power is not without constraints. Fritz
v. Courtyard Marriott, 592 So. 2d 1167, 1169 (Fla. 1st DCA 1992). A JCC’s
findings must be in accordance with the requirements of chapter 440 and be
supported by competent, substantial evidence (CSE). Quiroz v. Health Cent.
Hosp., 929 So. 2d 563, 565 (Fla. 1st DCA 2006).
A JCC’s factual findings will be
upheld if any CSE supports the JCC’s decision, regardless of whether “other persuasive
evidence, if accepted by the JCC, might have supported a contrary ruling.” Pinnacle
Benefits, Inc. v. Alby, 913 So. 2d 756, 757 (Fla. 1st DCA 2005) (emphasis
in original). However, to the extent the issues raised on appeal concern
statutory construction, a question of law is presented, and our review is de
novo. Palm Beach Cty. Sch. Dist. v. Ferrer, 990 So. 2d 13, 14 (Fla. 1st
DCA 2008); Matrix Emp. Leasing v. Hernandez, 975 So. 2d 1217, 1218 (Fla.
1st DCA 2008); Mylock v. Champion Int’l, 906 So. 2d 363, 365 (Fla. 1st
DCA 2005).
upheld if any CSE supports the JCC’s decision, regardless of whether “other persuasive
evidence, if accepted by the JCC, might have supported a contrary ruling.” Pinnacle
Benefits, Inc. v. Alby, 913 So. 2d 756, 757 (Fla. 1st DCA 2005) (emphasis
in original). However, to the extent the issues raised on appeal concern
statutory construction, a question of law is presented, and our review is de
novo. Palm Beach Cty. Sch. Dist. v. Ferrer, 990 So. 2d 13, 14 (Fla. 1st
DCA 2008); Matrix Emp. Leasing v. Hernandez, 975 So. 2d 1217, 1218 (Fla.
1st DCA 2008); Mylock v. Champion Int’l, 906 So. 2d 363, 365 (Fla. 1st
DCA 2005).
Sections 440.09(4) and 440.105,
Florida Statutes, are often referred to as the mechanisms that created the
“fraud defense.” This “misnomer appears to have narrowed the application of the
sanction beyond that intended by the legislature.” Village Apartments v.
Hernandez, 856 So. 2d 1140, 1141 (Fla. 1st DCA 2003). Not all prohibited
acts in section 440.105 entail a “fraud” element. See §
440.105(4)(b)2.-3., Fla. Stat. In interpreting a statute, “full effect must be
given to the language selected by the legislature.” Hernandez, 856 So.
2d at 1141. Accordingly, per section 440.09(4), the commission of “any” act of
an employee prohibited by section 440.105 results in forfeiture of benefits,
not just those statutorily designated as “fraudulent.”2 This Court has previously emphasized
that the 2003 Amendments to section 440.09(4)(a), adding the phrase “or any
criminal act,” broadened the subsection to cover not only acts described in
section 440.105, but also other criminal acts, as long as “all of those acts
are done for the purpose of securing workers’ compensation benefits.” Matrix
Emp. Leasing, 975 So. 2d at 1219.
Florida Statutes, are often referred to as the mechanisms that created the
“fraud defense.” This “misnomer appears to have narrowed the application of the
sanction beyond that intended by the legislature.” Village Apartments v.
Hernandez, 856 So. 2d 1140, 1141 (Fla. 1st DCA 2003). Not all prohibited
acts in section 440.105 entail a “fraud” element. See §
440.105(4)(b)2.-3., Fla. Stat. In interpreting a statute, “full effect must be
given to the language selected by the legislature.” Hernandez, 856 So.
2d at 1141. Accordingly, per section 440.09(4), the commission of “any” act of
an employee prohibited by section 440.105 results in forfeiture of benefits,
not just those statutorily designated as “fraudulent.”2 This Court has previously emphasized
that the 2003 Amendments to section 440.09(4)(a), adding the phrase “or any
criminal act,” broadened the subsection to cover not only acts described in
section 440.105, but also other criminal acts, as long as “all of those acts
are done for the purpose of securing workers’ compensation benefits.” Matrix
Emp. Leasing, 975 So. 2d at 1219.
