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Fla. L. Weekly D2297aTop of Form
Fla. L. Weekly D2297aTop of Form
Workers’
compensation — Limitation of actions — Estoppel — Judge of compensation
claims erred in finding that employer/carrier was estopped from asserting a
statute of limitations defense against claimant’s request for benefits where
there was no evidence that claimant detrimentally relied on a misrepresentation
or omission made by employer/carrier
compensation — Limitation of actions — Estoppel — Judge of compensation
claims erred in finding that employer/carrier was estopped from asserting a
statute of limitations defense against claimant’s request for benefits where
there was no evidence that claimant detrimentally relied on a misrepresentation
or omission made by employer/carrier
CITY
OF DANIA BEACH and PGCS, Appellants, v. DAVID ZIPOLI, Appellee. 1st District.
Case No. 1D16-0693. Opinion filed October 10, 2016. An appeal from an order of
the Judge of Compensation Claims. Daniel A. Lewis, Judge. Date of Accident:
January 16, 2009. Counsel: George W. Boring, III, Public Entity Legal
Solutions, Lake Mary, for Appellants. Kimberly A. Hill of Kimberly A. Hill,
P.L., Fort Lauderdale, for Appellee.
OF DANIA BEACH and PGCS, Appellants, v. DAVID ZIPOLI, Appellee. 1st District.
Case No. 1D16-0693. Opinion filed October 10, 2016. An appeal from an order of
the Judge of Compensation Claims. Daniel A. Lewis, Judge. Date of Accident:
January 16, 2009. Counsel: George W. Boring, III, Public Entity Legal
Solutions, Lake Mary, 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) appeals
an order of the Judge of Compensation Claims (JCC) finding that it was estopped
from asserting a statute of limitations defense against the Claimant’s request
for benefits. Because the elements of estoppel were not established in this
case, we reverse.
CURIAM.) In this workers’ compensation case, the Employer/Carrier (E/C) appeals
an order of the Judge of Compensation Claims (JCC) finding that it was estopped
from asserting a statute of limitations defense against the Claimant’s request
for benefits. Because the elements of estoppel were not established in this
case, we reverse.
Background
The
Claimant sustained a compensable low-back injury on January 16, 2009. The E/C
provided both medical treatment and indemnity benefits. In September 2009, the
E/C sent the Claimant a letter stating that he had reached maximum medical
improvement (MMI) with a permanent impairment rating (PIR), that he was
entitled to impairment income benefits (IBs) under section 440.15(3), Florida
Statutes, and that his “medical treatment [was] subject to a one-year Statute
of Limitations.”1 The parties have since stipulated
that the Claimant reached MMI on July 28, 2009, with a 7% PIR.
Claimant sustained a compensable low-back injury on January 16, 2009. The E/C
provided both medical treatment and indemnity benefits. In September 2009, the
E/C sent the Claimant a letter stating that he had reached maximum medical
improvement (MMI) with a permanent impairment rating (PIR), that he was
entitled to impairment income benefits (IBs) under section 440.15(3), Florida
Statutes, and that his “medical treatment [was] subject to a one-year Statute
of Limitations.”1 The parties have since stipulated
that the Claimant reached MMI on July 28, 2009, with a 7% PIR.
The
E/C concedes that it was dilatory in paying one of the IB installments and
admits it never paid the penalties and interest related to this late payment. See
§§ 440.20(6) (penalties) & 440.20(8) (interest), Fla. Stat. (2008). The
last payment of the fourteen weeks’ worth of IBs to which the Claimant was
entitled — the most recent provision of any indemnity benefits to the Claimant
— was made on November 3, 2009.
E/C concedes that it was dilatory in paying one of the IB installments and
admits it never paid the penalties and interest related to this late payment. See
§§ 440.20(6) (penalties) & 440.20(8) (interest), Fla. Stat. (2008). The
last payment of the fourteen weeks’ worth of IBs to which the Claimant was
entitled — the most recent provision of any indemnity benefits to the Claimant
— was made on November 3, 2009.
The
medical benefits provided to the Claimant included treatment with Dr.
Christopher Brown. The Claimant’s last visit with Dr. Brown — the most recent
provision of any claim-related medical benefit to the Claimant — took place in
May of 2010. Important to our analysis, when the Claimant later called Dr.
Brown’s office to schedule a follow-up appointment, he was “erroneously”
advised that his case was closed and that he was no longer authorized to
receive treatment from Dr. Brown. This turned out to be a critical component in
the untimely advancement of his claim because, as discussed below, the only
evidence of reliance in this record is that the Claimant believed — mistakenly
— that Dr. Brown or his staff was in charge of his case.
medical benefits provided to the Claimant included treatment with Dr.
