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        <title><![CDATA[workers' compensation - Jeffrey P. Gale, P.A.]]></title>
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        <description><![CDATA[Jeffrey P. Gale, P.A.'s Website]]></description>
        <lastBuildDate>Fri, 10 Apr 2026 01:27:05 GMT</lastBuildDate>
        
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                <title><![CDATA[Jeffrey P. Gale, P.A. /// Landmark Decision Changes How the Statute of Limitations is Applied in Florida Workers’ Compensation Cases]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-landmark-decision-changes-how-the-statute-of-limitations-is-applied-in-florida-workers-compensation-cases/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-landmark-decision-changes-how-the-statute-of-limitations-is-applied-in-florida-workers-compensation-cases/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Fri, 10 Apr 2026 01:15:12 GMT</pubDate>
                
                    <category><![CDATA[Insurance Law]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[440.19]]></category>
                
                    <category><![CDATA[chapter 440.19 florida statutes]]></category>
                
                    <category><![CDATA[estes v palm beach county school district]]></category>
                
                    <category><![CDATA[first district court of appeal]]></category>
                
                    <category><![CDATA[florida workers' compensation sol]]></category>
                
                    <category><![CDATA[florida workers' compensation statute of limitations]]></category>
                
                    <category><![CDATA[major contributing cause]]></category>
                
                    <category><![CDATA[sol]]></category>
                
                    <category><![CDATA[statute of limitations]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                    <category><![CDATA[workplace injuries]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2020/09/calendar-1192688.jpg" />
                
                <description><![CDATA[<p>For more than thirty years, lawyers and judges have misapplied the statute of limitations in Florida workers’ compensation cases. Undoubtedly, this error has deprived countless injured workers of benefits to which they were entitled. In Estes v. Palm Beach County School District, an opinion issued on March 23, 2026, the First District Court of Appeal&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>For more than thirty years, lawyers and judges have misapplied the statute of limitations in Florida workers’ compensation cases. Undoubtedly, this error has deprived countless injured workers of benefits to which they were entitled.</p>



<p>In <em><a href="/Users/Jeff/Dropbox/Public/Jeff/WORKCOMP/LAW/SOL/WOW!%20WOW!%20Estes%20v.%20PALM%20BEACH%20COUNTY%20SCHOOL%20DISTRICT,%20Fla_%20Dist.%20Court%20of%20Appeals,%201st%20Dist.%202026%20-%20Google%20Scholar.html" target="_blank" rel="noreferrer noopener">Estes v. Palm Beach County School District</a></em>, an opinion issued on March 23, 2026, the <a href="https://1dca.flcourts.gov/" target="_blank" rel="noreferrer noopener">First District Court of Appeal</a> fundamentally reshaped the workers’ compensation landscape by redefining the application of the statute of limitations (SOL). The decision benefited Nancy Estes by allowing her to file a benefits claim nearly six months after it would have been barred under the previous interpretation of the law, with an additional eighteen months available had she needed it.</p>



<p>The statute of limitations for workers’ compensation claims is governed by <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.19.html" target="_blank" rel="noreferrer noopener">section 440.19 of the Florida Statutes</a>. In 1994, a <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2025&Title=%2D%3E2025%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">comprehensive overhaul of Florida’s Workers’ Compensation Law</a> took effect. As part of that reform, the Legislature replaced the statute‑of‑limitations framework in section 440.19(1), Florida Statutes, which had allowed claimants to obtain successive two‑year extensions to pursue benefits. Under that framework, a claim could be filed within 2 years after the date of the last payment of compensation or after the date of the last remedial treatment or rehabilitative services furnished by the employer. </p>



<p>Under this pre-1994 regime, the <a href="https://supremecourt.flcourts.gov/" target="_blank" rel="noreferrer noopener">Florida Supreme Court</a> consistently treated the statutory language as an <em>extension</em> of the statute of limitations as opposed to a suspension of it (citations omitted). Starting in 1994, the <a href="https://www.leg.state.fl.us/Welcome/index.cfm?CFID=148786472&CFTOKEN=df2a0a465284eeb6-90B86865-BC64-29EB-44FE16345748A647" target="_blank" rel="noreferrer noopener">Florida Legislature</a> changed the text of the operative statute of limitations provision in § 440.19 from an extension-based regime to a tolling-based one. (In doing so, the Legislature reduced the add-on time from two years to one.) Let’s use the facts in <em>Estes</em> to demonstrate how the two systems differ in application:</p>



<p>The accident occurred on September 30, 2021. The Employer/Carrier (E/C) provided workers’ compensation medical and indemnity benefits to Estes for approximately sixteen months, from October 2021 through January 26, 2023. After that period, the E/C denied further benefits, asserting that the accident was not the <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" target="_blank" rel="noreferrer noopener">major contributing cause</a> of her need for additional treatment or compensation. In June 2024 – approximately seventeen months after receiving her last benefits – Estes filed a petition for benefits (PFB) seeking a one‑time change of orthopedist and other relief. The E/C denied the claims, asserting that the statute of limitations barred them in their entirety. Its analysis relied on principles drawn from the pre‑1994 framework, under which the statute of limitations would have expired on January 26, 2024 – one year after the E/C last provided medical or indemnity benefits. The Judge of Compensation Claims (JCC) accepted the E/C’s position.</p>



<p>Relying on straightforward statutory interpretation – overlooked for decades – the First DCA reversed the JCC by concluding that the 1994 amendment created a suspension‑based statute‑of‑limitations system, replacing the pre‑1994 extension‑based model. Under the 1994 framework, the two‑year statute of limitations was suspended – i.e., tolled – from October 2021 through January 26, 2023, the period during which the E/C was providing workers’ compensation benefits. When benefits ceased, the statute did not simply restart with a one‑year extension, as under the pre‑1994 model. Instead, the claimant received that one‑year extension to January 2024, and only after that extension expired did the remainder of the original two‑year limitations period begin to run. Because only one month had elapsed between the accident and the first provision of benefits, approximately twenty‑three months remained on the primary limitations period. Thus, rather than having only one year from January 2023 to file a claim, Estes had the one‑year extension <strong>plus the remaining twenty‑three months</strong> – giving her until late December 2025 to bring a claim.</p>



<p>If your claim has been denied on statute of limitations grounds, please contact our office for a free consultation to assess whether the assertion was misplaced. </p>



<p><strong>**********************</strong></p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Chwa Medikal Limite nan Ka Konpansasyon Travayè Florid yo]]></title>
                <link>https://www.jeffgalelaw.com/blog/2855923/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/2855923/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Mon, 05 Jan 2026 20:35:19 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[1x change]]></category>
                
                    <category><![CDATA[440.13]]></category>
                
                    <category><![CDATA[chapter 440]]></category>
                
                    <category><![CDATA[doctor selection]]></category>
                
                    <category><![CDATA[one-time change]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2023/05/surgeon-3-391477-m.jpg" />
                
                <description><![CDATA[<p>Lwa Florid § 440.13 gouvène dispozisyon swen medikal anba sistèm konpansasyon travayè Florid la. Anjeneral, anplwayè a ak konpayi asirans li a (kolektivman, “E/C”) egzèse yon kontwòl sibstansyèl sou swen medikal yon travayè blese. Manifestasyon ki pi enpòtan nan kontwòl sa a se dwa legal E/C a pou chwazi doktè otorize pou trete moun ki&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p class="has-medium-font-size">Lwa Florid § 440.13 gouvène dispozisyon swen medikal anba sistèm konpansasyon travayè Florid la. Anjeneral, anplwayè a ak konpayi asirans li a (kolektivman, “E/C”) egzèse yon kontwòl sibstansyèl sou swen medikal yon travayè blese.</p>



<p class="has-medium-font-size">Manifestasyon ki pi enpòtan nan kontwòl sa a se dwa legal E/C a pou chwazi doktè otorize pou trete moun ki fè reklamasyon an. An pratik, dinamik sa a souvan lakòz opinyon medikal ki aliyen ak enterè E/C a, souvan nan detriman travayè blese a. Piske doktè sa yo depann sou referans konpayi asirans pou yon gwo pòsyon nan pratik yo, opinyon yo ka—konsyaman oswa otreman—reflete reyalite ekonomik sa a.</p>



<p class="has-medium-font-size">Sepandan, nan kèk okazyon limite, doktè ijans lan pèdi kontwòl swen medikal la tanporèman. Senaryo ki pi komen an rive lè moun k ap fè reklamasyon an sibi blesi grav ki mande entène lopital ak operasyon dijans. Nan ka sa yo, chirijyen k ap bay tretman an—sitou yon moun ki gen yon pratik prive—souvan kontinye kòm doktè prensipal la apre moun k ap fè reklamasyon an kite lopital la. Pandan ke doktè sa a pa chwazi pa doktè moun k ap fè reklamasyon an, doktè moun k ap fè reklamasyon an pa chwazi non plis. Malgre sa, kontwòl inisyal doktè ijans lan sou seleksyon doktè a deranje.</p>



<p class="has-medium-font-size">Seksyon 440.13(2)(c) nan Lwa Florid yo bay E/C a yon “peryòd tan rezonab” pou bay premye tretman ak swen medikal. Si E/C a pa fè sa, moun k ap fè reklamasyon an “ka jwenn premye tretman sa a sou kont anplwayè a”. Menm lè sa a, sepandan, lwa a pèmèt E/C a reprann kontwòl swen medikal la pita.</p>



<p class="has-medium-font-size">Prensip sa a te ilistre nan ka Carmack kont Eta Florid, Depatman Agrikilti, 31 So. 3d 798 (Fla. 1st DCA 2009). La, moun ki te fè reklamasyon an te soufri yon aksidan ki ka resevwa konpansasyon, men Tribinal E/C a te refize otorize tretman sikyatrik ki soti nan blesi fizik nan janm ak nan do moun ki te fè reklamasyon an. Moun ki te fè reklamasyon an te chèche tretman ak yon sikyat poukont li epi li te depoze yon Petisyon pou Benefis pou mande otorizasyon swen nan tan lontan ak nan lavni ak doktè sa a. Jij Reklamasyon Konpansasyon an te bay lòd pou Tribinal E/C a peye pou tretman an jiska dat dènye odyans lan, men li te refize otorize swen kontinyèl ak sikyat moun ki te fè reklamasyon an te chwazi a. Okontrè, yo te pèmèt Tribinal E/C a chwazi yon lòt sikyat. Tribinal Apèl Premye Distri a te konfime sa, sa ki te ranfòse kapasite Tribinal E/C a pou reprann kontwòl sou swen medikal la menm apre yon premye echèk pou otorize tretman.</p>



<p class="has-medium-font-size">Seksyon 440.13(2)(f) nan Lwa Florid yo bay sa ki souvan sèl opòtinite enpòtan pou yon moun k ap fè reklamasyon chwazi yon doktè ki pral rete otorize pou lavni. Sepandan, opòtinite sa a rive sèlman lè E/C a komèt yon erè legal. Pati ki enpòtan nan lwa a bay:</p>



<h2 class="wp-block-heading has-medium-font-size" id="ucj-12">Sou demann alekri anplwaye a, konpayi asirans lan dwe bay anplwaye a opòtinite pou chanje doktè yon fwa pandan tretman an pou nenpòt aksidan… Konpayi asirans lan dwe otorize yon lòt doktè ki pa dwe afilye pwofesyonèlman ak ansyen doktè a nan lespas 5 jou apre li fin resevwa demann lan. Si konpayi asirans lan pa bay yon chanjman doktè jan anplwaye a mande a, anplwaye a ka chwazi doktè a epi doktè sa a dwe konsidere kòm otorize si tretman y ap bay la konpanse epi li nesesè medikalman.</h2>



<p class="has-medium-font-size">Nan ka Zekanovic kont American II, Corp., 208 So. 3d 851 (Fla. 1st DCA 2017), Distri a pa t reponn nan senk jou a demann alekri moun ki te fè reklamasyon an pou yon chanjman doktè yon sèl fwa anba seksyon 440.13(2)(f). Moun ki te fè reklamasyon an te depoze yon Petisyon pou Benefis apre sa pou mande otorizasyon yon doktè espesifik kòm chanjman yon sèl fwa li. Malgre ke JCC a te jwenn ke moun ki te fè reklamasyon an te gen dwa pou chanjman yon sèl fwa a, JCC a te konkli ke paske moun ki te fè reklamasyon an pa t ko jwenn tretman ak doktè li te mande a anvan yo te pase lòd la, Distri a te kenbe dwa pou chwazi doktè ranplasman an. Nan apèl la, Premye Distri a te ranvèse desizyon an, li te deside ke echèk Distri a pou reponn alè te fè li pèdi dwa li pou chwazi doktè a, epi ke moun ki te fè reklamasyon an te gen dwa pou trete ak doktè li te chwazi a.</p>



<p class="has-medium-font-size">Nan pratik nou an, nou regilyèman mande chanjman doktè yon sèl fwa. Etandone konsekans enpòtan yon repons ki pa alè—anpalan de pèt kontwòl medikal—E/C a prèske toujou konfòme li nan senk jou legal la epi li kenbe dwa pou chwazi doktè ranplasman an. Ka kote E/C a pa reponn alè yo ra anpil. Sepandan, nan ka sa a, yon echèk konsa te rive. Li enpòtan pou note ke neglijans lan sanble akòz avoka opozan an olye ke ajistè a. Nan enterè pwofesyonalis, nou te ofri pou travay an kolaborasyon ak avoka a pou idantifye yon lòt doktè ki akseptab pou tou de pati yo. Diskisyon sa yo jiskaprezan pa reyisi, paske nou pa vle dakò ak youn nan doktè karyè yo chwazi regilyèman. Antretan, moun ki fè reklamasyon an pwograme pou trete ak doktè li te chwazi a pita nan mwa sa a. Avoka opozan an konprann ke si pa gen yon akò sou yon lòt doktè anvan randevou sa a, E/C a ap oblije otorize tretman ak doktè moun ki fè reklamasyon an chwazi a dapre seksyon 440.13(2)(f).</p>