Determining whether there has been a
violation of section 440.105(4)(b) requires a two-part inquiry: 1) a finding as
to whether a false (or fraudulent or misleading) oral or written statement was
made by the person; and 2) a finding as to whether, at the time the statement
was made, it was made with the required intent. Arreola v. Admin. Concepts,
17 So. 3d 792, 794 (Fla. 1st DCA 2009). It is not necessary that the
misrepresentation be material in actuality. “Rather, the relevant inquiry is
whether a claimant’s misrepresentation- a misrepresentation the claimant
thought would have a material impact on his case- was made with the intent to
secure benefits.” Id.; Village of N. Palm Beach v. McKale, 911
So. 2d 1282 (Fla. 1st DCA 2005). Furthermore, the statements are not required
to have been made under oath so long as the Claimant knew at the time that the
statements were false. Hernandez, 856 So. 2d at 1142.
violation of section 440.105(4)(b) requires a two-part inquiry: 1) a finding as
to whether a false (or fraudulent or misleading) oral or written statement was
made by the person; and 2) a finding as to whether, at the time the statement
was made, it was made with the required intent. Arreola v. Admin. Concepts,
17 So. 3d 792, 794 (Fla. 1st DCA 2009). It is not necessary that the
misrepresentation be material in actuality. “Rather, the relevant inquiry is
whether a claimant’s misrepresentation- a misrepresentation the claimant
thought would have a material impact on his case- was made with the intent to
secure benefits.” Id.; Village of N. Palm Beach v. McKale, 911
So. 2d 1282 (Fla. 1st DCA 2005). Furthermore, the statements are not required
to have been made under oath so long as the Claimant knew at the time that the
statements were false. Hernandez, 856 So. 2d at 1142.
As to the first prong, it is
undisputed here that the Claimant provided multiple false and/or misleading
written and oral statements. The JCC acknowledged this. When confronted at
hearing, the Claimant conceded he misrepresented the etiology of his injuries
when seeking initial medical care at Shands. Further misrepresentations were
made by the Claimant at Wesley Chapel Hospital and relating to pre-existing
medical history. The misrepresentations occurred during depositions, IMEs (completing
patient history forms), and medical treatment. Uncontroverted evidence supports
multiple misrepresentations by the Claimant, thus satisfying the first prong.
undisputed here that the Claimant provided multiple false and/or misleading
written and oral statements. The JCC acknowledged this. When confronted at
hearing, the Claimant conceded he misrepresented the etiology of his injuries
when seeking initial medical care at Shands. Further misrepresentations were
made by the Claimant at Wesley Chapel Hospital and relating to pre-existing
medical history. The misrepresentations occurred during depositions, IMEs (completing
patient history forms), and medical treatment. Uncontroverted evidence supports
multiple misrepresentations by the Claimant, thus satisfying the first prong.
As to the second prong, the JCC
determined the E/C failed to prove the Claimant’s misrepresentations were made
for the “purpose of obtaining workers’ compensation benefits.” Regarding the
Claimant’s statements of inaccurate pre-existing medical history, the JCC
ruled,
determined the E/C failed to prove the Claimant’s misrepresentations were made
for the “purpose of obtaining workers’ compensation benefits.” Regarding the
Claimant’s statements of inaccurate pre-existing medical history, the JCC
ruled,
Dr. Inga
was aware that Claimant had a prior lumbar injury from a 1997 motor vehicle
accident, and that Claimant had a history of chronic back pain from 2006-2007.
(Inga depo. pp. 18-20). Accordingly, I find Claimant did not misrepresent
his prior back condition.
was aware that Claimant had a prior lumbar injury from a 1997 motor vehicle
accident, and that Claimant had a history of chronic back pain from 2006-2007.
(Inga depo. pp. 18-20). Accordingly, I find Claimant did not misrepresent
his prior back condition.
(Emphasis added.) Similarly, the JCC
found the following regarding the Claimant’s misrepresentations to Dr. Delgado,
found the following regarding the Claimant’s misrepresentations to Dr. Delgado,
Additionally,
although Dr. Delgado was in possession of Claimant’s medical records indicating
a back injury from the 1998-1999 auto accident, Dr. Delgado did not question
Claimant about a prior back condition or any discrepancy in the intake form
Claimant completed.
although Dr. Delgado was in possession of Claimant’s medical records indicating
a back injury from the 1998-1999 auto accident, Dr. Delgado did not question
Claimant about a prior back condition or any discrepancy in the intake form
Claimant completed.
(Emphasis added.)
It is clear the JCC regarded the
Claimant’s oral and/or written misrepresentation(s) to Drs. Inga and Delgado
regarding prior medical history as excused or “nullified” because the doctors
actually possessed accurate medical information, regardless of the source. The
JCC erred in placing an affirmative duty, not statutorily mandated, on the
evaluating physicians to interrogate the Claimant regarding known
misrepresentations. Furthermore, a plain reading of sections 440.105(4) and
440.09(4) provides no basis for the JCC’s exoneration of the
misrepresentations. It matters not whether the doctors were provided with
accurate information regarding etiology of injuries or pre-existing medical
conditions and treatment by a source other than the Claimant. The purpose of
section 440.105(4) is to sanction “any person” who, with the requisite intent,
commits any of the enumerated, prohibited acts.
