Siena v. Orange County Fire/Rescue/CCMSI,(Fla. 1^st DCA 8/20/25)
Powers of JCC/Attorney Disqualification

The DCA affirmed the JCC’s Order disqualifying the Bichler Longo firm from representing the claimant. The underlying issue resulted from the Bichler firm hiring an attorney who previously worked on the claimant’s case for the defense firm.The defense firm moved to disqualify the claimant’s firm although there was no pending PFB following the appeal of the JCC’s original Order denying the claimant widow death benefits. The DCA found the JCC had jurisdiction to disqualify the firm and properly exercised his discretion in so doing. JCC Tannebaum issued a lengthy decision analyzing and discussing those issues.Click here to view Opinion

Mejia Palacios v. AHCA (Fla. 1^st DCA 8/20/25)
Medicaid Liens/Determination of Amount

The DCA reversed and remanded the ALJ’s determination of the percentage amount of an injured worker’s settlement that should go toward reimbursing Medicaid. Medicaid paid $35,031.49 following claimant’s workplace fall. In discovery in the underlying case, it was shown claimant had fall protection gear available, but that he conceded he declined to use it and it would have prevented his fall.The case settled for $238,500.00.There was no stipulation as to how much of that settlement was for medical care.F.S. s. 409.910(11)(f) provides a formula for Medicaid lien recovery which is, after attorney fees and taxable cost, “one half the remaining recovery up to the total amount of medical assistance provided by Medicaid.”AHCA sought the full amount of the lien based on that formula, and Palacios filed a DOAH petition, attended a hearing and presented two expert witnesses (regarding “Full Value,” in relation to his argument that the amount to be recovered was only for medical care) and entered documentary evidence. AHCA presented only the summary of expenses. The ALJ considered that evidence and “proportionality methodology” in determining that the amount the claimant should pay should be impacted by his comparative negligence (and thus not reduced). The DCA found there was no reasonable basis to reject Palacio’s uncontroverted evidence in support of the lower lien.Click here to view Opinion

JCC Pitts (Orlando) - Multiple PFBs were filed regarding the claimant’s September 28, 2023 accident while employed by Soffit Installer, LLC, which was found to have no WC insurance coverage. The legal issue was whether the claimant, allegedly a 10% owner of Soffit, was barred from receiving benefits due to a Certificate of Exemption issued by the Department of Financial Services. The claimant denied any knowledge of ownership or an exemption application being filed on his behalf. The evidence, including testimony and documentation, revealed that the claimant began working and was initially paid in cash. Testimony from the owner of Soffit was deemed not credible, and it was determined that the claimant did not complete or submit the required DWC-250 form to elect exemption from WC coverage. Consequently, the JCC ruled that the claimant was not an exempt corporate officer and was entitled to benefits under the workers' compensation coverage of Advanced Home Exteriors, the statutory employer.Click here to view Order

Compensability

JCC Jacobs (Orlando) - The JCC ruled in favor of the claimant finding that he was entitled to the presumption of causation under §112.18, F.S., regarding the diagnosis of cardiomyopathy, which was determined to be a covered condition. The evidence established that the claimant, a lieutenant with the Brevard County Fire Service, had no history of heart disease prior to May 8, 2024, when he underwent an annual physical revealing abnormal results that necessitated further evaluation. Testimony from the claimant's IME, Dr. Borzak, and somewhat from the E/C’s IME, Dr. Parikh, corroborated that cardiomyopathy is recognized as heart disease, despite the E/C’s argument citing the North Collier decision, which the JCC determined was not sufficient to rebut the presumption as both examining cardiologists acknowledged the claimant’s condition. The claimant was awarded TTD benefits from May 8, 2024, through June 21, 2024, and the E/C was ordered to provide recommended medical treatment and attorney's fees and costs were awarded.Click here to view Order

JCC Weiss (Ft. Myers) – Denied and dismissed all claims with prejudice. The claimant, a commercial loan processor, alleged that hearing a fire alarm while at work on August 26, 2024, caused her tinnitus and other ear-related issues. Following the hearing, the JCC found that the claimant failed to meet her burden of proof regarding the causal connection between her medical conditions and the alleged incident at work. Despite the testimony of her treating ENT, Dr. Greene, who attributed her symptoms to the fire alarm exposure, the JCC determined his opinion was based on an inaccurate history provided by the claimant, who had prior diagnoses of tinnitus and hearing loss that were not disclosed to Dr. Greene. Furthermore, the E/C’s IME physician, Dr. Klausner, opined that the claimant's symptoms were not related to the workplace incident but rather could be explained by various other factors, including her medical history and lifestyle. Finally, the JCC rejected the claimant's arguments due to contradictions in her medical records and testimony and denied and dismissed all claims, including attorney’s fees and costs, with prejudice. Click here to view Order

JCC Almeyda (Miami) – Awarded compensability and continued medical treatment. The claimant's 2024 right-knee injury was found to remain related to the work accident, despite the E/C’s denial of further medical treatment due to preexisting conditions. The JCC accepted the testimony of the claimant's IME, Dr. Eric Shapiro, over the opinions of the E/C's physicians, determining that the claimant's current knee condition was a progression of her prior work-related knee injuries from 2010, 2015 and 2022 and not merely due to osteoarthritis or non-work-related factors. The JCC ruled in favor of the claimant and ordered the E/C to provide ongoing care with Dr. Sergio Glait, physical therapy for both knees and necessary injections as prescribed by Dr. Shapiro. Attorney's fees and costs were reserved for determination in a later proceeding.Click here to view Order