<p class="has-medium-font-size">**************************************</p>



<p class="has-medium-font-size">Kontakte nou nan 305-758-4900 oubyen pa imèl pou w konnen dwa legal ou yo.</p>



<p class="has-medium-font-size">Jeffrey P. Gale, P.A. se yon kabinè avoka ki baze nan Sid Florid ki angaje nan sistèm jidisyè a epi pou reprezante epi jwenn jistis pou moun – pòv yo, moun ki blese yo, moun ki bliye yo, moun ki pa gen vwa yo, moun ki san defans yo ak moun ki kondane yo, epi pou pwoteje dwa moun sa yo kont opresyon kòporasyon ak gouvènman an. Nou pa reprezante gouvènman, kòporasyon oswa gwo enterè biznis yo.</p>



<p class="has-medium-font-size">Pandan ke rezolisyon rapid nan pwoblèm legal ou a se objektif nou, apwòch nou an fondamantalman diferan. Kliyan nou yo se “moun” epi yo pa “ka” oswa “dosye”. Nou pran tan pou nou bati yon relasyon ak kliyan nou yo, nou reyalize ke se sèlman atravè yon entèraksyon ki gen sans nou ka pi byen sèvi bezwen yo. Nan fason sa a, nou te kapab pi byen ede moun ki bezwen reprezantasyon legal.</p>



<p class="has-medium-font-size">AVÈTISMAN: Enfòmasyon sa a ki bay pa Jeffrey P. Gale, P.A. se pou rezon enfòmasyon sèlman epi li fèt pou itilize kòm yon gid ki pa legal anvan konsiltasyon ak yon avoka ki abitye ak sitiyasyon legal espesifik ou a. Li pa ta dwe konsidere kòm konsèy legal oswa konsèy. Pa gen okenn entansyon pou bay konsèy legal oswa konsèy sa yo, ni eksplisitman ni enplisitman. Enfòmasyon sa a pa ranplase konsèy oswa konsèy yon avoka. Si ou bezwen konsèy legal, ou ta dwe chèche sèvis yon avoka.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Limited Medical Choices in Florida Workers’ Compensation Cases]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-limited-medical-choices-in-florida-workers-compensation-cases/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-limited-medical-choices-in-florida-workers-compensation-cases/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Fri, 02 Jan 2026 17:21:54 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[1x change]]></category>
                
                    <category><![CDATA[choice of doctor]]></category>
                
                    <category><![CDATA[doctor selection]]></category>
                
                    <category><![CDATA[insurance carrier]]></category>
                
                    <category><![CDATA[medical choices]]></category>
                
                    <category><![CDATA[medical control]]></category>
                
                    <category><![CDATA[one-time change]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                    <category><![CDATA[workers' compensation doctor selection]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2020/09/doctor.jpg" />
                
                <description><![CDATA[<p>Florida Statute § 440.13 governs the provision of medical care under Florida’s workers’ compensation system. As a general rule, the employer and its insurance carrier (collectively, the “E/C”) exercise substantial control over an injured worker’s medical care. The most significant manifestation of this control is the E/C’s statutory right to select the claimant’s authorized treating&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p class="has-medium-font-size"><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" target="_blank" rel="noreferrer noopener">Florida Statute § 440.13</a> governs the provision of medical care under <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2025&Title=%2D%3E2025%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Florida’s workers’ compensation system</a>. As a general rule, the employer and its insurance carrier (collectively, the “E/C”) exercise substantial control over an injured worker’s medical care.</p>



<p class="has-medium-font-size">The most significant manifestation of this control is the E/C’s statutory right to select the claimant’s authorized treating physicians. In practice, this dynamic frequently results in medical opinions that align with the interests of the E/C, often to the detriment of the injured worker. Because these physicians depend upon carrier referrals for a substantial portion of their practices, their opinions may—consciously or otherwise—reflect that economic reality.</p>



<p class="has-medium-font-size">On limited occasions, however, the E/C temporarily loses control of the medical care. The most common scenario arises when the claimant sustains severe injuries requiring emergency hospitalization and surgery. In such cases, the treating surgeon—particularly one who maintains a private practice—often continues as the primary physician following the claimant’s discharge from the hospital. While this physician is not selected by the E/C, neither is the physician chosen by the claimant. Nonetheless, the E/C’s initial control over physician selection is disrupted.</p>



<p class="has-medium-font-size"><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" target="_blank" rel="noreferrer noopener">Section 440.13(2)(c), Florida Statutes</a>, provides the E/C with a “reasonable time period” to furnish initial medical treatment and care. If the E/C fails to do so, the claimant “may obtain such initial treatment at the expense of the employer.” Even then, however, the statute allows the E/C to later regain control of the medical care.</p>



<p class="has-medium-font-size">This principle was illustrated in <a href="https://scholar.google.com/scholar_case?case=6265342161636717559&q=Carmack+v.+Department+of+Agriculture&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Carmack v. State of Florida, Department of Agriculture</em>, 31 So. 3d 798 (Fla. 1st DCA 2009)</a>. There, the claimant suffered a compensable accident but the E/C refused to authorize psychiatric treatment arising from physical injuries to the claimant’s leg and back. The claimant independently sought treatment with a psychiatrist and filed a <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html">Petition for Benefits</a> seeking authorization of both past and future care with that physician. The <a href="https://www.jcc.state.fl.us/JCC/judges/" target="_blank" rel="noreferrer noopener">Judge of Compensation Claims</a> ordered the E/C to pay for treatment through the date of the final hearing, but declined to authorize ongoing care with the claimant’s chosen psychiatrist. Instead, the E/C was permitted to select a different psychiatrist. The <a href="https://1dca.flcourts.gov/" target="_blank" rel="noreferrer noopener">First District Court of Appeal </a>affirmed, reinforcing the E/C’s ability to reassert control over the medical care even after an initial failure to authorize treatment.</p>



<p class="has-medium-font-size"><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" target="_blank" rel="noreferrer noopener">Section 440.13(2)(f), Florida Statutes</a>, provides what is often the only meaningful opportunity for a claimant to select a physician who will remain authorized prospectively. That opportunity, however, arises only when the E/C commits a statutory misstep. The relevant portion of the statute provides:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p class="has-medium-font-size">“Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident…. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary.”</p>
</blockquote>



<p class="has-medium-font-size">In <a href="https://scholar.google.com/scholar_case?case=14763290808112156690&q=Zekanovic+v.+American+II,+Corp&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Zekanovic v. American II, Corp.</em>, 208 So. 3d 851 (Fla. 1st DCA 2017)</a>, the E/C failed to respond within five days to the claimant’s written request for a one-time change of physician under section 440.13(2)(f). The claimant subsequently filed a Petition for Benefits seeking authorization of a specific physician as his one-time change. Although the JCC found that the claimant was entitled to the one-time change, the JCC concluded that because the claimant had not yet obtained treatment with the requested physician prior to the entry of the order, the E/C retained the right to select the replacement physician. On appeal, the First District reversed, holding that the E/C’s failure to timely respond forfeited its right to select the physician, and that the claimant was entitled to treat with the physician he selected.</p>



<p class="has-medium-font-size">In our practice, we routinely request one-time changes of physician. Given the significant consequence of a failure to timely respond—namely, forfeiture of medical control—the E/C almost always complies within the statutory five-day window and retains the right to select the replacement physician. Instances in which the E/C fails to timely respond are exceedingly rare.</p>



<p class="has-medium-font-size">In this case, however, such a failure occurred. Notably, the oversight appears attributable to opposing counsel rather than the adjuster. In the interest of professionalism, we offered to work collaboratively with counsel to identify an alternative physician acceptable to both parties. Those discussions have thus far been unsuccessful, as we are unwilling to agree to one of the routinely selected carrier physicians. In the interim, the claimant is scheduled to treat with the physician she selected later this month. Opposing counsel understands that absent an agreement on an alternative physician before that appointment, the E/C will be obligated to authorize treatment with the claimant’s chosen doctor pursuant to section 440.13(2)(f).</p>



<p class="has-medium-font-size"><strong>**********************</strong></p>



<p class="has-medium-font-size"><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p class="has-medium-font-size"><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p class="has-medium-font-size">While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p class="has-medium-font-size"><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Las Compañías de Seguros de Compensación Laboral Suelen Estar Exentas de las Acciones Legales Previstas en el Estatuto de Florida 624.155]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-las-companias-de-seguros-de-compensacion-laboral-suelen-estar-exentas-de-las-acciones-legales-previstas-en-el-estatuto-de-florida-624-155/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-las-companias-de-seguros-de-compensacion-laboral-suelen-estar-exentas-de-las-acciones-legales-previstas-en-el-estatuto-de-florida-624-155/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Fri, 02 Jan 2026 16:58:12 GMT</pubDate>
                
                    <category><![CDATA[Civil Litigation]]></category>
                
                    <category><![CDATA[Insurance Law]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[624.155]]></category>
                
                    <category><![CDATA[Aguilera]]></category>
                
                    <category><![CDATA[aguilera v inservices]]></category>
                
                    <category><![CDATA[bad faith claims handling]]></category>
                
                    <category><![CDATA[civil remedies for claim handling]]></category>
                
                    <category><![CDATA[claims handling]]></category>
                
                    <category><![CDATA[inc.]]></category>
                
                    <category><![CDATA[unconscionable insurance claims handling]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                <description><![CDATA[<p>El Estatuto de Florida 624.155 otorga a las personas el derecho a demandar a las compañías de seguros si gestionan de forma indebida las reclamaciones y causan perjuicios económicos. Sin embargo, las aseguradoras de compensación laboral están exentas de estas disposiciones. El artículo 440.11(4) establece lo siguiente: “Sin perjuicio de lo dispuesto en el artículo&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p class="has-medium-font-size"><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0624/Sections/0624.155.html" target="_blank" rel="noreferrer noopener">El Estatuto de Florida 624.155</a> otorga a las personas el derecho a demandar a las compañías de seguros si gestionan de forma indebida las reclamaciones y causan perjuicios económicos. Sin embargo, las aseguradoras de compensación laboral están exentas de estas disposiciones. El artículo <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">440.11(4) establece lo siguiente</a>:</p>



<p class="has-medium-font-size">“Sin perjuicio de lo dispuesto en el artículo 624.155, la responsabilidad de una aseguradora ante un empleado o ante cualquier persona con derecho a interponer una demanda en nombre del empleado será la establecida en este capítulo, que será exclusiva y sustituirá a cualquier otra responsabilidad”.</p>



<p class="has-medium-font-size">Esto significa, en esencia, que los trabajadores lesionados suelen estar limitados a los recursos estipulados en el <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">Capítulo 440 de los Estatutos de Florida</a> al tratar con las aseguradoras de compensación laboral. En la mayoría de los casos, estos recursos se adaptan a las circunstancias.</p>



<p class="has-medium-font-size">Sin embargo, existe una excepción importante a los recursos del Capítulo 440.</p>



<p class="has-medium-font-size">En <a href="https://scholar.google.com/scholar_case?case=2257258137551755359&q=Aguilera+v.+Inservices,+Inc&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener">A<em>guilera v. Inservices, Inc.,</em> 905 So. 2d 84 (Fla 2005)</a>, <a href="https://supremecourt.flcourts.gov/" target="_blank" rel="noreferrer noopener">la Corte Suprema de Florida</a> declaró que los empleados pueden presentar demandas civiles independientes por agravio contra las aseguradoras por conducta que cause daño intencionalmente.</p>



<p class="has-medium-font-size">La Corte distinguió entre mala conducta deliberada y flagrante y simples demoras procesales o mala fe habitual en la tramitación de la reclamación de indemnización del empleado, contempladas en la disposición de exclusividad de responsabilidad del artículo 440.11(4) de los Estatutos de Florida. El Tribunal explicó:</p>



<p class="has-medium-font-size">“Con respecto a la responsabilidad de una aseguradora de compensación laboral, <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">el artículo 440.11(4) </a>disponía que ‘sin perjuicio de lo dispuesto en el artículo 624.155, la responsabilidad de una aseguradora ante un empleado o ante cualquier persona con derecho a interponer una demanda en nombre del empleado será la establecida en este capítulo, la cual será exclusiva y sustituirá a cualquier otra responsabilidad’. En esencia, el sistema está diseñado para que los empleadores y las aseguradoras asuman la responsabilidad de cantidades limitadas de beneficios médicos y por pérdida de salario resultantes de lesiones laborales, independientemente de la culpa, a cambio de limitaciones en su responsabilidad, mientras que el empleado recibiría, en consecuencia, una compensación limitada por pérdida de salario y beneficios médicos de forma rápida y eficiente. El sistema de compensación laboral nunca fue diseñado ni concebido para actuar como un escudo para quienes incurren en conductas intencionales que causan lesiones a los trabajadores a través del propio proceso de beneficios”.</p>



<p class="has-medium-font-size">Las disposiciones de inmunidad del artículo 440.11(4) son formidables; solo una conducta verdaderamente atroz puede superarlas. Los hechos del caso Aguilera demuestran lo exigente que es ese estándar.</p>



<ol class="wp-block-list">
<li class="has-medium-font-size">Se notificó nuevamente a la aseguradora que se requería atención urológica urgente porque la orina de Aguilera supuestamente había comenzado a oler a heces.</li>



<li class="has-medium-font-size">Cuatro días después, se le informó a Aguilera que sus beneficios de compensación laboral serían cancelados, a pesar del informe de dos médicos, incluyendo la opinión del propio médico de la aseguradora, de que no debía regresar al trabajo.</li>



