Cases

Pursuant to Section 440.105(4)(b)1-3, Florida Statutes, it is unlawful for any person to make or cause to be made any false, fraudulent, incomplete, or misleading oral or written statement for the purpose of securing compensation. An employee who knowingly or intentionally violates Section 440.105(4)(b), 1-3 is not entitled to workers' compensation benefits.  See Section 440.09(4)(a), Florida Statutes.  

Under Rule 60Q-6.113(2), a fraud or misrepresentation defense based on Sections 440.09(4)(a) and Section 440.105, F.S., must be detailed specifically in the pre-trial proceedings in the trial stipulation with specificity detailing the conduct giving less to the defense.  To establish a defense, the employer/carrier must prove violations of Section 440.105(4)(b) by a preponderance of the evidence.  The JCC is then required to determine whether the claimant knowingly or intentionally made the false, fraudulent, incomplete or misleading statement, whether or oral or written, for the purpose of obtaining workers' compensation benefits or in support of his claim for benefits. The false, fraudulent or misleading statement does not need to be material to the claim; however, it must be made for the purpose obtaining workers' compensation benefits. A JCC's ruling on a fraud or misrepresentation defense is reviewed for competent and substantial evidence and the factual findings will be upheld if any such evidence supports the JCC's decision, regardless of whether other persuasive evidence if accepted by the JCC might have supported a contrary ruling.  But to the extent the ruling involves the JCC's interpretation and application of the statute, it is a question of law subject to the de novo standard of review.

Based upon the credibility of the injured worker, the JCC determined that the claimant did not mis-state facts to the employer/carrier supporting a misrepresentation defense.  Court determined that it is within the JCC's discretion to resolve a conflict in the evidence and make credibility determinations.

JCC also determined that the claimant did not make fraudulent misrepresentations to her doctor based upon surveillance films obtained by the employer/carrier. The misrepresentations statute requires that the employer/carrier prove the claimant made or caused to be made a false, fraudulent, or incomplete or misleading oral or written statement for the purpose of securing compensation.  JCC determined that there was no oral or written statement by claimant to her doctor that would serve as the necessary predicate for a valid misrepresentation finding.