Employers and their workers compensation carriers have been hit with two major blows as a result of a decision from the first District Court of Appeals in Miles v. City of Edgewater Police Department and a decision from the Florida Supreme Court in Castellanos v. Next Door Company. Both of these cases deal with different…

Like other forms of civil litigation, the majority of workers’ compensation claims settle short of trial. Even claims that have been tried and appealed on multiple occasions tend to settle via lump sum at some point. Settlement of a claim is comprised of 2 major elements: settlement of future wage loss/indemnity benefits and settlement of…

The First District Court of Appeal has suggested that in order to deny benefits pursuant to a Major Contributing Cause (MCC) analysis, the employer/carrier may need to issue a 120 day pay and investigate letter in every case. Babahmetovic v. Scan Design Florida, Inc./Zenith Ins. Co. (Fla. 1st DCA, Oct 8, 2015). The dispute in…

Workers’ compensation defense attorneys and adjusters in Florida are constantly pressed to meet statutory deadlines. 30 days for filing the Response to PFB …. 14 days for issuance of a total denial… 5 days for responding to the one-time change… and the list goes on. But one of the most important, and most forgotten deadlines,…

The First District Court of Appeal (DCA) issued an opinion holding that a claimant’s request for a one-time change in his treating physician must be set forth in a direct and obvious way, and that a request for a one-time change that is intentionally hidden does not compel an employer/carrier to act. The First DCA…

One method where the claimant’s attorney can control authorization of physicians is through the five-day rule under 440.13(2)(f). This statute states that where the claimant sets forth his request for his one-time change in treating physician, the employer/carrier must offer an alternative physician within 5 days. If the employer/carrier does not offer an alternative physician…

The First DCA recently rejected an appeal where the claimant argued that service of a Petition for Benefits on an EC compelled the employer/carrier to act, even though the PFB was not filed with DOAH until much later. Elms v. Castle Construction, (Fla. 1st DCA, Oct. 10, 2014). This author tried the case before Judge…

Effective July 1, 2014, Chapter 440 now allows for calculation of the compensation rate as EITHER 66 2/3% OR 66.67%. This is the legislative response to Escambia County School District Board v. Vickery-Orso, which found the proper method for determining the compensation is not by multiplying the average weekly wage by .6667 or .66667, but…

Every adjuster has received that e-mail or fax from a claimant’s attorney with a whopping emergency room bill. Had the claimant waited a few more days and simply gone to their authorized provider, the carrier would only be on the hook for a simple follow-up visit, as opposed to the hospital bill which often multiplies…

The problematic request for a one-time change in treating physician can severely impact a case if not handled properly. As new case law continues to modify the acceptable manner of appropriately and timely responding to these requests, adjusters have greater burdens in appropriately responding. Below are some tips to help preserve the EC’s right to…

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