NOVEMBER 2015 CASE LAW REVIEW

November_HeaderGOMEZ-LUJANO V. PALM BEACH GRILL-HOUSTON’S/TRAVELERS INS.

Facts: The claimant suffered a compensable injury on October 31, 2001. As a result of the injury, the Employer/Carrier (E/C) provided, among other things, 104 weeks’ worth of temporary indemnity benefits ending on December 3, 2004. The claimant returned to work from 2005 until April 2007, when he underwent shoulder surgery for one of his compensable injuries. As a result, the claimant was removed from work from April 30, 2007, to June 12, 2007, and was restricted from working full-duty from June 13, 2007, to September 14, 2007.

The claimant filed two petitions for benefits seeking, among other things, additional temporary disability benefits or, in the alternative, PTD benefits.

Analysis: Relying on the 104-week statutory limitation contained in paragraphs 440.15(2)(a) and 440.15(4)(b), Florida Statutes (2001), the JCC denied the request for temporary benefits. The JCC also denied the request for PTD benefits, reasoning that the claimant did not meet his burden to prove entitlement to such under the law in effect on the date of his accident. The claimant appealed.

The 1st DCA agreed that the JCC properly applied their decision in Westphal v. City of St. Petersburg, 122 So. 2d 440 (Fla. 1st DCA 2013) (en banc), when she denied the requests for PTD benefits and for temporary benefits beyond the 104-week statutory limitation. The Court pointed out that while Westphal supplants a claimant’s need to establish attainment of MMI, the claimant still needs to prove the other elements of a claim for PTD benefits. Although Westphal makes a claimant “eligible to assert a claim for permanent and total disability benefits,” it does not automatically entitle a claimant to the payment of such benefits, and the claimant was still required to present evidence that he otherwise meets the legal standards for such an award.

FRANCISCO GOBEL, APPELLANT, V. AMERICAN AIRLINES AND SEDGWICK CMS, APPELLEES

Facts: The claimant appealed the JCC’s order denying stipulated litigation costs of $200 payable by the E/C.

After the claimant prevailed on a claim for medical benefits, the parties stipulated to an E/C-paid attorney fees and costs and submitted it to the JCC for approval. The JCC denied the stipulation because no supporting documentation describing the costs was provided. The JCC expressed concern that he was unable to determine if the claimed costs were truly costs as opposed to attorney’s fees disguised as costs. The claimant argued that no documentation was necessary since Florida Administrative Code Rule 60Q-6.123(5) provides, in part, that “[a] claim for cost reimbursement in the amount of $250 or less shall not be set forth with specificity or detail.” The JCC rejected the claimant’s argument based upon his determination that the administrative rule is not valid. The Court concluded, however, that both the JCC and Claimant mistakenly applied rule 60Q-6.123(5) to this case.

Analysis: The Court said that rule 60Q-6.123(5) applies only to settlements under section 440.20(11), Florida Statutes, where a claimant is responsible for paying his or her own attorney’s fees and costs. In contrast, the stipulation in this situation was for E/C-paid costs. Florida Administrative Code Rule 60Q-6.124(2), which is the applicable rule for fees and costs paid by a carrier apart from section 440.20(11) settlements, permits parties to “stipulate to the payment of attorney’s fees and costs,” with no requirement that the agreed-upon costs be justified or detailed. Such matters are governed by the law of contracts and settlement, with no specialized rules.

The Court pointed out that the claimant was not being asked to pay the costs incurred by his lawyer and that the JCC’s apparent concern for Claimant’s welfare was misplaced.

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