Medicare and Workers Compensation

Medicare is like the mob. They’re protecting their turf. Some have chosen not to pay heed to their warnings. They have given us warnings. Non compliance is everywhere. Medicare ain’t playing. It’s mandatory. Know the facts, be proactive-start compliance efforts early. #LSlaw

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De la Cruz v Able Body Temporary Staffing

This March 6, 2012 1DCA opinion affirmed in part and reversed in part the JCC decision of Judge Sojourner. In this case, the claimant filed several petitions for benefits after injuring his right knee and left wrist in a workplace fall. Among other things, Claimant sought authorization for a total knee replacement and TPD benefits related to the wrist injury that the Employer/Carrier had accepted as compensable. The 1DCA held that the JCC correctly held that the workplace accident was not the major contributing cause of Claimant’s need for knee surgery, and therefore, denied all related claims. The 1DCA affirmed that portion of the order. However, the 1DCA opined that the JCC did not rule on the TPD claim for the claimant's compensable wrist injury. The 1DCA held that "Failure to rule on a fully tried issue is reversible error". To support their position, the 1 DCA cited the 1997 Betancourt v. Sears Roebuck & Co. Case. The 1DCA...

Is coronavirus compensable under WC?

According to the NCCI, The answer to that question is maybe. While WC laws provide compensation for “occupational diseases” that arise out of and in the course of employment, many state statutes exclude “ordinary diseases of life” (e.g., the common cold or flu). There are occupational groups that arguably would have a higher probability for exposure such as healthcare workers. However, even in those cases, there may be uncertainty as to whether the disease is compensable. Would time away from work during recovery be considered “temporary disability” or is it just normal “sick time”? https://www.ncci.com/Articles/Pages/Insights-COVID19-WorkersComp.aspx

Arlotta v city of West Palm Beach

A March 26, 2012 1DCA decision that reversed JCC D'Ambrosio. This case continues to show the importance that the 1DCA is putting on Expert Medical Advisors (EMA). Judges of Compensation Claims have less and less control In a case where there are conflicting medical opinions. In this case, there was a conflicting medical opinion and Judge of Compensation Claims appointed an EMA to address “the issues of 1) whether the Claimant has gynecomastia, 2) the cause of the gynecomastia, and 3) what treatment is recommended.” However, before the claimant was seen by the EMA physician, the claimant had an unauthorized surgery. The claimant wanted to give copies of the unauthorized medical records to the EMA. The Employer/Carrier filed a motion to dismiss the Claimant's claims arguing that Claimant’s unilateral decision to undergo surgery prevented the EMA from answering the questions put to him and that the E/C had been prejudiced in its ability to defend the claims. The JCC fou...

Luks Santaniello's Florida Workers Compensation blog

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