41
Fla. L. Weekly D401bTop of Form

Workers’
compensation — Medical benefits — Diagnostic testing after claimant’s
discharge from emergency room for workplace injury — Judge of compensation
claims erred in denying claim for payment of medical bills for diagnostic
testing on ground that further diagnostic testing was not directed at assessing
or treating compensable injuries from blow to claimant’s head because initial
CT brain scan was read as indicative of a stroke — Because JCC overlooked
medical reports indicating that further testing was performed to rule out
post-concussive edema, and causes of claimant’s post-injury symptoms have never
been determined, it was error to rule out the possibility of any relationship
between the compensable injury and the need for further testing

(PER CURIAM.) In this workers’ compensation case, Claimant
argues that the Judge of Compensation Claims (JCC) erred in denying his claim
for payment of medical bills incurred after he was discharged from the
emergency room for a workplace injury. Because the JCC’s findings of fact are
inconsistent with the medical records and doctor’s opinion concerning the
medical testing reasonably required by the nature of the injury, we agree and
reverse the order below.

I

On February 7, 2014, Claimant, a law enforcement officer in
training, passed out and fell to the ground, striking his head on the concrete
pavement. The Employer/Carrier (E/C) accepted compensability of Claimant’s head
laceration resulting from the blow to the head and paid for the emergency room
treatment up through the time of discharge. The E/C nevertheless denied
responsibility for Claimant’s later hospitalization and additional diagnostic
testing which was ordered after an initial CT brain scan was read as indicative
of a stroke. The JCC ruled in the E/C’s favor based on his finding that the
additional diagnostic testing was not directed at assessing or treating the
injuries from the blow to the head. On appeal, Claimant argues that the
additional diagnostic testing was necessary to diagnose the nature and extent
of his compensable head injury.

II

To the extent this issue turns on resolution of the facts,
the review standard is competent substantial evidence; to the extent it
involves an interpretation of law, the standard is de novo. See Benniefield
v. City of Lakeland, 109 So. 3d 1288, 1290 (Fla. 1st DCA 2013).

Under paragraph 440.13(2)(a), Florida Statutes (2013),
employers are required to furnish “such medically necessary remedial treatment,
care, and attendance for such period as the nature of the injury or process of
recovery may require.” Medically necessary treatment includes “any medical
service or medical supply which is used to identify or treat an illness or
injury.” § 440.13(1)(k), Fla. Stat. (2013). It is well established in the case
law that diagnostic testing is always compensable if the purpose is to find out
the cause of the injured worker’s symptoms. See Arnau v. Winn Dixie
Stores, 105 So. 3d 669, 671 (Fla. 1st DCA 2013) citing Nealy v.
City of W. Palm Beach, 491 So. 2d 585, 586 (Fla. 1st DCA 1986) (“Whenever
the purpose of the diagnostic test is to determine the cause of a claimant’s
symptoms, which symptoms may be related to a compensable accident, the cost of
the diagnostic test is compensable.”); see also Superior Concrete
Constr. v. Olsen, 616 So. 2d 183, 183 (Fla. 1st DCA 1993); Perry v.
Ridgecrest Int’l, 548 So. 2d 826, 827-28 (Fla. 1st DCA 1989). This is true
even if the tests prove the symptoms are unrelated to the compensable injury. Nealy,
491 So. 2d at 586.

This court has held that the same principle applies in cases
governed by the major contributing cause standard (MCC) applicable to dates of
accident beginning January 1, 1994. See Chance v. Polk Cty. Sch. Bd.,
4 So. 3d 71, 73 (Fla. 1st DCA 2009) (holding JCC erred in applying MCC standard
to bar claimant from additional diagnostic testing to determine cause of
symptoms); Grainger v. Indian River Transp./Zurich U.S., 869 So. 2d
1269, 1271 (Fla. 1st DCA 2004) (finding JCC applied incorrect standard when he
ruled record did not show workplace injury was MCC for requested neurological
evaluation because “[a] claimant must establish a causal relationship between
his injury and the compensable accident in order to secure treatment,
but not to be entitled to diagnostic testing to determine the cause
of his symptoms.”) (Emphasis in original).

