Articles Posted in Workers’ Compensation

calculator.jpgPeople hurt on the job can often bring damage claims against their employer under workers’ compensation and third parties responsible for causing the accident. Normally, workers’ compensation medical and lost wage benefits are provided to the injured worker before the third party case is resolved.

Florida Statute 768.76 provides that amounts owed by negligent third parties are offset by benefits injured persons receive from collateral sources. However, the offset does not apply to benefits that must be repaid. The right a source has to be repaid is known as subrogation.

Workers compensation insurance carriers have subrogation rights pursuant to Florida Statute 440.39.
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legal document.jpgIt is customary in Florida for those wishing to settle workers’ compensation cases to be required to execute a voluntary resignation document. Typical resignation language will make it virtually impossible for the former employee to maintain a viable claim for unemployment compensation benefits. To avoid this consequence, language must be added to the effect that entitlement to unemployment compensation is not being waived,

This action led to a positive outcome for the applicant in Sullivan v. Florida Unemployment Appeals Commission (1st DCA; opinion filed May 15, 2012). In its initial form, the resignation language associated with the workers’ compensation settlement was silent on the issue of unemployment compensation. Ms. Sullivan refused to sign the form. Accordingly, her lawyer added the following language:

“Employer/Carrier will not contest Claimant’s application or request for unemployment benefits.”

The employer did not contest the language, allowing it to become part of the overall workers’ compensation settlement agreement. Thereafter, Ms. Sullivan applied for UC benefits. She was denied at the hearing level and by the Unemployment Compensation Appeals Commission. However, the 1st DCA reversed those holdings, siding, instead, with Ms. Sullivan.

The reasoning behind the holding in Sullivan is set forth in Rodriguez v. Florida Unemployment Appeals Commission, 851 So. 2d 247 (Fla. 3d DCA 2003):

Employers are to be held accountable for their actions and representations to employees, particularly when modifying terms of at-will employment and when seeking participation in voluntary layoffs, buyouts or other company initiated programs. Here [the claimant] received verbal and written representations from [the employer] about the uncertainty of her job and of a buyout package with a list of benefits, as well as assurances of eligibility for other benefits, i.e., unemployment compensation. These assurances by [the employer] were not wrongful but were designed to encourage or induce the acceptance of the voluntary buyout. Given the circumstances here and the liberal purpose of the statute authorizing unemployment benefits, the requirement of “good cause attributable to the employer” was satisfied.

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scales of justice.jpgOne of the most difficult concepts for our workers’ compensation clients to understand is that they will not receive any monetary compensation through Florida’s workers’ compensation system for pain and suffering. None. Zero. Nada. Zilch.

The notion is counterintuitive. Compounding the difficulty in understanding, much less accepting the concept, is that pain and suffering damages are payable in other types of injury cases – e.g., premises liability, medical malpractice, products liability.

To make sure our clients understand the concept, we begin the discussion at the initial conference and keep it going until the case is brought to a successful conclusion. Even then, the concept never sinks in fully with some of our clients.
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Telephone pole1.jpgDuring the past 12 months we have represented a handful of former Southern Bell linemen injured in the course and scope of their employment. Each was hired by Southern Bell (subsequently Bellsouth, now AT&T) in the 1970s to repair and install telecommunication cable. They started working for Southern Bell in their 20s and stayed until being forced by orthopedic conditions to retire in 2010 and later.

Their orthopedic conditions were caused by years of wear and tear from climbing telephone polls while toting heavy equipment and cable. Instead of being allowed to use ladders or hydraulic lifts, the linemen were forced to shimmy the poles like island natives gathering coconuts from tall palm trees. Boot hooks, jammed into the wood poles, kept them from falling.

Our first Southern Bell lineman case involved a 61 year old gentleman who retired after 39 years, done in by bad knees. His orthopedist was recommending total knee replacement surgery.

Common sense and experience told us that his knee problems were job related. Unless there has been acute trauma, like a football injury, repetitive trauma beyond the ordinary is the usual cause for damage of this severity at such a relatively young age. 39 years of pole climbing qualifies as beyond ordinary wear and tear.
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scales.jpgSome 80 years ago in Florida, workers’ compensation was substituted for the personal injury system as the nearly exclusive remedy for employees seeking compensation from employers for workplace accidents. The idea was that workers should not have to establish fault, a basic element of every personal injury case, in order to be compensated. In exchange for this valuable concession, employers were relieved from having to pay non-economic damages, broadly referred to as pain and suffering. In its original form, this quid pro quo was fair.