Claimant’s oral and/or written misrepresentation(s) to Drs. Inga and Delgado
regarding prior medical history as excused or “nullified” because the doctors
actually possessed accurate medical information, regardless of the source. The
JCC erred in placing an affirmative duty, not statutorily mandated, on the
evaluating physicians to interrogate the Claimant regarding known
misrepresentations. Furthermore, a plain reading of sections 440.105(4) and
440.09(4) provides no basis for the JCC’s exoneration of the
misrepresentations. It matters not whether the doctors were provided with
accurate information regarding etiology of injuries or pre-existing medical
conditions and treatment by a source other than the Claimant. The purpose of
section 440.105(4) is to sanction “any person” who, with the requisite intent,
commits any of the enumerated, prohibited acts.
Regarding the Claimant’s
misrepresentation that he was struck in the head with a baseball bat, the JCC
reasoned that because the Claimant never asked for the medical bills of Shands
to be paid by the E/C or alleged the bat incident occurred at work, the false
statements were not made for the purpose of obtaining workers’ compensation
benefits. In the Final Order, the JCC ruled:
misrepresentation that he was struck in the head with a baseball bat, the JCC
reasoned that because the Claimant never asked for the medical bills of Shands
to be paid by the E/C or alleged the bat incident occurred at work, the false
statements were not made for the purpose of obtaining workers’ compensation
benefits. In the Final Order, the JCC ruled:
Although
Claimant clearly misrepresented the cause of his facial/sinus condition at
Shands, I find he did not do so for the purpose of obtaining workers’
compensation benefits. Specifically, he never claimed he was hit in the face
with a baseball bat at work, nor did he seek to obtain treatment at Shands for
the condition by asserting it was a work-related injury. Accordingly,
Claimant’s misrepresentation to Shands regarding the cause of his sinus
condition was not made for the purpose of the obtaining workers’ compensation
benefits.
Claimant clearly misrepresented the cause of his facial/sinus condition at
Shands, I find he did not do so for the purpose of obtaining workers’
compensation benefits. Specifically, he never claimed he was hit in the face
with a baseball bat at work, nor did he seek to obtain treatment at Shands for
the condition by asserting it was a work-related injury. Accordingly,
Claimant’s misrepresentation to Shands regarding the cause of his sinus
condition was not made for the purpose of the obtaining workers’ compensation
benefits.
This reasoning misconstrues section
440.105(4) and requires an immediate causal nexus not contemplated by the
legislature. Section 440.09(4)(a) mandates forfeiture of benefits if the
misrepresentations were made for “the purpose of securing workers’ compensation
benefits.” Section 440.105(4) details those acts regarded as having been
committed for “the purpose of securing workers’ compensation benefits.” Section
440.105(4)(b) declares that it “shall be unlawful for any person:”
440.105(4) and requires an immediate causal nexus not contemplated by the
legislature. Section 440.09(4)(a) mandates forfeiture of benefits if the
misrepresentations were made for “the purpose of securing workers’ compensation
benefits.” Section 440.105(4) details those acts regarded as having been
committed for “the purpose of securing workers’ compensation benefits.” Section
440.105(4)(b) declares that it “shall be unlawful for any person:”
1. 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 this chapter.
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 this chapter.
2. To present
or cause to be presented any written or oral statement as part of, or in
support of, a claim for payment or other benefit pursuant to any provision of
this chapter, knowing that such statement contains any false, incomplete,
or misleading information concerning any fact or thing material to such
claim.
or cause to be presented any written or oral statement as part of, or in
support of, a claim for payment or other benefit pursuant to any provision of
this chapter, knowing that such statement contains any false, incomplete,
or misleading information concerning any fact or thing material to such
claim.
3. To prepare
or cause to be prepared any written or oral statement that is intended to
be presented to any employer, insurance company, or self-insured program in
connection with, or in support of, any claim for payment or other benefit
pursuant to any provision of this chapter, knowing that such statement
contains any false, incomplete, or misleading information concerning any fact
or thing material to such claim.
or cause to be prepared any written or oral statement that is intended to
be presented to any employer, insurance company, or self-insured program in
connection with, or in support of, any claim for payment or other benefit
pursuant to any provision of this chapter, knowing that such statement
contains any false, incomplete, or misleading information concerning any fact
or thing material to such claim.
(Emphasis added.) Accordingly, the
second prong of the misrepresentation analysis may be satisfied if any one of
three subsections is triggered.
second prong of the misrepresentation analysis may be satisfied if any one of
three subsections is triggered.