Christopher Brown. The Claimant’s last visit with Dr. Brown — the most recent
provision of any claim-related medical benefit to the Claimant — took place in
May of 2010. Important to our analysis, when the Claimant later called Dr.
Brown’s office to schedule a follow-up appointment, he was “erroneously”
advised that his case was closed and that he was no longer authorized to
receive treatment from Dr. Brown. This turned out to be a critical component in
the untimely advancement of his claim because, as discussed below, the only
evidence of reliance in this record is that the Claimant believed — mistakenly
— that Dr. Brown or his staff was in charge of his case.
Litigation
On
December 22, 2014, more than four years after the Claimant last received any
workers’ compensation benefits, the Claimant filed a petition for benefits
(PFB) seeking authorization of medical care, IBs “at the correct rate,”
penalties and interest on any late payment of indemnity benefits, and
attorney’s fees and costs. The E/C contested the claims, asserting, among other
defenses, that the claims were barred by the statute of limitations found in
section 440.19, Florida Statutes, which provides that a PFB must be filed
within two years after the date a claimant knew or should have known that his
injury arose out of a compensable, work-related event, with the exception that
the two-year period is tolled for one year following the date any indemnity
benefit is paid or medical treatment is furnished.
December 22, 2014, more than four years after the Claimant last received any
workers’ compensation benefits, the Claimant filed a petition for benefits
(PFB) seeking authorization of medical care, IBs “at the correct rate,”
penalties and interest on any late payment of indemnity benefits, and
attorney’s fees and costs. The E/C contested the claims, asserting, among other
defenses, that the claims were barred by the statute of limitations found in
section 440.19, Florida Statutes, which provides that a PFB must be filed
within two years after the date a claimant knew or should have known that his
injury arose out of a compensable, work-related event, with the exception that
the two-year period is tolled for one year following the date any indemnity
benefit is paid or medical treatment is furnished.
In
response to the E/C’s statute of limitations defense, the Claimant argued four
grounds, albeit intertwined, upon which the E/C was allegedly estopped from
asserting the limitations defense — 1.) Although IBs were paid to the
Claimant, one payment was late and should have included penalties and interest;
2.) IBs were not paid at correct rate based on average weekly wages (AWW) and
earnings considerations at the time of IB payment; 3.) The September of 2009
letter to the Claimant was a misstatement of the applicable statute of
limitations (SOL)2; and 4.) Dr. Brown’s office advised
the Claimant that his case was closed. The Claimant asserted, under grounds one
and two, that the E/C was estopped from asserting the statute of limitations
because the E/C failed to fulfill its mandatory duty to pay, thus leaving the
Claimant unaware of his entitlement to certain classes of benefits — i.e., to
penalties and interest and/or the higher rate of IB payments. Among other cases
provided to the JCC, the Claimant relied on Gauthier v. Florida
International University, 38 So. 3d 221 (Fla. 1st DCA 2010), where this
Court concluded that the claimant had detrimentally relied on the E/C’s failure
to comply with its statutory duties — specifically, to obtain an MMI and PIR
and pay IBs based on that PIR — leaving the claimant unaware of her potential
entitlement to benefits and foreclosing her ability to toll the statute of
limitations. Ultimately, the JCC agreed with the Claimant’s Gauthier
argument and found that the E/C was estopped from raising its limitations
defense.
response to the E/C’s statute of limitations defense, the Claimant argued four
grounds, albeit intertwined, upon which the E/C was allegedly estopped from
asserting the limitations defense — 1.) Although IBs were paid to the
Claimant, one payment was late and should have included penalties and interest;
2.) IBs were not paid at correct rate based on average weekly wages (AWW) and
earnings considerations at the time of IB payment; 3.) The September of 2009
letter to the Claimant was a misstatement of the applicable statute of
limitations (SOL)2; and 4.) Dr. Brown’s office advised
the Claimant that his case was closed. The Claimant asserted, under grounds one
and two, that the E/C was estopped from asserting the statute of limitations
because the E/C failed to fulfill its mandatory duty to pay, thus leaving the
Claimant unaware of his entitlement to certain classes of benefits — i.e., to
penalties and interest and/or the higher rate of IB payments. Among other cases
provided to the JCC, the Claimant relied on Gauthier v. Florida
International University, 38 So. 3d 221 (Fla. 1st DCA 2010), where this
Court concluded that the claimant had detrimentally relied on the E/C’s failure
to comply with its statutory duties — specifically, to obtain an MMI and PIR
and pay IBs based on that PIR — leaving the claimant unaware of her potential
entitlement to benefits and foreclosing her ability to toll the statute of
limitations. Ultimately, the JCC agreed with the Claimant’s Gauthier
argument and found that the E/C was estopped from raising its limitations
defense.
