Cases

Parties stipulated that the employer/carrier accepted compensability of a work related exposure and "building related illnesses associated with indoor air quality problems."  Medical care was authorized with a pulmonologist.  The JCC approved this joint stipulation by order.  Thereafter, the employer/carrier issued a Notice of Denial terminating all further medical treatment to the claimant. The decision to deny further medical care was based solely on a peer review report.  In the Notice of Denial, the employer/carrier asserted that the work accident was no longer the major contributing cause of the need for medical treatment. The employer/carrier's expert determined that the claimant had a vocal cord dysfunction unrelated to a workplace exposure and the claimant did not suffer from asthma and accordingly, the asthma medications prescribed by the pulmonologist was not payable. The authorized doctor disagreed with the IME's diagnosis.  

JCC entered order denying all claims. The JCC accepted the testimony of the employer/carrier's IME.  On appeal, court reversed.

Once a claimant has established compensability of an injury via a prior ruling or a stipulation, the employer/carrier cannot challenge the causal connection between the work accident and the injury.  The employer/carrier may only question the causal connection between the injury and the requested benefit.  The employer/carrier bears the burden of proof to demonstrate a break in the causation chain, such as the occurrence of a new accident or that the requested treatment was due to a condition unrelated to the injury which the employer/carrier had accepted as compensable.  A break is understood to occur when the work related cause drops to 50% or less of the total cause of the need for the requested benefit.  In this case, the employer/carrier did not assert that there had been any break in the chain of causation or provide evidence to support any such break.  By the employer/carrier's stipulation of compensability, the claimant was excused of the burden to re-establish causation.  The IME that was performed by the employer/carrier indicated simply that the doctor originally had misdiagnosed the claimant's condition, not that an unrelated condition was causing the current need for treatment. The claimant's symptoms had not substantially changed since the original compensable exposure agreed to between the parties.