The quid pro quo is fair no longer. Through years of Republican rule – beginning with Governor Jeb Bush, in concert with right-wing dominated legislatures – the once equal quid pro quo balance has given way to a one-sided workers’ compensation system strongly favoring employers and their insurance carriers over injured workers.

See these blogs to understand the imbalance:

Due to the gross imbalance, accident lawyers must always consider ways to overcome the workers’ compensation immunity granted to employers. Unfortunately, the option is rarely available.

The known ways of overcoming the immunity have been:

  1. If an employer fails to have workers’ compensation coverage in place. See Florida Statute Section 440.11(a)
  2. An employer commits an intentional tort that causes the injury or death. See Section 440.11(b)
  3. Estoppel. The employer denies that the accident occurred in the course and scope of employment. See Byerley v. Citrus Publ’g, Inc., 725 So.2d 1230 (Fla. 5th DCA 1999)

As of March 21, 2012, there may be a fourth way.
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worker.jpgPeople harmed in accidents by the negligence of others often have available to them other sources, such as private insurance and governmental programs, to provide lost wages and medical benefits while they wait to be compensated by the tortfeasors (at-fault parties) for their losses. Florida Statute 768.76 calls these other sources collateral sources.

768.76(1) permits a tortfeasor an offset in the amount of any collateral source of indemnity and medical benefit unless the source of indemnity has a right of subrogation. In other words, if the recipient of the collateral source benefits does not have to repay the providers, the tortfeasor does not have to pay for them.

The reasoning behind this principle, known as the Collateral Source Rule, is to prevent victims from receiving a windfall.
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law books.jpgSometimes workers are hurt in the course and scope of their employment by the negligence of third parties. Third parties in this context are entities other than those entitled to workers’ compensation immunity. Employers and some subcontractors are entitled to the immunity. Those that are not must pay damages in accordance with the personal injury laws, something quite different than the benefits prescribed by workers’ compensation.

Sometimes employees are harassed or terminated by employers for claiming workers’ compensation benefits. Chapter 440 does not protect employers against being sued for this type of violation. See Florida Statute 440.205. See, also, our blog, Survey of Florida’s Workers’ Compensation Wrongful Termination Law.

Sometimes workers’ compensation insurance companies and their adjusters engage in unconscionable conduct during the claims handling process. They are not immune from suit for this type of conduct. See Aguilera v. Inservices, Inc., 905 So. 2d 84 (Fla. 2005).

When our office suspects that any one of these violations has occurred, we sometimes use the discovery procedures available in workers’ compensation cases as a vehicle to learn about the potential other causes.
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worker2.jpgTwo legislative sessions have passed since State Senator Chris Smith, a Democrat, whose District 29 encompasses parts of Broward and Palm counties, voted with Republicans to eliminate reasonable fees from the state’s workers’ compensation system for claimants’ attorneys. The purpose of the bill was to keep injured workers from being able to fight for their rights. It has worked as expected.

The bill approved by Senator Smith replaced a statute that required employers and their insurance carriers to pay claimants’ attorneys a “reasonable attorney’s fee” for successfully securing wrongly denied workers’ compensation benefits. This was done very simply by removing the word reasonable from the statute, then imposing arbitrarily low caps on fees regardless of the time, effort, and cost invested to win the case.

Not surprisingly, the legislature placed no caps on defense attorney fees, the amount employers and insurance carriers could paid their attorneys to defend cases, win, lose, or draw. A good example of this happened in Jennifer Kauffman v. Community Inclusions, Inc./Guarantee Insurance Company, a case in which the insurance company paid its attorney $14,720 in a losing cause, while the successful claimant’s attorney was limited by the statute to a fee of $648.41 for 100.3 hours of work, or $6.48 per hour. (Inexplicably, the Florida Supreme Court refused to consider on appeal the challenge to the constitutionality of the fee.)

This is the type of outcome the bill was designed to create. This bill was supported by Senator Smith, the only Democrat Senator to do so. Even some moderate Republicans voted against it!!!

Hardly a ringing endorsement for the rights of Florida’s working men and women.

The vote came on the last day of the 2009 legislative session. Because of the votes against by some moderate Republicans, two votes were needed from Democrats to gain passage. Those votes were obtained. However, within minutes of the vote, the other Senator changed her mind and expressed a desire to vote against the bill. Procedurally, this could be accomplished, however, it required Senator Smith to vote to allow a re-vote. He refused to do it. In essence, then, Senator Chris Smith was the deciding vote for the law that has eviscerated the rights of injured Florida workers.

