firefighter by DVIDSHUB on flickrThe Florida Supreme Court will hear oral argument in the Westphal v. City of St. Petersburg early June 2014, a case that employers, insurance carriers, and workers compensation attorneys are closely watching. The First District Court of Appeal, which hears all workers compensation appeals from the Judges of Compensation Claims, certified the following question:

Is a worker who is totally disabled as a result of a workplace accident, but still improving from a medical standpoint at the time temporary total disability benefits expire, deemed to be at “maximum medical improvement” (MMI) by operation of law and therefore eligible to assert a claim for permanent and total disability benefits?

“Date of maximum medical improvement” is defined as “the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.” The date an injured worker reaches MMI is a significant milestone in workers compensation, as it has historically determined the end of eligibility for temporary disability benefits.

Background of the Westphal Case

Bradley Westphal, a firefighter, felt a sharp pain in his back as he was moving heavy furniture while fighting a fire. By the time he returned to the fire station, he reported extreme pain and a loss of feeling in his left leg from the knee down. The City of St. Petersburg accepted compensability of his low back and left knee injuries and provided both indemnity and medical benefits.

Mr. Westphal sought and obtained temporary total disability (TTD) benefits for a period of 104 weeks but he was still totally disabled at the time those benefits expired. He filed a petition for benefits seeking permanent total disability (PTD) benefits, but the judge of compensation claims denied the petition after agreeing with Mr. Westphal’s treating physician that he was not at MMI.

This controversy stems from a supposed “gap” in the statute, in which some totally disabled workers are ineligible to apply for PTD benefits if they are not medically deemed to be at MMI. The First DCA was deeply concerned about this “gap,” with the majority finding that “the notion that there can be a period of time during which a disabled worker is not entitled to be compensated for his or her workplace injury is contrary to the basic purpose of the Workers’ Compensation Law.”

The First DCA’s Opinion

The First DCA withdrew an earlier decision which declared the 102 week statutory limitation on TTD benefits unconstitutional. In place of the earlier opinion, it issued an “en banc” decision holding that a worker who is totally disabled as a result of a workplace accident, and remains totally disabled by the end of his or her eligibility for temporary total disability benefits, is deemed to be at maximum medical improvement by operation of law.  Therefore, the worker is eligible to assert a claim for permanent and total disability. In doing so, the First DCA rejected its prior decisions that held an employee whose temporary benefits have run out, or are expected to do so imminently, must be able to show not only total disability at the end of temporary benefits but also that total disability will be existing after the date of MMI.

The court observed that employers and workers compensation carriers are not without recourse, since the Workers Compensation Law (§ 440.15(1)(d), Fla. Stat. (2009)) allows them to discontinue the payment of disability benefits to a worker who has regained earning capacity through rehabilitation: “When an employee is deemed to be at maximum medical improvement by operation of law, the employer is not stuck with that determination forever. The worker’s status and eligibility for benefits can change with the circumstances.”

However, the dissenting judges characterized the court’s decision as an “end run” and “brazen defiance of a clear statutory directive” that limits temporary benefits to two years under Florida law.

The Bottom Line

Given the importance of the First DCA’s ruling to future workers’ compensation benefits and cases, employers, insurance carriers, and attorneys are anxiously waiting to see how the Florida Supreme Court rules on these issues. We will of course keep you posted—stay tuned to our blog for updates.

Photo Courtesy of DVIDSHUB on Flickr