Recently, the Florida First District published its decision in Noland v. City of Deerfield Beach, No. 1D19-1492. The case is interesting from several legal perspectives including the effect of stipulations, the breadth of stipulations, waiver that can result from not pleading specific defenses, and more.
The injured worker suffered a work accident in 1997 and the matter proceeded to trial in 2019 (22 years later). This reiterates the ongoing nature of workers' compensation cases. It is practical and possible for issues to arise and for disputes to be litigated after a number of years.
The claim in Noland was for authorization of "an orthopedic physician to treat his left knee" after he had a knee joint replacement in 2018 "that was performed under his private health insurance." The injured worker did not prevail at trial on the claim and sought review of the Court. The Court was not receptive to his arguments of error and affirmed the Judge of Compensation Claims (JCC).
The injured worker's argument on appeal was essentially that a notation on the pretrial compliance questionnaire effectively accepted that the claim for a physician and care was compensable. The argument focused upon a question in the form that asks what was "the 'was the specific body part . . . related to the accident.'” The Employer/Carrier (E/C) marked that question "left knee." The Claimant asserted that the notation rendered care and treatment compensable, despite defenses to the claim noted in that same stipulation form.
Elsewhere in the document, the E/C asserted defenses to the claim for care and treatment of the left knee following the 2018 surgery. These included that the work was not the major contributing cause (MCC) of the need for treatment and that “[t]he treatment requested is no longer related to the workplace condition.” The outcome of the case and the effect to be afforded to a notation of the "body part" on a stipulation form is worthy of consideration.
The Court concluded that the worker's stipulation "argument is an overly broad reading of the pretrial stipulation." It explained that this "stipulation established that a compensable accident occurred and that the injury sustained in that accident would be compensable." However, the notation of "left knee," in itself, "did not constitute an agreement to provide any requested treatment or other benefit."
In concluding that the response to the "body part" question did not override the remainder of the defenses raised, the Court distinguished the precedent argued by the worker. Specifically, Meehan v. Orange County Data and Appraisals, 272 So. 3d 458 (Fla. 1st DCA 2019), which held that a "broad stipulation" to accept "building-related illness,” was sufficient to encompass treatment for various parts of the body. The Court explained this resulted from "broad wording utilized," and that "more carefully defining the compensable injury," might have led to different results. The "one line" in the questionnaire in Noland, the Court explained, is not the equivalent of "the broad negotiated stipulation involved in Meehan."
The Court concluded that the "superficial comparison of the stipulation in" Noland "to the stipulations in other cases is unavailing." It found the MCC defense to be "on the very same uniform pretrial stipulation form," that it "was timely, consistently, and adequately preserved, and then proven at trial by competent, substantial evidence."
It is also notable that the worker in this case did not immediately seek care for the injury in 1997. The Court noted that he instead "treated outside the workers’ compensation system" and underwent surgery. He then "returned to work full time, ran 2.5 miles a day, and played competitive softball, with no further reports of treatment for the left knee after 2001." But, as he "neared retirement in 2018, his doctor recommended dual knee replacements."
The injured worker underwent those surgeries, again "under his private health insurance." However, he discussed with the surgeon's office whether the left knee "could be processed under workers’ compensation." Upon learning that "the surgeon would not accept workers’ compensation," he proceeded under health insurance. The worker testified "he wanted the best surgeon and would lie if necessary to get the best."
The attorney representing the worker sent the surgeon a letter denying that there were any claims pending for either the right or left knee. That was not true, as both the attorney and the worker "had already signed and filed a Petition for Benefits seeking to require the E/C to provide ongoing treatment for the left knee." The Court noted that a second Petition remains pending that seeks to have the E/C pay the cost of the left knee surgery that was performed. The Court noted as an aside that "the E/C did not assert a misrepresentation defense as to either of these PFBs."
Notably, there was significant medical testimony regarding the need for the 2018 knee replacement surgery. One physician testified "the cause was osteoarthritis." And, "the surgeon who performed the dual knee replacements in 2018 opined that the surgery was necessary because Claimant was bowlegged and had pre-existing osteoarthritis." The E/C’s Independent Medical Examiner testified consistently that the need for surgery was “chronic pre-existing degenerative osteoarthritis and his chronic varus deformity [bowleggedness] that is congenital and chronic and predates the industrial accident.” The Court noted that "only Claimant’s IME physician related the need for ongoing treatment of the left knee after the 2018 surgery to the 1997 accident." Thus, there was competent substantial evidence regarding the MCC defense, although the trial judge could instead have accepted the Claimant's IME expert's opinion.
There was a reference in the testimony to the "lack of documented medical treatment to the left knee from 2001 to 2018." However, the injured worker "attempted to establish through his own testimony that the E/C provided left knee treatments after the 1997 accident." The Court noted that the JCC specifically found the Claimant not credible because of multiple false and contradictory statements." In the appeal, the worker conceded that an MCC defense might "break . . . the causation chain" in appropriate circumstances.
Notably, the trial judge also denied a "statute of limitations defense." The judge concluded it was "untimely because it was not raised in the original pretrial stipulation." The statute of limitations is in section 440.19, Fla. Stat. and is limited in (4) requiring that to avail itself of such a defense requires that "the carrier advances the defense of a statute of limitations in its initial response to the petition for benefits." Noland is a reminder of the requirement of that defense.
There are notable lessons Noland. First, stipulations remain binding. However, broad statements such as "body part" may be limited by other parts of the same stipulation such as the pled defenses. Some will say that specific and negotiated stipulations are due more consideration. Second, the reminder that the statute of limitation defense is subject to waiver is pertinent. Third, issues not raised by the parties are not decided at trial or on appeal. That misrepresentation was not pled was noted by the Court. Finally, it is possible that a compensable injury may require treatment; however, it is also possible that treatment eventually required may not necessarily result from a particular work accident. It is possible that other causes, including degeneration or pre-existing conditions, might be "a break in the 'causal chain.'"