<li class="has-medium-font-size">La aseguradora intervino y, de hecho, bloqueó la recepción de Aguilera de la medicación que le había recetado el médico de urgencias del hospital para su afección urinaria.</li>



<li class="has-medium-font-size">Posteriormente, la aseguradora volvió a denegar la solicitud de emergencia de Aguilera para la atención de un urólogo, alegando que no era médicamente necesaria. En ese momento, la aseguradora contaba con documentación médica que demostraba la falsedad de su postura y establecía claramente la necesidad médica de la atención.</li>



<li class="has-medium-font-size">El médico tratante de Aguilera informó a la aseguradora que su necesidad de una consulta urológica era urgente y que su condición se estaba deteriorando. El propio médico de la aseguradora le recetó a Aguilera varias pruebas de orina, y las citas fueron programadas por la enfermera de la aseguradora.</li>



<li class="has-medium-font-size">Sin embargo, uno de los peritos de la aseguradora intervino de nuevo y simplemente canceló unilateralmente algunas de estas pruebas médicas.</li>



<li class="has-medium-font-size">Las pruebas que finalmente se realizaron, específicamente una uretrografía retrógrada, revelaron que Aguilera tenía una fístula, o un orificio en la vejiga.</li>



<li class="has-medium-font-size">El perito de la aseguradora denegó la autorización para la cirugía de emergencia e insistió en una segunda opinión.</li>



<li class="has-medium-font-size">El perito se presentó en secreto en el consultorio del médico para la cita de Aguilera con un urólogo forense independiente (IME).</li>



<li class="has-medium-font-size">El perito instó a Aguilera a mentirle a su abogado y a engañarlo, diciéndole que no se había presentado en el consultorio, contrariamente a la realidad. La cirugía definitiva de Aguilera, cuya necesidad se había diagnosticado como de emergencia ya en junio de 1999, no fue finalmente autorizada ni aprobada hasta el 22 de marzo de 2000. Para entonces, según las acusaciones, Aguilera llevaba más de diez meses orinando heces y sangre.</li>
</ol>



<p class="has-medium-font-size">La decisión de Aguilera repercutió en toda la industria aseguradora, lo que provocó una reestructuración inmediata de las prácticas de tramitación de reclamaciones para atender mejor las necesidades de los trabajadores lesionados. Si bien persisten algunos abusos, las faltas más flagrantes se han reducido en gran medida.</p>



<p class="has-medium-font-size">Prevalecer bajo el marco legal establecido por el caso Aguilera es excepcionalmente difícil; los hechos deben ser tan graves que resulten indignantes, y los daños resultantes deben ser permanentes y sustanciales. En consecuencia, solo se han presentado un número limitado de casos de este tipo.</p>



<p>***************************</p>



<p class="has-medium-font-size">Contáctenos al 305-758-4900 o por correo electrónico (jgale@jeffgalelaw.com) para una consulta gratuita y confidencial y conozca sus derechos legales.</p>



<p class="has-medium-font-size">Jeffrey P. Gale, P.A. es un bufete de abogados con sede en el sur de Florida, comprometido con el sistema judicial y con la representación y la obtención de justicia para las personas: los pobres, los lesionados, los olvidados, los que no tienen voz, los indefensos y los desamparados, y con la protección de sus derechos frente a la opresión de corporaciones y gobiernos. No representamos a gobiernos, corporaciones ni grandes empresas.</p>



<p class="has-medium-font-size">Si bien nuestro objetivo es la pronta resolución de su asunto legal, nuestro enfoque es fundamentalmente diferente. Nuestros clientes son personas, no casos ni expedientes. Nos tomamos el tiempo necesario para establecer una relación con nuestros clientes, conscientes de que solo a través de una interacción significativa podemos satisfacer mejor sus necesidades. De esta manera, hemos podido brindar la mejor ayuda a quienes requieren representación legal.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Florida Workers’ Compensation: Jurisdiction for Out-of-State Injuries]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-jurisdiction-for-out-of-state-injuries/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-jurisdiction-for-out-of-state-injuries/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Wed, 10 Dec 2025 20:34:47 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                <description><![CDATA[<p>Can a Worker Injured Outside Florida Be Eligible for Florida Workers’ Compensation Benefits? Under § 440.09(1)(d), Fla. Stat., an employee injured outside Florida may still be entitled to Florida workers’ compensation benefits if certain conditions are met: “If an accident happens while the employee is employed elsewhere than in this state, which would entitle the&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p class="has-medium-font-size"><strong>Can a Worker Injured Outside Florida Be Eligible for Florida Workers’ Compensation Benefits?</strong></p>



<p class="has-medium-font-size">Under<a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" target="_blank" rel="noreferrer noopener"> § 440.09(1)(d), Fla. Stat.</a>, an employee injured outside Florida may still be entitled to <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2025&Title=%2D%3E2025%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Florida workers’ compensation benefits</a> if certain conditions are met:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p class="has-medium-font-size">“If an accident happens while the employee is employed elsewhere than in this state, which would entitle the employee or his or her dependents to compensation if it had happened in this state, the employee or his or her dependents are entitled to compensation if the contract of employment was made in this state, or the employment was principally localized in this state. However, if an employee receives compensation or damages under the laws of any other state, the total compensation for the injury may not be greater than is provided in this chapter.”</p>



<p class="has-medium-font-size"><strong>Key Elements for Florida Jurisdiction</strong></p>
</blockquote>



<ol class="wp-block-list">
<li>The contract of employment was made in Florida; or</li>



<li>The employment was principally localized in Florida.</li>
</ol>



<p class="has-medium-font-size"><strong>The Contract of Employment</strong></p>



<p class="has-medium-font-size">Florida courts determine where an employment contract was made by considering (1) the authority of the person involved in hiring negotiations, and (2) the place where the employment conditions were to be performed. <a href="https://scholar.google.com/scholar_case?case=7987934957075307138&q=Cleveland+Consol.,+Inc.+v.+Haren&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Cleveland Consol., Inc. v. Haren</em>, 672 So.2d 592, 593 (Fla. 1st DCA 1996)</a> (quoting <a href="https://scholar.google.com/scholar_case?case=10400816525594203944&q=Nelson+v.+McAbee+Constr.,+Inc.&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Nelson v. McAbee Constr., Inc.</em>, 591 So.2d 1015, 1016 (Fla. 1st DCA 1991)</a>).</p>



<p class="has-medium-font-size">In <a href="https://scholar.google.com/scholar_case?case=561615312669508003&q=DL+Peoples+Group,+Inc.+v.+Hawley&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>DL Peoples Group, Inc. v. Hawley</em>, 804 So.2d 561 (Fla. 1st DCA 2002)</a>, the claimant had minimal contacts with Florida, yet the <a href="https://www.jcc.state.fl.us/JCC/judges/" target="_blank" rel="noreferrer noopener">Florida JCC</a> had jurisdiction because the contract was executed in Florida. Hawley was interviewed and signed the employment agreement in Missouri, but the final approval and execution of the agreement occurred in Florida. The Court emphasized that:</p>



<ul class="wp-block-list">
<li>Mutual promises between the employee and employer created a bilateral contract (<a href="https://scholar.google.com/scholar_case?case=5077295917748403768&q=McIntosh+v.+Harbour+Club+Villas+Condominium&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>McIntosh v. Harbour Club Villas Condominium</em>, 468 So.2d 1075, 1076</a>; <a href="https://scholar.google.com/scholar_case?case=13355290900030423623&q=Baiter+v.+Pan+American+Bank+of+Hialeah&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Baiter v. Pan American Bank of Hialeah</em>, 383 So.2d 256, 257</a>; <a href="https://scholar.google.com/scholar_case?case=171105200041419514&q=Mark+Realty,+Inc.+v.+Rogness&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Mark Realty, Inc. v. Rogness</em>, 418 So.2d 373, 376)</a>.</li>



<li>A contract is formed where the last act necessary to make a binding agreement occurs (<em>Peters v. E.O. Painter Fertilizer Co.</em>, 75 So. 749; <em>Ray-Hof Agencies, Inc. v. Petersen</em>, 123 So.2d 251, 253; <em>Goodman v. Olsen</em>, 305 So.2d 753).</li>
</ul>



<p class="has-medium-font-size">Because Hawley’s acceptance and the employer’s final approval occurred in Florida, the employment contract was considered made in Florida. See also <a href="https://scholar.google.com/scholar_case?case=10299982487273773160&q=Owens+v.+CCJ+Auto+Transp.&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Owens v. CCJ Auto Transp.</em>, 59 So.3d 179 (Fla. 1st DCA 2011)</a>; <em>Miller Contracting Co. of Ohio v. Hutto</em>, 156 So.2d 745 (Fla. 1963).</p>



<p class="has-medium-font-size"><strong>Principal Location of Employment</strong></p>



<p class="has-medium-font-size">For jurisdiction purposes under <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" target="_blank" rel="noreferrer noopener">§ 440.09(1)(d)</a>, the principal location of the employee’s work—not the employer’s business—is determinative. <a href="https://scholar.google.com/scholar_case?case=4226857259078723499&q=Johnson+v.+United+Airlines&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Johnson v. United Airlines</em>, 550 So.2d 134, 135 (Fla. 1st DCA 1989)</a>; <a href="https://scholar.google.com/scholar_case?case=6387634212787673470&q=General+Elec.+v.+DeCubas&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>General Elec. v. DeCubas</em>, 504 So.2d 1276, 1277 (Fla. 1st DCA 1986)</a>.</p>



<p class="has-medium-font-size">In <em>DeCubas</em>, a Florida resident injured in Georgia spent 73% of his working time in Florida. The court held that his employment was principally localized in Florida. Similarly, in <a href="https://scholar.google.com/scholar_case?case=6945759155392557654&q=Hazealeferiou+v.+Labor+Ready&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Hazealeferiou v. Labor Ready</em>, 947 So.2d 599 (Fla. 1st DCA 2007)</a>, a flight attendant’s work was primarily based in Florida despite spending most flight hours outside the state. The Court emphasized that temporal distribution is important but not dispositive; supervision, payroll, and work assignments in Florida confirmed principal localization.</p>



<p class="has-medium-font-size"><strong>Conclusion</strong></p>



<p class="has-medium-font-size">Determining Florida workers’ compensation eligibility for out-of-state injuries often requires careful analysis of the employment contract and the principal location of employment. Because these cases can involve nuanced jurisdictional issues, consulting a workers’ compensation expert is advisable before taking a position.</p>



<p class="has-medium-font-size">For example, just yesterday I participated in a lengthy discussion with a Maryland attorney about a potential client who was injured in Florida but resides in Maryland and was hired in Maryland by a Washington-based company. We examined the jurisdictional issues and compared the type, nature, and quality of workers’ compensation benefits available in Florida versus Maryland to determine whether the matter should be referred to our firm for pursuit of Florida benefits or handled under Maryland’s system. Because several key questions remain unanswered, no final determination has yet been made.</p>



<p><strong>**********************</strong></p>



<p class="has-medium-font-size"><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p class="has-medium-font-size"><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p class="has-medium-font-size">While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p class="has-medium-font-size"><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Workers’ Compensation Insurers Exempt from Civil Remedies Under Florida Statute 624.155]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-insurers-not-subject-to-statute-624-155-civil-remedies/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-insurers-not-subject-to-statute-624-155-civil-remedies/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Wed, 12 Nov 2025 22:05:01 GMT</pubDate>
                
                    <category><![CDATA[Civil Litigation]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[440.11(4)]]></category>
                
                    <category><![CDATA[Aguilera]]></category>
                
                    <category><![CDATA[aguilera v inservices]]></category>
                
                    <category><![CDATA[egregious conduct]]></category>
                
                    <category><![CDATA[exclusiveness of liability]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                <description><![CDATA[<p>Florida Statute 624.155 gives people the right to sue insurance companies if they mishandle claims and cause financial harm. However, workers’ compensation insurance carriers are exempt from these provisions. Section 440.11(4) provides as follows: “Notwithstanding the provisions of s.&nbsp;624.155, the liability of a carrier to an employee or to anyone entitled to bring suit in&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p class="has-medium-font-size"><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0624/Sections/0624.155.html" target="_blank" rel="noreferrer noopener">Florida Statute 624.155</a> gives people the right to sue insurance companies if they mishandle claims and cause financial harm. However, workers’ compensation insurance carriers are exempt from these provisions. <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">Section 440.11(4) </a>provides as follows: </p>



<p class="has-medium-font-size">“Notwithstanding the provisions of s.&nbsp;<a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0624/Sections/0624.155.html">624.155</a>, the liability of a carrier to an employee or to anyone entitled to bring suit in the name of the employee shall be as provided in this chapter, which shall be exclusive and in place of all other liability.”</p>



<p class="has-medium-font-size">This essentially means that injured workers are usually limited to the remedies spelled out in <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2025&Title=%2D%3E2025%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Chapter 440 of the Florida Statutes</a> when dealing with workers’ compensation insurers. In most instances, those remedies are suitable to the circumstances.</p>



<p class="has-medium-font-size">There is, however, one important exception to the <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2025&Title=%2D%3E2025%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Chapter 440</a> remedies.</p>



<p class="has-medium-font-size">In <a href="https://scholar.google.com/scholar_case?case=2257258137551755359&q=AGUILERA+v.+INSERVICES+INC+&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Aguilera v. Inservices, Inc.</em>, 905 So. 2d 84 (Fla 2005)</a>, the Florida Supreme Court declared that employees may present independent civil tort actions against insurance carriers for conduct intentionally causing harm.</p>



<p class="has-medium-font-size">The Court distinguished between deliberate, egregious misconduct and mere procedural delays or routine bad faith in the handling of the employee’s compensation claim captured within the exclusiveness of liability provision of <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">s. 440.11(4), Florida Statutes</a>. The Court explained:</p>