The Claimant, just a few days before
the merits hearing, dropped his claims relating to the facial and head injuries
and did not seek payment of the Shands’ medical bill. However, this formal
dismissal of claims does not shield the Claimant from the reach of section
440.09(4). A party may not strategically manipulate pleadings to circumvent its
sanctions. Contrary to the JCC’s reasoning, the ramifications of the Claimant’s
misrepresentations regarding being struck in the head by a baseball bat were
not isolated to liability for a Shands medical bill. The misrepresentations
were material to claim investigation, compensability, and causation.
the merits hearing, dropped his claims relating to the facial and head injuries
and did not seek payment of the Shands’ medical bill. However, this formal
dismissal of claims does not shield the Claimant from the reach of section
440.09(4). A party may not strategically manipulate pleadings to circumvent its
sanctions. Contrary to the JCC’s reasoning, the ramifications of the Claimant’s
misrepresentations regarding being struck in the head by a baseball bat were
not isolated to liability for a Shands medical bill. The misrepresentations
were material to claim investigation, compensability, and causation.
Here, the Claimant maintained for
months that his facial/sinus injuries were a result of the alleged work
accident, and he provided sworn testimony to that effect. It was not until the
filing of pre-trial legal memoranda several days before hearing that the
Claimant advised he was not seeking benefits related to the facial/sinus
injuries. The JCC erroneously required that for benefit denial under section
440.09(4), the E/C had to link the allegedly false or misleading statements
directly to the particular injury for which benefits are sought — to the
Claimant’s lower back in this instance. As this Court has previously explained,
“such a requirement is not found in the law.” THG Rentals & Sales of
Clearwater, Inc. v. Arnold, 196 So. 3d 485, 487 (Fla. 1st DCA 2016).
Furthermore, such an application is contrary to a plain reading of section
440.105(4).
months that his facial/sinus injuries were a result of the alleged work
accident, and he provided sworn testimony to that effect. It was not until the
filing of pre-trial legal memoranda several days before hearing that the
Claimant advised he was not seeking benefits related to the facial/sinus
injuries. The JCC erroneously required that for benefit denial under section
440.09(4), the E/C had to link the allegedly false or misleading statements
directly to the particular injury for which benefits are sought — to the
Claimant’s lower back in this instance. As this Court has previously explained,
“such a requirement is not found in the law.” THG Rentals & Sales of
Clearwater, Inc. v. Arnold, 196 So. 3d 485, 487 (Fla. 1st DCA 2016).
Furthermore, such an application is contrary to a plain reading of section
440.105(4).
“Honesty is not a luxury to be
invoked at the convenience of a litigant.” Baker v. Myers Tractor Servs.,
Inc., 765 So. 2d 149, 150 (Fla. 1st DCA 2000). The workers’ compensation
system is designed to be efficient and self-executing. See § 440.015,
Fla. Stat. It should not be incumbent upon litigants to undertake exhaustive
investigation to flush out the mendacities of an adversary. The parties have a
right to expect that all statements, whether written or oral, are truthful and
adequately responsive.
invoked at the convenience of a litigant.” Baker v. Myers Tractor Servs.,
Inc., 765 So. 2d 149, 150 (Fla. 1st DCA 2000). The workers’ compensation
system is designed to be efficient and self-executing. See § 440.015,
Fla. Stat. It should not be incumbent upon litigants to undertake exhaustive
investigation to flush out the mendacities of an adversary. The parties have a
right to expect that all statements, whether written or oral, are truthful and
adequately responsive.
The Claimant’s argument on appeal
that the E/C waived, expressly or impliedly, the misrepresentation defenses
during the course of the merits hearing is without merit. Pursuant to section
440.09(4)(a), and having violated section 440.105, the Claimant is not entitled
to workers’ compensation benefits.
that the E/C waived, expressly or impliedly, the misrepresentation defenses
during the course of the merits hearing is without merit. Pursuant to section
440.09(4)(a), and having violated section 440.105, the Claimant is not entitled
to workers’ compensation benefits.
REVERSE AND REMAND. (B.L. THOMAS,
C.J., and WETHERELL, J., CONCUR.)
C.J., and WETHERELL, J., CONCUR.)
__________________
1The Claimant was terminated by the
Employer in December 2014, based on a positive drug test for methamphetamine
and amphetamines, after driving a backhoe so far into the water that it had to
be towed out.
Employer in December 2014, based on a positive drug test for methamphetamine
and amphetamines, after driving a backhoe so far into the water that it had to
be towed out.
2Section 440.105, Florida Statutes,
lists prohibited activities of employees, employers, insurance entities,
licensed medical providers, attorneys, and a broad reference to “any person.”
However, section 440.09(4), Florida Statutes, provides the sanction for
employees who violate section 440.105, Florida Statutes.
lists prohibited activities of employees, employers, insurance entities,
licensed medical providers, attorneys, and a broad reference to “any person.”
However, section 440.09(4), Florida Statutes, provides the sanction for
employees who violate section 440.105, Florida Statutes.
* * *