Indemnity

JCC Walker (Pensacola) - Awarded TPD and other benefits. The claimant, a 49-year-old former employee, sustained a compensable accident on July 18, 2023. At hearing, he testified about ongoing right foot and ankle pain that hindered his ability to work, resulting in a significant reduction in earnings. The E/C did not present any defenses due to a previous Order striking their defenses for failure to attend the state mediation nor respond to the Order to Show Cause and did not appear for the hearing. The JCC issued an Order following the hearing and found that while the claimant did not qualify for TTD benefits as no physician had put him on a no-work status, he was entitled to TPD benefits due to ongoing medical restrictions and his loss of income. The JCC also granted the request for medical treatment, set the AWW at $750.00 and awarded the penalties, interest and attorney's fees, while reserving jurisdiction for unresolved amounts. Click here to view Order

JCC Anthony (Tampa) – Granted claimant’s Motion for Advance. The JCC granted the claimant's Motion for Advance, awarding $2,500.00 based on a finding of substantial loss of earning capacity due to the 10/5/2024 compensable accident. The claimant had sustained a right distal-radius fracture, which required surgery and resulted in significant work restrictions limiting her to only nine hours of work per week. Despite having returned to work, she faced financial difficulties due to her reduced income and outstanding bills totaling over $7,500.00, which she established through her testimony and documentary evidence. The JCC found that the advance was in the claimant's best interest, would not materially prejudice the rights of the E/C and was reasonable under the circumstances, thus satisfying the criteria outlined in section 440.20(12)(d), F.S. The advance was deemed necessary to help the claimant address her immediate financial obligations while awaiting further developments in her case. The Order also permitted the E/C to recoup the amount according to the law.Click here to view Order

JCC Walker (Pensacola) – Denied adjustment to AWW and attorney’s fees and costs. The JCC denied the claimant's request to increase her average weekly wage from $1,211.77, which the E/C had established based on payroll records and confirmed through testimony. The claimant argued that the E/C's calculations were inaccurate and sought attorney's fees under Guerrera v. Becton Dickenson & Co., but the JCC ruled that she failed to provide evidence supporting an increase in the AWW.Click here to view Order

JCC Newman (Tallahassee) – Awarded TPD and medical care. The JCC awarded the claimant TPD benefits due to a compensable knee injury while working as a day laborer. The claimant had sought treatment at Tallahassee Memorial Hospital following the accident in which he slipped and fell while using a weed-eater, resulting in significant knee pain. The E/C asserted there was no medical evidence supporting the claim for benefits and argued non-compliance with authorized care at the Tallahassee Memorial Urgent Care Center. However, the JCC found credible the opinions of Dr. Alex Ho and Dr. Ryan Cotton, both of whom testified that the accident was the major contributing cause of claimant's injury and need for orthopedic care. The JCC concluded that the claimant had not reached MMI and was entitled to TPD benefits and ordered the E/C to authorize orthopedic treatment but denied the claim for TTD benefits.Click here to view Order

Medical

JCC Ring (Ft. Lauderdale) – The JCC granted the claimant's request for a one-time change physician after finding that the E/C was estopped from asserting the statute of limitations (SOL) defense because they failed to provide the required notice regarding the SOL periods as mandated by F.S. 440.185. During the hearing, the claimant credibly testified that he had not received any informational materials from the E/C and had no knowledge of the SOL until he spoke with his attorney in December 2024. The E/C's argument that the PFB, filed on December 19, 2024, was time-barred due to the expiration of the two-year limitation and one-year tolling period was rejected, and the JCC awarded attorney's fees and costs to the claimant's counsel for securing benefits.Click here to view Order

JCC Massey (Tampa) – Denied claimant’s request for one-time change. The claimant requested a one-time change of physicians from Dr. Stuart Patterson to Dr. Thao Nguyen pursuant to 440.13(2)(f). Because the E/C had already authorized an appropriate change to Dr. Adam Jester, who was a board-certified orthopedic surgeon same as Dr. Patterson, the JCC ruled the claimant was not entitled to another change despite the claimant’s argument that Dr. Jester did not share the same sub-specialty as Dr. Patterson concerning the treatment of hand and wrist conditions, including de Quervain's tenosynovitis. The JCC found that Dr. Patterson had not provided a diagnosis or treatment plan during the initial visit, also making the one-time change request premature. Furthermore, the treatment provided by Dr. Jester, which included diagnostic injections and a referral to Dr. Nguyen for surgical evaluation, was deemed reasonable and appropriate. Accordingly,the claim for the change and for attorney's fees and costs was denied.Click here to view Order

Please note that the DCA Opinions and Merit Orders contained in this newsletter are non-final until 30 days after their rendition. Until that time, they are subject to amendment, vacation, or other action which may remove or alter some or all of the decision. Please contact any HR Law attorney if you have a question as to the finality and applicability of an Opinion or Order. We endeavor to include any amendments or alterations to Opinions or Orders that may occur at a later date.