<p class="has-medium-font-size">“With regard to the liability of a worker’s compensation insurance carrier, section 440.11(4) provided that ‘[n]otwithstanding the provisions of s[ection] 624.155, the liability of a carrier to an employee or to anyone entitled to bring suit in the name of the employee shall be as provided in this chapter, which shall be exclusive and in place of all other liability.’ Essentially, the system is designed for employers and insurance carriers to assume responsibility for limited amounts of medical and wage loss benefits resulting from workplace injuries without regard to fault in exchange for limitations on their liability, while the employee would correspondingly receive quick and efficient delivery of limited wage loss compensation and medical benefits. The workers’ compensation system was never designed nor was it intended to act as a shield for those engaged in intentional conduct inflicting injuries upon workers through the benefit process itself.”</p>



<p class="has-medium-font-size">The immunity provisions of section 440.11(4) are formidable; only truly egregious conduct can surmount them. The facts in <em>Aguilera</em> demonstrate just how high that bar is set.</p>



<ul class="wp-block-list">
<li class="has-medium-font-size">The insurance carrier was again notified that urological care was needed now on an emergency basis because Aguilera’s urine had allegedly begun to smell like feces.</li>



<li class="has-medium-font-size">Four days later, Aguilera was advised that his workers’ compensation benefits were being terminated, notwithstanding the report of two doctors, including the opinion of the insurance carrier’s own doctor, that he should not return to work.</li>



<li class="has-medium-font-size">The insurance carrier intervened and actually blocked Aguilera’s&nbsp;receipt of medication which had been prescribed for him by the hospital emergency physician for his urinary condition.</li>



<li class="has-medium-font-size">Thereafter, the insurance carrier again denied Aguilera’s emergency request for the care of a urologist on the asserted basis that it was not medically necessary. At this time, the insurance carrier actually had within its possession medical documentation which both demonstrated the falsity of its position and clearly established the medical necessity for the care.</li>



<li class="has-medium-font-size">The insurance carrier was advised by Aguilera’s treating physician that his need for a urological consultation had become urgent and that his condition was deteriorating. </li>



<li class="has-medium-font-size">The insurance carrier’s own doctor issued Aguilera prescriptions for various urinary tests, and the appointments were in fact scheduled by the insurance carrier’s nurse. </li>



<li class="has-medium-font-size">However, one of the insurance carrier’s adjusters again intervened and simply unilaterally canceled some of this medical testing. </li>



<li class="has-medium-font-size">Testing that was ultimately performed, specifically a retrograde urethrogram, revealed that Aguilera had a fistula, or a hole in his bladder.</li>



<li class="has-medium-font-size">The insurance adjuster refused authorization for the emergency surgery and insisted on a second opinion.</li>



<li class="has-medium-font-size">The adjuster secretly appeared at the physician’s office for Aguilera’s appointment with an IME (independent medical examiner) urologist. </li>



<li class="has-medium-font-size">The adjuster urged Aguilera to lie to his counsel and to deceive his attorney by advising that she had not appeared at the doctor’s office contrary to the true fact.&nbsp;</li>



<li class="has-medium-font-size">Aguilera’s ultimate surgery, the need for which had been diagnosed as an emergency as early as June of 1999, was not finally&nbsp;authorized or approved until March 22, 2000. By this time, according to the allegations, Aguilera had been urinating feces and blood for over ten months.</li>
</ul>



<p class="has-medium-font-size">The <em>Aguilera</em> decision reverberated throughout the insurance industry, prompting an immediate overhaul of claims handling practices to better address the needs of injured workers. Although some abuses persist, the most flagrant misconduct has largely been curtailed. </p>



<p class="has-medium-font-size">Prevailing under the <em>Aguilera</em> framework is exceptionally challenging; the facts must be so egregious as to shock the conscience, and the resulting damages must be both permanent and substantial. Consequently, only a limited number of such cases have been brought forward.</p>



<p class="has-medium-font-size">*********************************************************</p>



<p class="has-medium-font-size"><strong>Contact us</strong>&nbsp;toll free at 866-785-GALE or by email (jgale@jeffgalelaw.com) for a free, confidential consultation to learn your legal rights.</p>



<p class="has-medium-font-size"><strong>Jeffrey P. Gale, P.A.</strong>&nbsp;is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p class="has-medium-font-size">While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p class="has-medium-font-size"></p>



<p></p>



<p></p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Repetitive Trauma Under Florida Workers’ Compensation Law]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-repetitive-trauma-under-florida-workers-compensation-law/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-repetitive-trauma-under-florida-workers-compensation-law/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Fri, 31 Oct 2025 19:33:59 GMT</pubDate>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[clear and convincing evidence]]></category>
                
                    <category><![CDATA[cumulative injury]]></category>
                
                    <category><![CDATA[festa standard]]></category>
                
                    <category><![CDATA[greater hazard]]></category>
                
                    <category><![CDATA[prolonged exposure]]></category>
                
                    <category><![CDATA[repetitive trauma]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2015/06/repetive-trauma.jpg" />
                
                <description><![CDATA[<p>Most work-related injuries arise from acute, single-incident accidents — a fall, a lifting injury, or a sudden mechanical failure. With few exceptions (such as injuries caused by horseplay), these “one-time” accidents are compensable under Florida’s workers’ compensation system. But what about injuries that develop gradually over time — through years of physical stress or repetitive&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Most work-related injuries arise from <strong>acute, single-incident accidents</strong> — a fall, a lifting injury, or a sudden mechanical failure. With few exceptions (such as injuries caused by horseplay), these “one-time” accidents are compensable under Florida’s workers’ compensation system.</p>



<p>But what about injuries that develop <strong>gradually over time</strong> — through years of physical stress or repetitive motion? Are these covered as well?</p>



<h3 class="wp-block-heading" id="h-the-festa-standard">The Festa Standard</h3>



<p>The answer is <strong>yes</strong>, provided the injured worker can establish three elements set forth in <a href="https://scholar.google.com/scholar_case?case=6227990369240210503&q=rodriguez+v.+frito-lay+inc.&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><em>Festa v. Teleflex, Inc.</em>, 382 So. 2d 122, 124 (Fla. 1st DCA 1980)</a>:</p>



<ol class="wp-block-list">
<li><strong>Prolonged exposure</strong>,</li>



<li><strong>A cumulative effect</strong> resulting in injury or the aggravation of a preexisting condition, and</li>



<li><strong>A hazard greater than that to which the general public is exposed.</strong></li>
</ol>



<p>Subsequent cases have refined these requirements. In <a href="https://scholar.google.com/scholar_case?case=317515019098665050&q=rodriguez+v.+frito-lay+inc.&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><em>Rodriguez v. Frito-Lay, Inc.</em>, 600 So. 2d 1167 (Fla. 1st DCA 1992)</a>, the First District appeared to relax the “greater hazard” requirement. Meanwhile, the Florida Supreme Court in <a href="https://scholar.google.com/scholar_case?case=11932088527859380098&q=university+of+florida+v.+massie&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><em>University of Florida v. Massie</em>, 602 So. 2d 516 (Fla. 1992)</a>, held that for a preexisting condition to be compensable, it must be <strong>aggravated by a non-routine, job-related physical condition</strong> or by <strong>repeated physical trauma</strong> — signaling a limit on recovery for aggravations based solely on mental or emotional stress.</p>



<h3 class="wp-block-heading" id="h-the-burden-of-proof-clear-and-convincing-evidence">The Burden of Proof: Clear and Convincing Evidence</h3>



<p>Repetitive trauma claims are subject to a higher evidentiary burden under <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.02.html" target="_blank" rel="noreferrer noopener">section 440.02(1), Florida Statutes</a>. The claimant must establish compensability by <strong>clear and convincing evidence</strong>, rather than the usual preponderance standard.</p>



<p>“Clear and convincing evidence” means evidence of such weight and character as to produce in the judge’s mind a firm belief or conviction, without hesitation, as to the truth of the allegations.</p>



<h3 class="wp-block-heading" id="h-a-case-example-the-mattress-factory-worker">A Case Example: The Mattress Factory Worker</h3>



<p>The first workers’ compensation case I ever took to a final hearing illustrates the <em>Festa</em> standard well.</p>



<p>My client was a woman in her 60s who spent more than 15 years constructing box-spring mattress frames in a warehouse. Her job required her to assemble and lift each frame—ranging from single to king size—onto a dolly beside her workstation. Over time, she developed severe cervical pain that forced her to retire. The employer and carrier denied her claim, arguing there was no single accident to explain her cervical disc herniations.</p>



<p>We filed a <em>Festa</em> repetitive trauma claim.</p>



<ul class="wp-block-list">
<li><strong>Element (1): Prolonged exposure</strong> was easily shown by her 15-year work history.</li>



<li><strong>Element (2): Cumulative injury</strong> was established through lay and medical testimony. She denied any prior neck injuries, and her treating orthopedist opined that her job duties were the probable cause of her herniations.</li>



<li><strong>Element (3): Greater hazard</strong> was proven through both lay and expert evidence. She testified that, having once picked cotton as a young woman in the rural South, that work was difficult—but far less strenuous than her duties in the mattress factory. Her physician testified that her work exposed her to significantly greater physical demands than those faced by the general public. (We also urged the judge to take judicial notice of that fact.)</li>
</ul>



<p>The judge ruled in our favor—finding the injury compensable and awarding <strong><a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html" target="_blank" rel="noreferrer noopener">Permanent Total Disability benefits</a></strong> under <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html" target="_blank" rel="noreferrer noopener">section 440.15(1), Florida Statutes</a>.</p>



<h3 class="wp-block-heading" id="h-lessons-from-experience">Lessons from Experience</h3>



<p>Since that case, we have successfully applied the <em>Festa</em> standard many times. While repetitive trauma claims present greater evidentiary challenges than single-incident accidents, they remain an essential avenue for justice when workplace injuries develop gradually over years of service.</p>



<h3 class="wp-block-heading" id="h-other-key-cases-on-repetitive-trauma">Other Key Cases on Repetitive Trauma</h3>



<ul class="wp-block-list">
<li><a href="https://scholar.google.com/scholar_case?case=16469014628108463015&q=houle+v.+asphalt+sealing+%26+stripping+co.,+inc.&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><em><strong>Houle v. Asphalt Sealing & Stripping Co., Inc.</strong>,</em> 397 So. 2d 669 (Fla. 1981)</a> – Heavy lifting over time found consistent with claimed back injury.</li>



<li><a href="https://scholar.google.com/scholar_case?case=6834974613997945373&q=sewell+v.+j.c.+penney&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><strong><em>Sewell v. J.C. Penney</em></strong>, 569 So. 2d 1335 (Fla. 1st DCA 1990)</a> – The court took judicial notice that the claimant’s job exposed her to greater hazards than the public.</li>



<li><a href="https://scholar.google.com/scholar_case?case=56835054430136730&q=johnson+v.+knight&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><strong><em>Johnson v. Knight</em></strong>, 594 So. 2d 836 (Fla. 1st DCA 1992)</a> – Expert testimony is not always required to establish the “greater hazard” element.</li>



<li><a href="https://scholar.google.com/scholar_case?case=578505856051611118&q=Daugherty+v.+Red+Lobster&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><strong><em>Daugherty v. Red Lobster</em></strong>, 550 So. 2d 171 (Fla. 1st DCA 1989)</a> – Waitress awarded benefits for back injury caused by repetitive tray-carrying.</li>



<li><a href="https://scholar.google.com/scholar_case?case=83465103140677941&q=Orlando+Precast+Products+v.+Ciofalo&hl=en&as_sdt=2,10&as_vis=1" target="_blank" rel="noreferrer noopener"><strong><em>Orlando Precast Products v. Ciofalo</em></strong>, 501 So. 2d 1326 (Fla. 1st DCA 1986)</a> – Truck driver’s prolonged sitting, twisting, and heavy lifting met the greater hazard requirement.</li>



<li><a href="https://scholar.google.com/scholar_case?case=1382735877301262041&q=Winn-Dixie+Stores+v.+Morgan&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><strong><em>Winn-Dixie Stores v. Morgan</em></strong>, 533 So. 2d 783 (Fla. 1st DCA 1988)</a> – Compensable wrist injury established where repetitive manual tasks led to trauma.</li>
</ul>



<hr class="wp-block-separator has-alpha-channel-opacity" />



<h3 class="wp-block-heading" id="h-final-thoughts">Final Thoughts</h3>



<p>Repetitive trauma claims are not “second-class” cases under Florida’s workers’ compensation law. They demand more rigorous proof, but when properly developed, they can yield full and fair recovery for workers whose bodies have been worn down by years of honest labor.</p>



<p>As <em>Festa</em> and its progeny remind us, the absence of a single, dramatic accident does not make an injury any less real—or any less compensable. </p>



<p>Interestingly, in repetitive trauma cases, the statute of limitations begins to run on the date the injury becomes <strong>disabling</strong>—that is, when it results in lost wages or modified duty. We have successfully applied this principle to cases involving longstanding medical conditions that only recently, within the past two years, became disabling.</p>



<p>*********************************************************</p>



<p><strong>Contact us</strong>&nbsp;toll free at 866-785-GALE or by email (jgale@jeffgalelaw.com) for a free, confidential consultation to learn your legal rights.</p>



<p><strong>Jeffrey P. Gale, P.A.</strong>&nbsp;is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p></p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Valuation Date for Workers’ Compensation Subrogation Lien]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-cutoff-date-for-workers-compensation-subrogation-liens/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-cutoff-date-for-workers-compensation-subrogation-liens/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Thu, 25 Sep 2025 18:51:26 GMT</pubDate>
                