Analysis
We
find that the facts in Gauthier are distinguishable from the facts of
this case. Furthermore, the holding in Gauthier must be narrowly
construed and only applies to a unique set of facts substantially similar to
the facts of Gauthier.
find that the facts in Gauthier are distinguishable from the facts of
this case. Furthermore, the holding in Gauthier must be narrowly
construed and only applies to a unique set of facts substantially similar to
the facts of Gauthier.
In Gauthier,
the claimant “showed by uncontested evidence that the E/C failed to act when it
was under a duty to do so and that [the] claimant was misled to her detriment
due to the E/C’s omission.” 38 So. 3d at 225. Thus, in that case, the elements
of estoppel — detrimental reliance on a party’s misrepresentation — were
established. See Deere v. Sarasota Cty. Sch. Bd., 880 So. 2d 825,
826 (Fla. 1st DCA 2004) (“To demonstrate estoppel, Appellant must show that (1)
the E/C misrepresented a material fact; (2) Appellant relied on the
misrepresentation; and (3) Appellant changed her position to her detriment
because of the misrepresentation.”); accord Winans v. Weber, 979
So. 2d 269, 275 (Fla. 2d DCA 2007) (holding that there can be no estoppel when
the party seeking estoppel “was not misled by the other party’s conduct”).
the claimant “showed by uncontested evidence that the E/C failed to act when it
was under a duty to do so and that [the] claimant was misled to her detriment
due to the E/C’s omission.” 38 So. 3d at 225. Thus, in that case, the elements
of estoppel — detrimental reliance on a party’s misrepresentation — were
established. See Deere v. Sarasota Cty. Sch. Bd., 880 So. 2d 825,
826 (Fla. 1st DCA 2004) (“To demonstrate estoppel, Appellant must show that (1)
the E/C misrepresented a material fact; (2) Appellant relied on the
misrepresentation; and (3) Appellant changed her position to her detriment
because of the misrepresentation.”); accord Winans v. Weber, 979
So. 2d 269, 275 (Fla. 2d DCA 2007) (holding that there can be no estoppel when
the party seeking estoppel “was not misled by the other party’s conduct”).
In Gauthier,
the claimant suffered a serious and catastrophic-type injury when she lost
vision in her right eye.3 Following surgery and recovery, the
claimant attended appointments every other month through June of 2007, when she
was instructed to return for annual visits only. She attended an appointment on
June 21, 2007. She later called in July of 2008 and obtained an annual
follow-up appointment for August 5, 2008. When she appeared for the August
appointment, she was advised that the E/C refused authorization. On these
facts, this Court found that the E/C failed to advise claimant of her
undisputed entitlement to significant impairment benefits, failed to acquire
MMI and an impairment rating from the doctors it had authorized, and failed to
pay the impairment benefits. Of note, payment of the impairment benefits would
have tolled the statute of limitations defense. Therefore, the absence of the
filing of a PFB by the claimant was due to the E/C’s failure to acquire MMI and
PIR information, failure to file appropriate DWC forms, and failure to convey
accurate information concerning claimant’s PIR or to initiate IB payments to
claimant — which the E/C was on actual notice were due pursuant to the serious
and permanent nature of her injuries.
the claimant suffered a serious and catastrophic-type injury when she lost
vision in her right eye.3 Following surgery and recovery, the
claimant attended appointments every other month through June of 2007, when she
was instructed to return for annual visits only. She attended an appointment on
June 21, 2007. She later called in July of 2008 and obtained an annual
follow-up appointment for August 5, 2008. When she appeared for the August
appointment, she was advised that the E/C refused authorization. On these
facts, this Court found that the E/C failed to advise claimant of her
undisputed entitlement to significant impairment benefits, failed to acquire
MMI and an impairment rating from the doctors it had authorized, and failed to
pay the impairment benefits. Of note, payment of the impairment benefits would
have tolled the statute of limitations defense. Therefore, the absence of the
filing of a PFB by the claimant was due to the E/C’s failure to acquire MMI and
PIR information, failure to file appropriate DWC forms, and failure to convey
accurate information concerning claimant’s PIR or to initiate IB payments to
claimant — which the E/C was on actual notice were due pursuant to the serious
and permanent nature of her injuries.
