Cases

In order for there to be a compensable accidental injury, the accident must be the major contributing cause of resulting injuries.  The injured worker bears the burden of proving entitlement to claimed medical benefits with evidence that the compensable industrial injury is the major contributing cause for the requested medical treatment.  Once the claimant establishes that the accident is the major contributing cause of the injuries, 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 care was due to a condition unrelated to the injury which the employer/carrier accepted as compensable. 

In this case, the employer/carrier accepted as compensable injuries to the lumbar spine without being specific as to the exact diagnosis that was admitted to be compensable, similar to the broad stipulation between the accident and resulting injuries as referenced in the case of Jackson v. Merit Elec., 37 So. 3d 381 (Fla. 1st DCA).  There was no evidence of any specific diagnosis that was admitted by the employer/carrier to be compensable; just the general statement that treatment for the claimant's back pain. 

Court determined that by accepting treatment for the general diagnosis made, this had the effect of admitting to compensability of all treatments to the claimant's back even though some of the treatment related to preexisting degenerative changes in the back.  By accepting general treatment to the back, court determined that the employer/carrier had stipulated that all treatment to the back would be compensable.  In this case, the employer/carrier failed 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.  Court determined that the employer/carrier's failure to prove a break in the causation chain precluded the employer/carrier denying compensability and accordingly, the court awarded benefits to the injured worker overturning the JCC's order to the contrary. The claimant was not required to establish major contributing cause because the employer/carrier entered into a broad stipulation with the claimant that did not define the accepted compensable injury any more narrowly than the lumbar spine.  As a result of that stipulation, the burden shifted to the employer/carrier to demonstrate a break in causation and the employer/carrier failed to provide evidence of any intervening or competing cause.