Workers' Compensation
Listed below is McConnaughhay, Coonrod, Pope, Weaver & Stern, P.A.'s workers' compensation case law database. The database dates back until 1971 and includes over 5500 workers' compensation court decisions.
To view the case summaries, select one of the general topics listed below.
Jefferson v. Wayne Dalton Corporation
793 So.2d 1081, 26 FLW D1931
Absent an emergency, only a claimant who has exhausted
all avenues of a managed care organization's grievance
procedures can be eligible for medical care from a
provider outside of the managed care network. The
authority of a JCC is limited in this area because
Section 440.134, Florida Statutes, places the
authorization and supervision of managed care
arrangements within the authority of the Agency for
Health Care Administration (AHCA).
Beginning January 1, 1997, managed care arrangements
became mandatory for every insurer. Because of the
fact that as of the time of this accident, it was
mandatory that a managed care arrangement be in place,
it was not necessary for the employer/carrier to prove
there was a managed care arrangement in place in order
to assert a defense that managed care grieveance
procedures had not been exhausted. There is a
presumption (since July 1, 1997) that a managed care
plan is in place although a claimant can prove
otherwise. (Note that managed care arrangements are now
not mandatory.)
JCC's denial of temporary partial benefits because of a
lack of work search reversed. A job search is not
required for this 1997 accident for a claimant to be
entitled to temporary partial benefits. A claimant
need only prove a causal connection between an injury
and loss of income. Even though in this instance, the
claimant was fired for insubordination, he could still
be entitled to benefits if he satisfies the burden of
showing that the injury contributed to his wage loss
after the termination. (See Ramos v. Wal Mart Store
#0187 summarized under "Temporary Partial.")
The standard of review in workers' compensation cases
is whether there is competent substantial evidence to
support the ruling of the Judge of Compensation Claims.
Traditionally, however, a Judge of Compensation Claims
must make findings of fact that justify his decision.
It is the function of the Judge of Compensation Claims
to determine the credibility of the witnesses and
resolve conflicts in the evidence. A Judge of
Compensation Claims cannot reject unrefuted medical
testimony without providing sufficient reason. In this
case, the judge rejected unrefuted medical testimony of
a psychiatrist who testified that the claimant could
not work without stating reasons for such rejection of
testimony. JCC's decision reversed and case remanded
for further findings.