                    <category><![CDATA[Civil Litigation]]></category>
                
                    <category><![CDATA[Liens]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[440.39]]></category>
                
                    <category><![CDATA[personal injuries]]></category>
                
                    <category><![CDATA[personal injury]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                    <category><![CDATA[workers' compensation lien]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2022/04/Pie-Chart.jpg" />
                
                <description><![CDATA[<p>Personal injury and workers’ compensation cases differ significantly in the remedies they offer and the parties they involve. It is not uncommon for an individual injured in the course of employment to also have a viable personal injury claim. Workers’ compensation cases are brought against the employer and its insurance carrier, whereas personal injury actions&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Personal injury and <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">workers’ compensation</a> cases differ significantly in the remedies they offer and the parties they involve. It is not uncommon for an individual injured in the course of employment to also have a viable personal injury claim. Workers’ compensation cases are brought against the employer and its insurance carrier, whereas personal injury actions target the negligent third party responsible for the incident, including any entities that may be <a href="https://en.wikipedia.org/wiki/Vicarious_liability" target="_blank" rel="noreferrer noopener">vicariously liable</a> for their conduct.</p>



<p>One of the most significant distinctions between workers’ compensation and personal injury cases lies in the role of fault: workers’ compensation operates as a no-fault system, while personal injury claims require the injured party to prove that another’s negligence caused the harm. Because workers’ compensation operates as a no-fault system, benefits are typically provided from the outset of the claim. In contrast, personal injury cases often require lengthy litigation to establish fault, meaning compensation may not be received for months or even years.</p>



<p>Pursuant to <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.39.html" target="_blank" rel="noreferrer noopener">Florida Statute § 440.39</a>, when an employee or their dependents accept workers’ compensation benefits or initiate proceedings to obtain them, the employer—or its insurer—is subrogated to the rights of the employee or dependents against any third-party tortfeasor. This subrogation applies to the extent of compensation benefits paid or payable, as outlined in subsection (2).</p>



<p>This right of subrogation entitles the employer and its workers’ compensation insurer to reimbursement from any recovery the injured employee obtains—whether by judgment or settlement—from a third-party tortfeasor.</p>



<p>The employer and its workers’ compensation carrier rarely recover the full value of their lien. <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.39.html" target="_blank" rel="noreferrer noopener">Florida Statute § 440.39(3)(a)</a> sets forth the formula used to calculate the extent of their recovery. It calls for a pro rata determination. The<a href="https://supremecourt.flcourts.gov/" target="_blank" rel="noreferrer noopener"> Florida Supreme Court’s</a> decision in <a href="https://scholar.google.com/scholar_case?case=11759727170035684001&q=Manfredo+v.+Employer%E2%80%99s+Casualty+Insurance+Co.&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Manfredo v. Employer’s Casualty Insurance Co</em>.</a> provides a clear and accessible explanation of how the statutory formula operates in practice.</p>



<p>In <a href="https://6dca.flcourts.gov/content/download/2446989/opinion/Opinion_2023-2377.pdf" target="_blank" rel="noreferrer noopener"><em>Liberty Mutual Insurance Company v. Robert A. Lee</em> (Feb. 7, 2025)</a>, the issue concerned the proper “valuation date” for calculating the subrogation lien. Lee argued that Liberty Mutual was entitled to reimbursement of only 11.61% of the benefits it had paid <strong>through the date of his settlement with the elevator operator</strong>. Liberty Mutual, by contrast, maintained that it should be reimbursed for 11.61% of the benefits it paid <strong>through the date of the equitable distribution</strong>.</p>



<p>The valuation date was important in the <em>Lee</em> case because Liberty Mutual paid over $300,000 in benefits to Lee and on Lee’s behalf after the date of the settlement agreement. </p>



<p>Liberty Mutual argued that its position is supported by the plain language of section 440.39(3) providing that the lien applies to “benefits paid or to be paid.” Florida’s Sixth District Court of Appeal agreed. </p>



<p>The Court’s decision made a $34,830.00+ difference. </p>



<p>*********************************************************</p>



<p><strong>Contact us</strong>&nbsp;toll free at 866-785-GALE or by email (jgale@jeffgalelaw.com) for a free, confidential consultation to learn your legal rights.</p>



<p><strong>Jeffrey P. Gale, P.A.</strong>&nbsp;is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



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                <title><![CDATA[Jeffrey P. Gale, P.A. // Entitlement to Lost Wages for Undocumented Workers Under Florida’s Workers’ Compensation System]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-entitlement-to-lost-wages-for-undocumented-workers-under-floridas-workers-compensation-system/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-entitlement-to-lost-wages-for-undocumented-workers-under-floridas-workers-compensation-system/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Thu, 18 Sep 2025 15:34:24 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[estoppel]]></category>
                
                    <category><![CDATA[form 1-9]]></category>
                
                    <category><![CDATA[i-9 form]]></category>
                
                    <category><![CDATA[lost wages]]></category>
                
                    <category><![CDATA[permanent total disability]]></category>
                
                    <category><![CDATA[ptd]]></category>
                
                    <category><![CDATA[temporary partial disability]]></category>
                
                    <category><![CDATA[temporary total disability]]></category>
                
                    <category><![CDATA[tpd]]></category>
                
                    <category><![CDATA[ttd]]></category>
                
                    <category><![CDATA[undocumented workers]]></category>
                
                    <category><![CDATA[work permit]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2023/04/worker2.jpg" />
                
                <description><![CDATA[<p>These are uncertain and challenging times in Florida (and the entire United States) for undocumented immigrants, as the Trump Administration and Florida Governor Ron DeSantis seemingly delight in making their lives increasingly difficult. Interestingly, when it comes to workers’ compensation benefits, Florida law protects certain undocumented workers. Florida offers three types of wage-loss benefits to&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>These are uncertain and challenging times in Florida (and the entire United States) for undocumented immigrants, as the Trump Administration and Florida Governor Ron DeSantis seemingly delight in making their lives increasingly difficult. </p>



<p>Interestingly, when it comes to workers’ compensation benefits, Florida law protects certain undocumented workers. </p>



<p>Florida offers three types of wage-loss benefits to injured workers: (1) <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html" target="_blank" rel="noreferrer noopener">Permanent Total Disability (§440.15(1), Fla. Stat.)</a>; (2) <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html" target="_blank" rel="noreferrer noopener">Temporary Total Disability (§440.15(2))</a>; and (3) <a href="https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html" target="_blank" rel="noreferrer noopener">Temporary Partial Disability (§440.15(4))</a>. To qualify for any of these benefits, the employee bears the burden of proving that the inability to obtain employment—or to earn pre-injury wages—is the result of physical limitations caused by the industrial accident, rather than general economic conditions or a lack of available work. <a href="https://scholar.google.com/scholar_case?case=9131033683429425735&q=Cenvill+Development+Corp.+v.+Candelo&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>City of Clermont v Rumph</em>, 450 So. 2d 573 (Fla. 1st DCA 1984)</a>. </p>



<p>Because undocumented workers are prohibited under both federal and state law from working legally in the United States, they are, by definition, unable to meet the burden of proving an ability to obtain lawful employment. </p>



<p>Surprisingly, Florida has adopted an equitable approach to this issue. In <a href="https://scholar.google.com/scholar_case?case=14447442378758471758&q=HDV+CONSTRUCTION+SYSTEMS,+INC.+v.+Aragon,+Fla:+Dist.+Court+of+Appeals,+1st+Dist.+2011&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>HDV Construction Systems, Inc. v. Aragon</em>, 66 So. 3d 331 (Fla. 1st DCA 2011)</a>, the First District Court of Appeal explained it as follows: </p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>Although there is no shortage of debate that can be had on the issue of illegal labor and its effect on our state, there is no dispute that the Florida Legislature has expressed an unyielding, textual intent that aliens, including those who are illegal and unlawfully employed, be covered and compensated under the Florida Workers’ Compensation Law. <em>See</em> § 440.02(15)(a), Fla. Stat. (2007) (defining “employee” to include any person who receives remuneration from an employer, including aliens, whether “lawfully or unlawfully employed”); <em>see also </em><a href="https://scholar.google.com/scholar_case?case=16086787629982632461&q=HDV+CONSTRUCTION+SYSTEMS,+INC.+v.+Aragon,+Fla:+Dist.+Court+of+Appeals,+1st+Dist.+2011&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Safeharbor Employer Servs., Inc. v. Velazquez,</em> 860 So.2d 984 (Fla. 1st DCA 2003)</a> (“Therefore, we conclude that the Florida legislature’s right to enact workers’ compensation benefits for illegal aliens is not preempted by federal action.”). Indeed, the purpose of workers’ compensation law is to place on industry, rather than the general taxpaying public, the expense incident to the hazards created by industry. <a href="https://scholar.google.com/scholar_case?case=16753015499112722489&q=HDV+CONSTRUCTION+SYSTEMS,+INC.+v.+Aragon,+Fla:+Dist.+Court+of+Appeals,+1st+Dist.+2011&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Gore v. Lee County Sch. Bd.,</em> 43 So.3d 846, 849 (Fla. 1st DCA 2010)</a> (explaining workers’ compensation legislation is designed to relieve society in general of expenses created by industry). Moreover, because the employer stands to benefit and profit from its employment of labor, and further is in the best position to avoid the risk of loss, the courts have uniformly recognized the impropriety of foisting on society the costs of a “broken body” and “diminished income” created by industry. <a href="https://scholar.google.com/scholar_case?about=13366732797544430500&q=HDV+CONSTRUCTION+SYSTEMS,+INC.+v.+Aragon,+Fla:+Dist.+Court+of+Appeals,+1st+Dist.+2011&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Mobile Elevator Co. v. White,</em> 39 So.2d 799, 800 (Fla.1949)</a>.</p>
</blockquote>



<p>This broad pronouncement is subject to an important qualification. In <a href="https://scholar.google.com/scholar_case?case=11968160896872420175&q=HDV+CONSTRUCTION+SYSTEMS,+INC.+v.+Aragon,+Fla:+Dist.+Court+of+Appeals,+1st+Dist.+2011&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Cenvill Development Corp. v. Candelo</em>, 478 So. 2d 1168 (Fla. 1st DCA 1985)</a>, the court held that an employer who hires an undocumented worker is precluded from asserting the worker’s immigration status as a defense to avoid liability for disability benefits—<strong>but only</strong> where the employer knew or should have known of the worker’s true status. As the court explained, this rule ‘prevents unauthorized aliens from suffering at the hands of an employer who would knowingly hire the alien and then conveniently use the unauthorized alien status to avoid paying wage-loss benefits.’ <em>Id.</em> at 1170. </p>



<p>In <em><a href="https://scholar.google.com/scholar_case?case=2345994156836984256&q=Cenvill+Development+Corp.+v.+Candelo&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener">HDV</a></em>, the Judge of Compensation Claims concluded, based on the authority of <a href="https://scholar.google.com/scholar_case?case=11968160896872420175&q=Cenvill+Development+Corp.+v.+Candelo&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Cenvill Development Corp. v. Candelo</em>, 478 So. 2d 1168 (Fla. 1st DCA 1985),</a> that, because the Employer knew or should have known of Claimant’s illegal status prior to his injury, but continued his employment nonetheless, the E/C was precluded from using Claimant’s illegal status as a defensive measure — requiring the E/C to respond to the disability imposed by Claimant’s significant and objectively demonstrated work-related injuries and physical restrictions, and his vocational limitations which include, but are not limited to, his unauthorized work status. The First DCA affirmed the lower court’s decision. </p>



<p>In our initial client interviews with undocumented workers, as well as in our discovery, we focus on establishing that the employer knew or should have known of the employee’s immigration status. For example, in our initial formal document requests, we ask the employer to produce ‘All Form I-9s signed by the claimant and the employer.’ The <a href="https://www.uscis.gov/i-9" target="_blank" rel="noreferrer noopener">Form I-9, or Employment Eligibility Verification</a>, is a mandatory government form that employers must complete and retain to confirm the identity and work authorization of every individual hired in the United States. Both the employee and employer are required to complete the form, which serves as proof of compliance with laws prohibiting the employment of unauthorized workers. The employer’s failure to ensure this form was completed indicates that it knew, or at minimum should have known, that its employee was undocumented. This is not the only way of demonstrating the requisite evidence. </p>



<p>*********************************************************</p>



<p><strong>Contact us</strong>&nbsp;toll free at 866-785-GALE or by email (jgale@jeffgalelaw.com) for a free, confidential consultation to learn your legal rights.</p>



<p><strong>Jeffrey P. Gale, P.A.</strong>&nbsp;is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Florida Workers’ Compensation: 2025 Legislative Session Recap]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-2025-legislative-session-recap/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-2025-legislative-session-recap/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Tue, 12 Aug 2025 15:52:42 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[erisa]]></category>
                
                    <category><![CDATA[florida legislature]]></category>
                
                    <category><![CDATA[legislative session]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2021/12/legal-document-1.jpg" />
                
                <description><![CDATA[<p>This blog is a verbatim repost, title and all, of an excellent article recently published in the Florida Workers’ Advocates internet Newsletter. The author: Justyn Needel, Legislative Specialist at Injured Workers Pharmacy. ********************************************** The 2025 legislative session in Florida was far from ordinary. Lawmakers reconvened for a&nbsp;special session, which concluded on&nbsp;June 15, 2025, to address&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p><strong>This blog is a verbatim repost, title and all, of an excellent article recently published in the <a href="https://floridaworkers.org/" target="_blank" rel="noreferrer noopener">Florida Workers’ Advocates</a> internet Newsletter. The author: Justyn Needel, Legislative Specialist at <a href="https://www.iwpharmacy.com/" target="_blank" rel="noreferrer noopener">Injured Workers Pharmacy</a>. </strong></p>