By
contrast, in this case, there is no record evidence that the Claimant
detrimentally relied on a misrepresentation or omission made by the E/C.
Instead, the only documented detrimental reliance was the Claimant’s reliance
on the comments of Dr. Brown’s office staff, comments unconnected to the E/C. See
Dep’t of Revenue ex. rel. Thorman v. Holley, 86 So. 3d 1199, 1203 (Fla.
1st DCA 2012) (“To satisfy the reliance prong of equitable estoppel, the party
asserting the defense must prove that he . . . made a detrimental change of
position based on a belief in the misrepresented fact.”). As to ground four of
the Claimant’s asserted estoppel arguments, there is no evidence that the E/C
knew about the discussion between the Claimant and Dr. Brown’s office or in any
way gave momentum to the Claimant’s mistaken belief that his case had been
terminated. Here, the E/C acquired the MMI and PIR, filed the appropriate forms
documenting the assignment and change of medical status, sent a letter to the
claimant advising of entitlement to IBs, and initiated payment of the IBs.
contrast, in this case, there is no record evidence that the Claimant
detrimentally relied on a misrepresentation or omission made by the E/C.
Instead, the only documented detrimental reliance was the Claimant’s reliance
on the comments of Dr. Brown’s office staff, comments unconnected to the E/C. See
Dep’t of Revenue ex. rel. Thorman v. Holley, 86 So. 3d 1199, 1203 (Fla.
1st DCA 2012) (“To satisfy the reliance prong of equitable estoppel, the party
asserting the defense must prove that he . . . made a detrimental change of
position based on a belief in the misrepresented fact.”). As to ground four of
the Claimant’s asserted estoppel arguments, there is no evidence that the E/C
knew about the discussion between the Claimant and Dr. Brown’s office or in any
way gave momentum to the Claimant’s mistaken belief that his case had been
terminated. Here, the E/C acquired the MMI and PIR, filed the appropriate forms
documenting the assignment and change of medical status, sent a letter to the
claimant advising of entitlement to IBs, and initiated payment of the IBs.
Further,
the Claimant stipulated that the E/C timely raised the affirmative defense of
statute of limitations and that he received notice of the statute of
limitations via an informational brochure compliant with section 440.185,
Florida Statutes. The merits hearing was bifurcated to address the issue of
compensability with a reservation of jurisdiction over benefits due, if
warranted.
the Claimant stipulated that the E/C timely raised the affirmative defense of
statute of limitations and that he received notice of the statute of
limitations via an informational brochure compliant with section 440.185,
Florida Statutes. The merits hearing was bifurcated to address the issue of
compensability with a reservation of jurisdiction over benefits due, if
warranted.
Gauthier
does not permit an inference of detrimental reliance whenever and wherever an
E/C has failed to meet a statutory obligation. Simply stated, in this case, the
JCC construed Gauthier too broadly.
does not permit an inference of detrimental reliance whenever and wherever an
E/C has failed to meet a statutory obligation. Simply stated, in this case, the
JCC construed Gauthier too broadly.
Conclusion
For
all of these reasons, we reverse the estoppel of the E/C’s statute of
limitations defense and find that the defense bars compensability and any
further entitlement to benefits.
all of these reasons, we reverse the estoppel of the E/C’s statute of
limitations defense and find that the defense bars compensability and any
further entitlement to benefits.
REVERSED.
(MAKAR, JAY, and M.K. THOMAS, JJ., CONCUR.)
(MAKAR, JAY, and M.K. THOMAS, JJ., CONCUR.)
__________________
1The
Claimant acknowledges that the E/C timely mailed the informational brochure
required by section 440.185(4), Florida Statutes, detailing the applicable
one-and two-year statutes of limitations.
Claimant acknowledges that the E/C timely mailed the informational brochure
required by section 440.185(4), Florida Statutes, detailing the applicable
one-and two-year statutes of limitations.
2The
record on appeal documents that at the hearing, the Claimant stipulated that he
received the full informational brochure from the E/C as required by section
440.185, Fla. Stat. Accordingly, any argument under this ground lacks merit.
record on appeal documents that at the hearing, the Claimant stipulated that he
received the full informational brochure from the E/C as required by section
440.185, Fla. Stat. Accordingly, any argument under this ground lacks merit.
3The
claimant later regained some level of vision after surgery, but ultimately
suffered significant and permanent vision loss in the right eye.
claimant later regained some level of vision after surgery, but ultimately
suffered significant and permanent vision loss in the right eye.
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