Not surprisiningly, then Governor Charlie Crist failed to veto the bill.

Following this debacle on the Senate floor, I engaged in email communications with Senator Smith. He asked for my views on the subject of carrier-paid attorneys fees in workers’ compensation cases. I told him what I thought. He indicated that he would work with his colleagues to gain passage of legislation to moderate the harsh consequences of the 2009 law. I told him that his chance to do the right thing was in 2009, that the odds of getting Republicans to back off from their major victory, one that set back the rights of injured workers more than any other in the 80+ years since a workers’ compensation system was instituted in Florida, were slim to none.

My assessment has proved correct.

Periodically after our initial communications, I would ask Senator Smith how his efforts to even the playing field were going. I never received a response. Not surprisingly, nothing was accomplished in 2010 or 2011 to moderate the bill, and, to my knowledge, nothing is on the 2012 legislative agenda either.

(For what it’s worth, at the time of his vote in 2009, Senator Smith was employed by a law firm which derived a good portion of its income from representing workers’ compensation insurance companies, although Mr. Smith was not himself a workers’ compensation practitioner. As of the posting of this blog, he remained an employee of the same law firm.)

This is the reality: as long as Republicans control the Florida Legislature, nothing will be done legislatively to change the law. If change is to come, it must come from the courts, the Florida Supreme Court, in particular. Sadly, this court seems to be cowed by the overbearing might of right-wing politics.
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people.jpgFlorida Statute 440.205 is supposed to protect employees from being terminated for making workers’ compensation claims. Making a claim can be as simple as reporting an accident. It does not require the filing of a formal Petition for Benefits with DOAH.

Proving a claim for wrongful termination can be difficult. Florida employers are not required to modify work duties or hold jobs open while employees recover from injuries, and Florida is an “At Will” employment state, a legal principle that allows employers to terminate employees at will, for no reason at all. (Thankfully, in addition to the protections of 440.205, At Will is constrained by the U.S. Constitution’s prohibition against discrimination based on age, race, and religion. Whistleblowers, individuals who report illegal activity, also are protected against At Will termination. Ironically, it is often safer for employers to fire employees for no reason at all than to fire for particular reasons.)

Employers hide behind these protections when accused of wrongful termination. In appropriate situations, they should be challenged.

An employer found to have violated 440.205, can be liable for civil damages such as lost wages and emotional distress, and subject to criminal fines as a second degree misdemeanor.
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calculator.jpgEmployees injured while working in accidents caused by third parties may be entitled to compensation through Florida’s workers’ compensation system and its personal injury laws. In the context of this blog, a third party is a person or company other than an injured worker’s employer. Examples include manufacturers of defective machinery and negligent operators of motor vehicles.

Florida’s workers’ compensation system is a no-fault system, meaning that for an injured worker to be eligible for benefits, the fault of another in bringing about the accident need not be proved. This is one of the biggest differences between the workers’ compensation system and the personal injury system, which is fault based.

To prevent the person harmed from receiving a windfall recovery, some or all of the money received from the third party must be repaid to the employer or the workers’ compensation carrier in rough proportion to value of the benefits they furnished. In other words, employers and workers’ compensation carriers have subrogation rights against the third party proceeds. This right is commonly referred to as the workers’ compensation lien.

Workers compensaiton is a creature of statute – see Chapter 440 of Florida’s statutes – and the right of subrogation is derived, in particular, from Section 440.39(2).

The employer or carrier can agree to waive the lien. However, the waiver may come at a cost, typically a reduction in the amount of money the employer/carrier are willing to pay to settle the workers’ compensation case.

More often, employers and carriers do not agree to waive liens. Fortunately, very rarely does the amount paid to satisfy a workers’ compensation lien equal the full amount of the lien.

440.39 describes the formula for satisfying the lien. The formula has been explained in clearer terms in the Florida Supreme Court case Manfredo v. Employer’s Casualty Insurance Company, 560 So.2d 1162 (Fla 1990).

This is the formula: Third party settlement amount less (-) attorney fees and costs divided by (/) full case value = the % value of the wc lien.; and here is the formula by way of an example:

  • WC lien (medical, indemnity, settlement, etc.): $ 100,000
  • $ 250,000 third party settlement less fees (40%) and costs = $ 135,000
  • Full case value: $ 1,000,000. (Settled for less due to tough liability, coverage limits, etc.)
  • $ 135,000 divided by $ 1,000,000 = 13.5%
  • 13.5% of $ 100,000 = $ 13,500.
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