<p>**********************************************</p>



<p>The 2025 legislative session in Florida was far from ordinary. Lawmakers reconvened for a&nbsp;special session, which concluded on&nbsp;June 15, 2025, to address unresolved issues from the regular session.&nbsp;No significant workers’ compensation reforms were enacted during this session, despite several notable proposals introduced earlier in the year.</p>



<p><strong>Workers</strong><strong>’&nbsp;</strong><strong>Compensation Bills</strong></p>



<p>Despite early momentum, several bills aimed at reforming or expanding Florida’s workers’ compensation system failed to make it through the legislative process:</p>



<ul class="wp-block-list">
<li><a href="https://flhouse.gov/Sections/Bills/billsdetail.aspx?BillId=80616" target="_blank" rel="noreferrer noopener">HB 87</a>
<ul class="wp-block-list">
<li>Status: Died in the Government Operations Subcommittee</li>



<li>Sponsor: Rep. Joe Casello (D)</li>



<li>The bill aimed to expand the list of cancers covered under a statutory benefits program for firefighters, offering an alternative to workers’ compensation. The proposed legislation would include acute myeloid leukemia.</li>
</ul>
</li>



<li><a href="https://flhouse.gov/Sections/Bills/billsdetail.aspx?BillId=80838" target="_blank" rel="noreferrer noopener">SB 366</a>
<ul class="wp-block-list">
<li>Status: Died in the Community Affairs Committee</li>



<li>Sponsor: Sen. Ana Maria Rodriguez (R)</li>



<li>This bill would have enhanced disability benefits for firefighters, law enforcement officers, and correctional officers by establishing a presumption that certain health conditions, such as heart disease, tuberculosis, and hypertension, are incurred in the line of duty unless proven otherwise.</li>
</ul>
</li>



<li><a href="https://flhouse.gov/Sections/Bills/billsdetail.aspx?BillId=81991" target="_blank" rel="noreferrer noopener">HB 1281</a>
<ul class="wp-block-list">
<li>Status: Died in Insurance & Banking Subcommittee</li>



<li>Sponsor: Rep. Kim Berfield (R)</li>



<li>This bill proposed streamlining the workers’ compensation system by revising the duties of the Department of Financial Services (DFS) and the Chief Financial Officer (CFO) to improve administrative efficiency and oversight.</li>
</ul>
</li>



<li><a href="https://flhouse.gov/Sections/Bills/billsdetail.aspx?BillId=81722" target="_blank" rel="noreferrer noopener">HB 1069</a>
<ul class="wp-block-list">
<li>Status: Died in Insurance & Banking Subcommittee</li>



<li>Sponsor: Rep. Tom Fabricio (R)</li>



<li>This bill would have allowed businesses to create alternative compensation programs for occupational injuries outside the state’s workers’ compensation system. Theat least 156 weeks of medical coverage and indemnity benefits equal to a minimum of 75% of the worker’s average weekly wage. </li>
</ul>
</li>
</ul>



<p><strong>What’s Next for Workers’ Compensation in Florida?</strong></p>



<p>Although the 2025 legislative session ended without major changes to Florida’s workers’ compensation laws, the conversation is not yet over.</p>



<p>Florida’s next regular legislative session is scheduled to begin on&nbsp;January 13, 2026, running for 60 consecutive days. Lawmakers can begin&nbsp;pre-filing bills in the fall of 2025, which means some familiar proposals may return.</p>



<p>Legislation often takes multiple attempts&nbsp;before becoming law. Many successful bills are introduced&nbsp;two or even three times&nbsp;before they gain enough traction to&nbsp;<a href="https://www.naeyc.org/our-work/public-policy-advocacy/federal-legislative-process-or-how-bill-becomes-law">pass</a>. This cycle allows lawmakers to refine language, build broader coalitions, and respond to feedback from stakeholders across the spectrum.</p>



<p>The upcoming 2026 elections are already casting a long shadow over Florida’s political landscape and could significantly influence the tone and priorities of the next legislative session.&nbsp;With Governor Ron DeSantis’ term limited, the race to succeed him is gearing up—as of today,&nbsp;<a href="https://dos.elections.myflorida.com/candidates/downloadcanlist.asp">26</a>&nbsp;candidates have filed to run.&nbsp;On the&nbsp;<a href="https://dos.fl.gov/elections/candidates-committees/offices-up-for-election/">state</a>&nbsp;level,&nbsp;all 120 seats in the Florida House of Representatives&nbsp;and&nbsp;20 of the 40 seats in the Florida Senate&nbsp;are also up for reelection. This political dynamic could lead to a more cautious or performative session, where lawmakers prioritize headline-grabbing proposals over complex reforms like those in the workers’ compensation space. However, it could also open the door for&nbsp;new leadership and fresh momentum&nbsp;behind previously stalled bills.</p>



<p>Justyn Needel, Legislative Specialist at Injured Workers Pharmacy</p>



<p>**********************************************</p>



<p><strong>My Thoughts on HB 1069</strong></p>



<p><a href="https://flhouse.gov/Sections/Bills/billsdetail.aspx?BillId=81722" target="_blank" rel="noreferrer noopener">HB 1069</a> was a calculated attempt to restrict benefits for injured workers. It mirrored aspects of the <a href="https://www.dol.gov/general/topic/retirement/erisa" target="_blank" rel="noreferrer noopener">ERISA</a> system — the federal law governing most private-sector retirement and health plans — a framework notorious for being cumbersome, one-sided, and tilted heavily toward private industry.</p>



<p>When the bill surfaced, I reached out to a colleague who is one of the few attorneys in the country who specializes in ERISA law. His insight is invaluable, not only because of his mastery of this complex system, but also because he has some familiarity with <a href="http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2024&Title=%2D%3E2024%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Florida’s workers’ compensation laws</a>. After comparing the two systems, he confirmed my concerns: Florida’s workers’ compensation process is far more streamlined and fair-minded toward injured claimants than the labyrinth of ERISA.</p>



<p>I had hoped to have him share this perspective with Florida legislators if the opportunity arose. Fortunately, HB 1069 never advanced far enough to require it.</p>



<p>*********************************************************</p>



<p><strong>Contact us</strong>&nbsp;toll free at 866-785-GALE or by email (jgale@jeffgalelaw.com) for a free, confidential consultation to learn your legal rights.</p>



<p><strong>Jeffrey P. Gale, P.A.</strong>&nbsp;is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // The Risks and Realities of Cash Advance Funding in Florida Injury Cases]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-the-risks-and-realities-of-cash-advance-funding-in-florida-injury-cases/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-the-risks-and-realities-of-cash-advance-funding-in-florida-injury-cases/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Thu, 31 Jul 2025 19:03:31 GMT</pubDate>
                
                    <category><![CDATA[Personal Injury]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[advanced funding]]></category>
                
                    <category><![CDATA[capstone]]></category>
                
                    <category><![CDATA[case funding]]></category>
                
                    <category><![CDATA[legal funding]]></category>
                
                    <category><![CDATA[personal injuries]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2016/04/dollars.jpg" />
                
                <description><![CDATA[<p>The competition to advance money to individuals injured in accidents is intense, driven by the prospect of a high return on investment. Numerous companies, including large national players, engage in this market, offering what is known as “non-recourse funding advances.” Because the only collateral is the injury claim itself—whether a workers’ compensation or personal injury&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>The competition to advance money to individuals injured in accidents is intense, driven by the prospect of a high return on investment. Numerous companies, including large national players, engage in this market, offering what is known as “non-recourse funding advances.” Because the only collateral is the injury claim itself—whether a <a href="http://www.leg.state.fl.us/Statutes/index.cfm?StatuteYear=2024&Tab=statutes&Submenu=1" target="_blank" rel="noreferrer noopener">workers’ compensation</a> or personal injury case—these companies are not bound by <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0687/Sections/0687.02.html#:~:text=(1)%20All%20contracts%20for%20the,interest%20are%20hereby%20declared%20usurious." target="_blank" rel="noreferrer noopener">Florida’s usury laws</a>, <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0687/Sections/0687.02.html#:~:text=(1)%20All%20contracts%20for%20the,interest%20are%20hereby%20declared%20usurious." target="_blank" rel="noreferrer noopener">which cap interest rates at 18%</a>. As a result, repayment amounts can quickly double or triple the original principal.</p>



<p>Advance companies have no recourse beyond the case. They cannot foreclose on property or garnish wages. If the case fails or the recovery is insufficient, the company bears the loss. Given the inherent uncertainties of litigation, this risk is very real. Cases can “go south” for a variety of reasons.</p>



<!--more-->



<p>To secure repayment, funding companies require injured individuals to sign lien and assignment agreements, obligating their attorneys to satisfy the lien directly from any settlement or judgment proceeds.</p>



<h3 class="wp-block-heading" id="h-important-considerations">Important Considerations</h3>



<ol class="wp-block-list">
<li><strong>Pressure to Accept Low Settlements</strong>: Because of compounding interest, clients may feel compelled to accept early, inadequate settlement offers to stop the financial bleeding.</li>



<li><strong>Pressure to Reject Fair Settlements</strong>: Conversely, some clients may reject reasonable offers in hopes of securing a recovery large enough to pay off the advance, thereby taking unreasonable risks at trial.</li>



<li><strong>Risk of Privilege Waivers</strong>: In assessing risk, some funding companies request detailed written evaluations from attorneys. If shared, these communications could be used by opposing parties to argue waiver of attorney-client or work-product protections.</li>
</ol>



<p>As a general practice, we advise clients to avoid these advances. However, we also recognize that financial necessity can override ideal strategy. Recently, we assisted a client with obtaining an advance to pay for a crucial surgery. He had suffered catastrophic injuries, lacked health insurance, and had exhausted his personal funds. While the repayment will be significant, the advance has given him access to medical care he would not otherwise have received. He was deeply grateful for our assistance.</p>



<h3 class="wp-block-heading" id="h-suggested-funding-companies">Suggested Funding Companies</h3>



<p>For clients who insist on proceeding, we provide names of several reputable funding companies as options, including:</p>



<ul class="wp-block-list">
<li><a href="https://clientlegalfunding.com/" target="_blank" rel="noreferrer noopener">Client Legal Funding</a></li>



<li><a href="https://clientlegalfunding.com/" target="_blank" rel="noreferrer noopener">Capstone Financial Services, LLC</a></li>



<li><a href="https://getsomecashnow.com/" target="_blank" rel="noreferrer noopener">Cash Now Funding Group</a></li>



<li><a href="https://multifundingusa.com/" target="_blank" rel="noreferrer noopener">Multi-Funding USA</a></li>



<li><a href="https://peachtreefinancial.com/" target="_blank" rel="noreferrer noopener">Peachtree Financial Solutions</a></li>
</ul>



<p>This is not an exhaustive list. Clients are strongly encouraged to research companies carefully, paying close attention to interest rates and repayment terms.</p>



<h3 class="wp-block-heading" id="h-why-we-can-t-provide-advances">Why We Can’t Provide Advances</h3>



<p>Clients often ask us directly for financial assistance. We must respectfully decline. Florida Bar Rule 4-1.8(e), set forth below, expressly prohibits lawyers from providing financial aid to clients in connection with pending or contemplated litigation, except in very limited circumstances. The purpose of this rule is sound: a lawyer with a financial stake in a client’s personal situation may feel pressured to compromise the case to secure repayment—for example, by pushing for an early settlement.</p>



<p><strong>Rule 4-1.8(e) – Financial Assistance to Clients</strong><br>A lawyer is prohibited from providing financial<br>assistance to a client in connection with pending or contemplated litigation, except that:<br>(1) a lawyer may advance court costs and expenses of litigation, the repayment of which may be contingent on the outcome of the matter; and<br>(2) a lawyer representing an indigent client may pay court costs and expenses of litigation on behalf of the client.</p>



<p><strong>*********************</strong></p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Fundamentals Matter — Proximate Cause]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-fundamentals-matter-proximate-cause/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-fundamentals-matter-proximate-cause/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Mon, 28 Jul 2025 17:38:59 GMT</pubDate>
                
                    <category><![CDATA[Civil Litigation]]></category>
                
                    <category><![CDATA[Litigation]]></category>
                
                    <category><![CDATA[Personal Injury]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[bodily injury]]></category>
                
                    <category><![CDATA[cause of action]]></category>
                
                    <category><![CDATA[directed verdict]]></category>
                
                    <category><![CDATA[fundamentals]]></category>
                
                    <category><![CDATA[lawsuit]]></category>
                
                    <category><![CDATA[medical malpractice]]></category>
                
                    <category><![CDATA[motor vehicle crash]]></category>
                
                    <category><![CDATA[personal injuries]]></category>
                
                    <category><![CDATA[personal injury]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                    <category><![CDATA[wrongful death]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2022/11/scales.jpg" />
                
                <description><![CDATA[<p>In every negligence action for personal injury or wrongful death, the plaintiff must establish three core elements: (1) a duty owed by the defendant; (2) a breach of that duty; and (3) that the breach proximately caused the claimed damages. While duty and breach often dominate attention, proximate cause is the element that connects wrongdoing&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<h1 class="wp-block-heading" id="h-"></h1>



<p>In every negligence action for personal injury or wrongful death, the plaintiff must establish three core elements: (1) a duty owed by the defendant; (2) a breach of that duty; and (3) that the breach proximately caused the claimed damages.</p>



<p>While duty and breach often dominate attention, <strong>proximate cause</strong> is the element that connects wrongdoing to legal responsibility. Without proximate cause, even clear negligence is not actionable.</p>