In Grainger, the court articulated the following
test: “The correctness of an order refusing a medical evaluation ‘must be
tested by whether the claimant adequately demonstrated that the evaluation was
reasonably required by the . . . nature of the injury. . . .’ ” 896 So. 2d at
1271 (quoting Sumner v. Gardinier, Inc., 526 So. 2d 1068, 1070 (Fla. 1st
DCA 1988)). Cf. Laxner v. Target Corp., 41 So. 3d 396, 397 (Fla.
1st DCA 2010) (finding CSE supported JCC’s denial of testing where expert
medical opinion established that extent and cause of injuries were known and
ascertainable). Thus, in the instant case, Claimant had the burden of showing
that the diagnostic tests performed during his hospitalization were reasonably
required by the nature of his workplace injury. If Claimant meets this burden,
then the evaluation should be covered under workers’ compensation. See Grainger,
869 So. 2d at 271.

III

Here, the E/C asserted that Claimant’s head laceration was
the only compensable head injury resulting from the fall; at the same time, the
E/C acknowledged the possibility that Claimant’s head injury may have involved
more than a simple laceration. For that reason, the E/C conceded that the initial
head CT scan was compensable as diagnostic testing following Claimant’s fall.
But, according to the E/C, once the initial head CT scan without contrast was
read as indicative of stroke, no further testing was required for the workplace
injury.

Claimant presented the testimony of Dr. Moore, the emergency
room physician. Dr. Moore testified that Claimant’s symptoms were not
consistent with the type of stroke initially presented on the CT scan and
“[t]hat’s why everything was a little unsure.” Taken as a whole, Dr. Moore’s
testimony establishes: (1) the initial differential diagnosis included
conditions such as concussion and dehydration that could be related to the head
blow or the work environment; (2) further testing was ordered because the
diagnosis of a stroke was uncertain at the time Claimant was hospitalized; (3)
a hemorrhagic stroke from trauma, although unlikely, was a possibility; (4)
Claimant had a negative neurologic examination; and (5) a carotid arteriogram
was ordered to rule out a carotid dissection which can be caused by head
trauma. The E/C did not present any expert medical opinion to counter Dr.
Moore’s opinions.

Despite Dr. Moore’s testimony, the JCC here found that
diagnostic testing related to Claimant’s injuries resulting from the blow to
the head ended when, in response to the initial CT scan, Dr. Moore admitted
Claimant to the hospital for further testing. As a general rule, if a doctor’s
testimony is unrefuted, the JCC may reject the testimony as unreliable, but must
give a reason. See Vadala v. Polk Cty. Sch. Bd., 822 So. 2d 582,
584 (Fla. 1st DCA 2002). Here, the JCC found that Dr. Moore’s testimony is
“somewhat contradictory.”

Although the JCC did not provide any further explanation as
to why he implicitly rejected Dr. Moore’s testimony with regard to the need for
further testing, he nonetheless found that “the medical records [after
Claimant’s hospitalization] indicate that all testing and observations were
performed to determine if claimant had an MCA stroke or a brain tumor.” This
finding, however, is not supported by the record. First, nothing in the record
contradicts Dr. Moore’s testimony (which was uncertain only to the extent
Claimant’s diagnosis was still uncertain and required additional testing) that
the carotid angiogram was medically necessary to rule out the possibility of a
carotid dissection due to the trauma. Second, Dr. Aldana, the neurologist who
first saw Claimant after his hospitalization, did not read the initial CT scan
as indicative of stroke, suspected a slow-growing lesion, and raised the
possibility of other causes (“an oligodendroglia versus other etiologies”).
Dr. Aldana also recommended a CT head scan with at least contrast because the
pattern of the brain lesion was not consistent with a stroke, and could
represent edema (swelling). Third, Dr. Molloy, another neurologist,
subsequently recommended a follow-up EEG and repeat CT scan expressly for the
purpose of ruling out post-concussive edema. According to the medical records,
these two tests were the last ones performed before Claimant was released from
the hospital. Thus, the record does not support the JCC’s ultimate conclusion
that “the purpose of the admission itself and the testing done during
hospitalization was not directed at treating or assessing injuries due to the
blow to the back of claimant’s head.”

Based on the record medical evidence, both the E/C and the
JCC in this case have overstated the results of the initial CT scan as decisive
evidence ruling out the possibility of any relationship between the compensable
injury and the need for further testing. Specifically, the JCC overlooked
medical reports indicating that further testing was performed to rule out
post-concussive edema. For this reason — and because the causes of Claimant’s
post-injury symptoms have never been determined — we REVERSE and REMAND for
entry of an order in accordance with this opinion. (ROBERTS, C.J., WOLF, and
THOMAS, JJ., CONCUR.)

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