<p>Florida courts apply the <strong>“more likely than not”</strong> standard to determine causation. The plaintiff must prove that the defendant’s negligence probably caused the injury—not merely that it possibly did. See <em>Tampa Electric Co. v. Jones</em>, 138 Fla. 746, 190 So. 26 (1939); <a href="https://scholar.google.com/scholar_case?case=16447243435186437742&q=Tampa+Electric+Co.+v.+Jones&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Greene v. Flewelling</em>, 366 So.2d 777 (Fla. 2d DCA 1978)</a>; <a href="https://scholar.google.com/scholar_case?case=4697853126987978045&q=Tampa+Electric+Co.+v.+Jones&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Bryant v. Jax Liquors</em>, 352 So.2d 542 (Fla. 1st DCA 1977)</a>. As Prosser succinctly put it:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“A mere possibility of causation is not enough; and when the matter remains one of pure speculation or conjecture, or the probabilities are at best evenly balanced, it becomes the duty of the court to direct a verdict for the defendant.”</p>
</blockquote>



<h2 class="wp-block-heading">The Gooding Benchmark</h2>



<p>The <strong><a href="https://science.nasa.gov/solar-system/what-is-the-north-star-and-how-do-you-find-it/" target="_blank" rel="noreferrer noopener">North Star</a> of Florida’s proximate cause law</strong> remains <a href="https://scholar.google.com/scholar_case?case=4912764144543777004&q=gooding+v+university+hospital&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Gooding v. University Hospital Building, Inc.</em>, 445 So.2d 1015 (Fla. 1984)</a>.</p>



<p>Emily Gooding, representing her late husband’s estate, alleged emergency room negligence in failing to timely diagnose and treat his abdominal aneurysm. Although her expert established a breach of medical standards, he failed to testify that immediate treatment would have more likely than not saved Mr. Gooding’s life. The Florida Supreme Court affirmed a reversal of the plaintiff’s jury verdict, holding that causation evidence must satisfy the “more likely than not” standard, not rest on a mere possibility of survival.</p>



<!--more-->



<h2 class="wp-block-heading">Directed Verdicts and Proximate Cause</h2>



<p>The <em>Gooding</em> principle shapes when courts must take causation questions away from the jury. A <strong>directed verdict</strong> is appropriate “where no proper view of the evidence could sustain a verdict in favor of the non-moving party.” See <a href="https://scholar.google.com/scholar_case?case=4733560343449775993&q=Friedrich+v.+Fetterman+%26+Assocs.,+P.A.&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Friedrich v. Fetterman & Assocs.</em>, 137 So.3d 362 (Fla. 2013)</a>.</p>



<p>A recent example is <a href="https://scholar.google.com/scholar_case?case=1731278457211333438&q=gooding+v+university+hospital&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>R.J. Reynolds Tobacco Co. v. Nelson</em>, 47 Fla. L. Weekly D2436 (Fla. 1st DCA 2022)</a>. There, Reynolds was sued for design defect negligence causing COPD. The appellate court reversed the plaintiff’s verdict, finding no competent evidence that Reynolds’ conduct proximately caused the plaintiff’s disease. Once again, the absence of substantial causation evidence mandated a directed verdict.</p>



<h2 class="wp-block-heading">But Sometimes, Proximate Cause <em>Is</em> a Jury Question</h2>



<p>Not all proximate cause cases end in favor of the defendant. In <a href="https://scholar.google.com/scholar_case?case=14787290568205596847&q=gooding+v+university+hospital&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Aragon v. Issa, M.D.</em>, 103 So.3d 887 (Fla. 4th DCA 2012)</a>, the appellate court reversed a trial judge’s post-verdict ruling for the defense. Because the plaintiff presented conflicting expert testimony supporting causation, the case should have been left to the jury.</p>



<p>Similarly, in <a href="https://scholar.google.com/scholar_case?case=1265116454086448203&q=gooding+v+university+hospital&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Claire’s Boutiques v. Locastro</em>, 85 So.3d 192 (Fla. 4th DCA 2012)</a>, the court upheld the denial of a directed verdict on causation. Although the defendant claimed there was insufficient proof that their negligence caused an infection, the court emphasized that if “sufficient evidence” supports the “more likely than not” standard, the issue must go to the trier of fact.</p>



<h2 class="wp-block-heading">Primary Cause ≠ Proximate Cause</h2>



<p>One of the most important clarifications in Florida law is that proximate cause does not require an act to be the “primary” cause of an injury. In <a href="https://scholar.google.com/scholar_case?case=1203982512167762496&q=Ruiz+v.+Tenet+Hialeah+Healthsystem,+Inc.&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Ruiz v. Tenet Hialeah Healthsystem, Inc.</em>, 260 So.3d 977 (Fla. 2018)</a>, the Florida Supreme Court reversed a directed verdict in a medical malpractice case.</p>



<p>The defendant doctor argued he merely “placed” the patient in a position to be harmed by the independent actions of others. The Court disagreed, reaffirming that:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>““the law does not require an act to be the exclusive or even the primary cause of an injury in order for that act to be considered the proximate cause of the injury: rather, it need only be a substantial cause of the injury.”</p>
</blockquote>



<p>This principle was famously applied in <em>Sardell v. Malanio</em>, 202 So.2d 746 (Fla. 1967), where a boy who threw a football was held potentially liable for injuries caused when another boy collided with a passerby while catching the ball. Proximate cause, the Court explained, hinges on whether an act substantially contributed to the injury, not whether it was direct or dominant.</p>



<h2 class="wp-block-heading">Proximate Cause in Workers’ Compensation</h2>



<p>Though often associated with tort law, proximate cause is equally fundamental in <strong>Florida workers’ compensation cases</strong>. Claimants must prove a causal link between an industrial accident and their injury with <strong>competent substantial evidence</strong>. See <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.02.html" target="_blank" rel="noreferrer noopener">§ 440.02(1), Fla. Stat.</a>; <a href="https://scholar.google.com/scholar_case?case=8671005780950648319&q=ESCAMBIA+BD.+OF+COUNTY+COM%E2%80%99RS+v.+REEDER&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Gator Industries, Inc. v. Neus</em>, 585 So.2d 1174 (Fla. 1st DCA 1991)</a>.</p>



<p>In <a href="https://scholar.google.com/scholar_case?case=17109277101775034802&q=ESCAMBIA+BD.+OF+COUNTY+COM%E2%80%99RS+v.+REEDER&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Escambia County Board of County Commissioners v. Reeder</em>, 648 So.2d 222 (Fla. 1994)</a>, the claimant’s compensation was not reduced despite his failure to wear a safety belt on a bulldozer. The court held that the employer had to prove a <strong>causal connection</strong> between the refusal to wear safety equipment and the injury. Because that proof was lacking, the 25% statutory penalty pursuant to  <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" target="_blank" rel="noreferrer noopener">§ 440.09(5) </a>could not be applied.</p>



<h2 class="wp-block-heading">Conclusion: Fundamentals Always Matter</h2>



<p>Like a receiver taking his eyes off the ball or a tennis player forgetting footwork, lawyers sometimes lose sight of foundational principles. <strong>Proximate cause is a legal fundamental.</strong> It bridges the gap between wrongful conduct and compensable harm. Whether in personal injury, medical malpractice, or workers’ compensation, failing to establish proximate cause is fatal to a claim. Conversely, remembering and proving it can be the difference between victory and defeat.</p>



<p>In litigation, fundamentals always matter.</p>



<p><strong>********************</strong></p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email (jgale@jeffgalelaw.com and kgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>



<p></p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Election of Remedies in Florida: The Point of No Return]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-election-of-remedies-in-florida-the-point-of-no-return/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-election-of-remedies-in-florida-the-point-of-no-return/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Tue, 22 Jul 2025 16:27:16 GMT</pubDate>
                
                    <category><![CDATA[Civil Litigation]]></category>
                
                    <category><![CDATA[Personal Injury]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[chapter 440]]></category>
                
                    <category><![CDATA[civil law]]></category>
                
                    <category><![CDATA[election of remedies]]></category>
                
                    <category><![CDATA[personal injury]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                    <category><![CDATA[workers' compensation immunity]]></category>
                
                    <category><![CDATA[workers' compensation or civil remedy]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2021/07/maze2.jpg" />
                
                <description><![CDATA[<p>Some legal wrongs give the aggrieved party more than one avenue of redress. A common example arises when an injured person must choose between pursuing a remedy under common law or seeking benefits under Florida’s Workers’ Compensation Law, Chapter 440, Florida Statutes. However, once a path is chosen and pursued past a certain threshold, the&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Some legal wrongs give the aggrieved party more than one avenue of redress. A common example arises when an injured person must choose between pursuing a remedy under common law or seeking benefits under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Florida’s Workers’ Compensation Law, Chapter 440, Florida Statutes</a>. However, once a path is chosen and pursued past a certain threshold, the alternative remedy may no longer be available. This is the doctrine of <strong>Election of Remedies</strong>.</p>



<p>It is not uncommon for the injured party to first receive workers’ compensation benefits before deciding whether to pursue civil damages. Florida appellate courts have thoroughly analyzed how far one can go down the workers’ compensation path before the election becomes binding. Far less guidance exists, however, on how far one may go in a civil action before being barred from later seeking workers’ compensation benefits.</p>



<!--more-->



<p>Yet, the governing legal principle applies to both scenarios:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>An election becomes binding “when the rights of the parties have been materially affected to the advantage of one or the disadvantage of the other,” and “[i]t is generally conceded that to be conclusive it must be efficacious to some extent.”<br>— <a href="https://scholar.google.com/scholar_case?about=11791367840157618106&q=Hume+v.+Thomason&hl=en&as_sdt=40006"><em>Williams v. Robineau</em>, 124 Fla. 422, 168 So. 644 (1936)</a>; <a href="https://scholar.google.com/scholar_case?case=10876902148536171805&q=Hume+v.+Thomason&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Williams v. Duggan</em>, 153 So. 2d 726 (Fla. 1963)</a></p>
</blockquote>



<p>In practice, determining when an election has matured is often clearer in civil litigation. Civil damages are not awarded until a court determines whether common law is the appropriate remedy. Until that point, the election generally remains open.</p>



<h3 class="wp-block-heading" id="h-the-hume-decision">The Hume Decision</h3>



<p>The case of <a href="https://scholar.google.com/scholar_case?case=18272498441313946349&q=Hume+v.+Thomason&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Hume v. Thomason</em>, 440 So. 2d 441 (Fla. 1st DCA 1983)</a>, illustrates the consequences of making a binding election. Hume, a carpenter injured while working on the Thomasons’ home, was entitled to elect between workers’ compensation and a civil lawsuit under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.11.html" target="_blank" rel="noreferrer noopener">§ 440.11(1), Florida Statutes</a>, because the employer failed to secure workers’ compensation coverage. Hume chose to sue in civil court, but the court entered final summary judgment against him. He then sought workers’ compensation benefits. The Thomasons objected, arguing that Hume had elected his remedy.</p>



<p>The judge of compensation claims agreed, and the First DCA affirmed:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“The summary judgment rendered in the circuit court was obviously efficacious from the Thomasons’ point of view, as it worked to their advantage and to Hume’s disadvantage. Thus, Hume’s election matured when judgment was entered finally adjudicating the rights of the parties. He was precluded thereafter from pursuing his workers’ compensation claim.”</p>
</blockquote>



<p>The court also observed the unfairness of requiring the employer to defend the same injury claim in two different forums:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“[T]he employer should not be twice placed in the position of defending himself where he had had to defend either a damage suit on the one hand or a compensation claim on the other to its final conclusion.”</p>
</blockquote>



<p>In short, <em>Hume</em> elected his remedy—and lost. End of story.</p>



<h3 class="wp-block-heading" id="h-the-gilbert-decision">The Gilbert Decision</h3>



<p>The principle was similarly tested in <a href="https://scholar.google.com/scholar_case?case=12771812480706435785&q=Gilbert+v.+FL+BIRTH-RELATED+NEUROLOGICAL&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Gilbert v. Florida Birth-Related Neurological Injury Compensation Association</em>, 724 So. 2d 688 (Fla. 2d DCA 1999)</a>. There, the plaintiffs settled a civil medical negligence claim and later filed a petition for benefits under the Florida Birth-Related Neurological Injury Compensation Plan (NICA). An administrative law judge dismissed the petition, citing the doctrine of election of remedies. The Second DCA reversed:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“The remedies are mutually exclusive, but only upon a determination of whether the infant is a NICA baby. That is the core issue of both the civil action and the administrative petition. … The resulting settlement of [the civil] action, although it may imply [the baby was not covered under NICA], fell short of such a determination.”</p>
</blockquote>



<p>In other words, an election is not binding unless the underlying factual issue has been definitively resolved.</p>



<h3 class="wp-block-heading" id="h-application-in-workers-compensation">Application in Workers’ Compensation</h3>



<p>In workers’ compensation matters, benefits are often received passively, without the injured worker affirmatively electing them. Such passive receipt—even if substantial—typically does not constitute a binding election.</p>



<p>More commonly, the issue arises when a claimant receives some benefits and then files a civil suit. Despite the general guidance from <em>Duggan</em>, the outer limit of how far one can go in the compensation system before forfeiting a civil remedy remains somewhat unclear.</p>



<p>Still, as shown in <em>Hume</em> and <em>Gilbert</em>, most decisions support the idea that an election is not binding until a <strong>factual determination on the core issue</strong> has been made. In civil cases, that core issue may be whether the claim is governed by the exclusive remedy provision of Chapter 440. In workers’ compensation cases, it may be whether the injury falls within the Act’s coverage.</p>



<p>**************************</p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Florida Workers’ Compensation: Creating Compensability of Injuries by Operation of Law (The “120-Day Rule”)]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-creating-compensability-of-injuries-by-operation-of-law-the-120-day-rule-2/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-creating-compensability-of-injuries-by-operation-of-law-the-120-day-rule-2/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Mon, 21 Jul 2025 17:06:58 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[120-day rule]]></category>
                
                    <category><![CDATA[440.20]]></category>
                
                    <category><![CDATA[chapter 440]]></category>
                
                    <category><![CDATA[operation of law]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2025/07/calendar-1192688.jpg" />
                
                <description><![CDATA[<p>Few provisions in Florida’s workers’ compensation law demand more careful attention from carriers than section 440.20(4), Florida Statutes. Commonly referred to as the “120-Day Rule,” this statute outlines the process for determining compensability of an injury and can create compensability by operation of law when not followed properly. The full statutory language is as follows:&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Few provisions in <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" target="_blank" rel="noreferrer noopener">Florida’s workers’ compensation law</a> demand more careful attention from carriers than <strong><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.20.html" target="_blank" rel="noreferrer noopener">section 440.20(4), Florida Statutes</a></strong>. Commonly referred to as the <strong>“120-Day Rule,”</strong> this statute outlines the process for determining compensability of an injury and can create compensability <strong>by operation of law</strong> when not followed properly. The full statutory language is as follows:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“If the carrier is uncertain of its obligation to provide all benefits or compensation, the carrier shall immediately and in good faith commence investigation of the employee’s entitlement to benefits… [and] shall admit or deny compensability within 120 days after the initial provision of compensation or benefits…. A carrier that fails to deny compensability within 120 days after the initial provision of benefits or payment of compensation … waives the right to do deny compensability, unless the carrier can establish material facts relevant to the issue of compensability that it could not have discovered through reasonable investigation within the 120-day period.”</p>
</blockquote>



<p>The provision acknowledges the complexity of determining whether an injury is work-related. To that end, it gives the <strong>employer/carrier (E/C)</strong> a limited window—120 days—to investigate the claim thoroughly. This includes gathering and reviewing medical records, deposing the injured worker and witnesses, and consulting with physicians.</p>



<!--more-->



<p>However, the statute has teeth: if the E/C provides benefits for a particular injury without denying compensability within 120 days, it waives the right to later contest whether the injury arose out of and occurred in the course of employment—<strong>unless</strong> it can establish that key facts could not reasonably have been discovered during the 120-day period. See<a href="https://scholar.google.com/scholar_case?case=7238187756255271963&q=North+River+Ins.+Co.+v.+Wuelling&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"> <em>North River Ins. Co. v. Wuelling</em>, 683 So. 2d 1090, 1092 (Fla. 1st DCA 1996) (en banc)</a>.</p>



<p>To determine if compensability has been established by operation of law, courts apply the test outlined in <a href="https://scholar.google.com/scholar_case?case=7733442091289716535&q=Sierra+v.+Metropolitan+Protective+Services&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Sierra v. Metropolitan Protective Services</em>, 188 So. 3d 863 (Fla. 1st DCA 2015)</a>. The court will consider:</p>



<ol class="wp-block-list">
<li><strong>When</strong> did the E/C first provide benefits for the disputed condition?</li>



<li><strong>Which</strong> specific injuries or conditions were covered?</li>



<li><strong>Did</strong> the E/C deny compensability within 120 days of first providing such benefits?</li>
</ol>



<h3 class="wp-block-heading" id="h-real-world-example">Real-World Example</h3>



<p>Our firm is currently handling a case that illustrates the operation of this rule. The claimant underwent an <strong>MRI more than two years post-accident</strong>, which revealed injuries not previously diagnosed. This MRI was ordered by a newly authorized physician during his first examination. At the follow-up, the doctor concluded that the accident was the <strong>major contributing cause (MCC)</strong> of the newly discovered injuries and notified the E/C in writing.</p>



<p>Since then, with the E/C’s full knowledge and authorization, the doctor has continued to treat these injuries for over 18 months—ordering physical therapy, prescribing medication, and issuing medical equipment. Under the governing case law, the E/C had <strong>120 days from the date it received the doctor’s opinion</strong> <strong>and paid for the condition</strong>, not from the date of the accident, to deny compensability. Failing to do so may have resulted in the injury being deemed compensable by operation of law.</p>



<hr class="wp-block-separator has-alpha-channel-opacity" />



<h3 class="wp-block-heading" id="h-conclusion">Conclusion</h3>



<p>The “120-Day Rule” strikes a fair balance. It gives employers and carriers a reasonable opportunity to investigate a claim without penalizing injured workers through endless delays. It also encourages medical providers to offer timely, clear opinions on causation. Most importantly, it prevents E/Cs from passively accepting and treating injuries only to later disavow responsibility.</p>



<p>Proper application of the 120-Day Rule is critical—both as a shield for employers/carriers and a safeguard for injured workers. As always, knowing when the clock starts—and what restarts it—makes all the difference.</p>



<p>********************************</p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noreferrer noopener" target="_blank">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p></p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. /// Debunking the “Prescription Doctrine” in Florida Workers’ Compensation]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-debunking-the-prescription-doctrine-in-florida-workers-compensation/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-debunking-the-prescription-doctrine-in-florida-workers-compensation/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Sat, 07 Jun 2025 13:28:07 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[440.13]]></category>
                
                    <category><![CDATA[440.192]]></category>
                
                    <category><![CDATA[florida's workers' compensation system]]></category>
                
                    <category><![CDATA[jcc]]></category>
                
                    <category><![CDATA[judge of compensation claims]]></category>
                
                    <category><![CDATA[myth]]></category>
                
                    <category><![CDATA[prescriptions]]></category>
                
                    <category><![CDATA[religious doctrine]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2025/06/IMG_2117.jpeg" />
                
                <description><![CDATA[<p>The belief that a physician’s written prescription must accompany every petition for benefits requesting medical care has taken on the status of religious doctrine in Florida workers’ compensation practice. This blog aims to challenge and clarify that misconception. A petition for benefits is the workers’ compensation equivalent of a civil complaint. It is the legal&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>The belief that a physician’s written prescription must accompany every petition for benefits requesting medical care has taken on the status of religious doctrine in Florida workers’ compensation practice. This blog aims to challenge and clarify that misconception.</p>



<p>A <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html" target="_blank" rel="noreferrer noopener">petition for benefits</a> is the workers’ compensation equivalent of a civil complaint. It is the legal vehicle used to initiate litigation against the employer and its insurance carrier (E/C).</p>



<p><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html" target="_blank" rel="noreferrer noopener">Section 440.192, Florida Statutes</a>, outlines the required contents of every petition, its purpose being to equip E/C with sufficient information to make informed decisions.</p>



<p>The so-called prescription doctrine finds its supposed legal foundation in <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html" target="_blank" rel="noreferrer noopener">Section 440.192(2)(i)</a>, which states:</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“The type or nature of treatment, care, or attendance sought and the justification for such treatment. If the employee is under the care of a physician for an injury identified under paragraph (c), a copy of the physician’s request, authorization, or recommendation for treatment, care, or attendance must accompany the petition.”</p>
</blockquote>



<p>Many practitioners and judges interpret this subsection as requiring a physician’s written request with every petition seeking medical care. They view the two sentences as linked and dependent. As a result, E/C routinely files motions to dismiss petitions that lack a doctor’s written request.</p>



<p>I respectfully disagree with this widely accepted interpretation.</p>



<!--more-->



<p>In my view, each sentence of <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html" target="_blank" rel="noreferrer noopener">440.192(2)(i)</a> applies independently to different scenarios. They are not intertwined.</p>



<p><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" target="_blank" rel="noreferrer noopener">Florida Statutes Section 440.13(2)</a> sets forth the E/C’s duty to provide necessary medical treatment. Authorized physicians routinely recommend services such as physical therapy, diagnostic studies, and specialist referrals. In such cases, the second sentence of <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.192.html" target="_blank" rel="noreferrer noopener">440.192(2)(i)</a> applies—but only when the petition relies on a physician’s written request for that treatment. (Notably, this request may not be limited to authorized physicians.)</p>



<p>However, the statute does not state that a physician’s request must always accompany a claim for medical benefits.</p>



<p>The second sentence simply instructs that if there is a written request, include it. This makes sense—if a written recommendation exists, attaching it facilitates an informed response from the E/C. Nothing more.</p>



<p>Conversely, the first sentence of 440.192(2)(i) outlines what is required when the request for treatment does not stem from a physician’s prescription. In those cases, the claimant must state the “type or nature” of the requested care and provide a justification. The aim remains the same: to allow the E/C to assess the claim.</p>



<p>This interpretation finds support in <a href="https://scholar.google.com/scholar_case?case=1100400727746196018&q=Burdick+v.+Bob%E2%80%99s+Space+Racers&hl=en&as_sdt=40006" target="_blank" rel="noreferrer noopener"><em>Burdick v. Bob’s Space Racers</em>, 659 So. 2d 351 (Fla. 1st DCA 1995)</a>. In <em>Burdick</em>, the claimant filed a petition seeking chiropractic treatment. The <a href="https://www.jcc.state.fl.us/JCC/judges/" target="_blank" rel="noreferrer noopener">Judge of Compensation Claims (JCC)</a> dismissed the petition, and the <a href="https://1dca.flcourts.gov/" target="_blank" rel="noreferrer noopener">First District Court of Appeal</a> affirmed the dismissal—not because it lacked a doctor’s request, but because it failed to meet the requirements of the first sentence of 440.192(2)(i). The second sentence was not even addressed, suggesting it was inapplicable to that claim.</p>



<p>In practice, a claimant may be unable to obtain a physician’s written request. This is especially true when the E/C authorizes treatment only for limited injuries, restricting providers from addressing other complaints. Some physicians, uncertain about their authority or unwilling to anger E/C, simply refrain from issuing prescriptions. In more extreme cases, the E/C refuses to authorize any treatment at all—making it impossible to obtain a prescription.</p>



<p>Such obstacles should not bar a claimant from seeking and securing medical care. The first sentence of 440.192(2)(i) exists precisely to address these circumstances.</p>



<p><strong>Conclusion:&nbsp;</strong>The rigid insistence on a physician’s prescription with every petition for medical benefits misreads the statute. A more reasonable and legally supported interpretation recognizes the independence of the two sentences in 440.192(2)(i). This reading preserves both the claimant’s right to pursue care and the E/C’s ability to evaluate the request.</p>



<p>It’s time to retire the myth and restore clarity to the process.</p>



<p>**************************************</p>



<p><strong>Contact us</strong>&nbsp;at 305-758-4900 or by email (kgale@jeffgalelaw.com and jgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="https://www.jeffgalelaw.com/">Jeffrey P. Gale, P.A.</a>&nbsp;is a&nbsp;<a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498">South Florida</a>&nbsp;based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. /// Personal Injury Liability Cases — The Perils of Ignoring Medicare’s Future Interest]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-person-injury-liability-cases-the-perils-of-ignoring-medicares-future-interest/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-person-injury-liability-cases-the-perils-of-ignoring-medicares-future-interest/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Tue, 29 Apr 2025 18:24:55 GMT</pubDate>
                
                    <category><![CDATA[Medicare Set Aside]]></category>
                
                    <category><![CDATA[Personal Injury]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[centers for medicare & medicaid]]></category>
                
                    <category><![CDATA[cms]]></category>
                
                    <category><![CDATA[liability insurance]]></category>
                
                    <category><![CDATA[medicare set aside]]></category>
                
                    <category><![CDATA[msa]]></category>
                
                    <category><![CDATA[personal injury]]></category>
                
                    <category><![CDATA[pip]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2015/11/caduceus-1219484-m.jpg" />
                
                <description><![CDATA[<p>Our law firm handles both workers’ compensation and personal injury cases, claimant’s/plaintiff’s side only. For years we have been dealing with Medicare Set-Asides (MSA) in our workers’ compensation cases. We have not been doing it in our personal injury cases. It may be time to start. A Medicare Set-Aside is a legal device used to&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Our law firm handles both <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" rel="noopener noreferrer" target="_blank">workers’ compensation</a> and personal injury cases, claimant’s/plaintiff’s side only. For years we have been dealing with <a href="https://www.cms.gov/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" rel="noopener noreferrer" target="_blank">Medicare Set-Asides (MSA)</a> in our <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" rel="noopener noreferrer" target="_blank">workers’ compensation</a> cases. We have not been doing it in our personal injury cases. It may be time to start.</p>



<p>A <a href="https://ametros.com/faqs/medicare-set-asides/what-is-a-medicare-set-aside/" rel="noopener noreferrer" target="_blank">Medicare Set-Aside</a> is a legal device used to make sure <a href="https://en.wikipedia.org/wiki/Medicare_(United_States)" rel="noopener noreferrer" target="_blank">Medicare</a> covers future medical expenses associated with accident-related injuries.</p>



<p>When <a href="https://en.wikipedia.org/wiki/Medicare_(United_States)" rel="noopener noreferrer" target="_blank">Medicare</a> began in 1966, it was the primary payor for all claims except for those covered by Workers’ Compensation, <a href="https://www.dol.gov/agencies/owcp/dcmwc" rel="noopener noreferrer" target="_blank">Federal Black Lung benefits</a>, and <a href="https://www.va.gov/" rel="noopener noreferrer" target="_blank">Veteran’s Administration (VA)</a> benefits. In 1980, <a href="https://en.wikipedia.org/wiki/United_States_Congress" rel="noopener noreferrer" target="_blank">Congress</a> passed legislation to expand the exception list to include the following plans:
</p>



<ul class="wp-block-list">
<li>Liability insurance plans (automobile, premises)</li>



<li><a href="http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.7407.html" target="_blank" rel="noopener noreferrer">No Fault (PIP)</a></li>



<li>Self-Insured</li>
</ul>



<p>
All of these plans, rather than <a href="https://www.medicare.gov/" rel="noopener noreferrer" target="_blank">Medicare</a>, are considered primary payors of medical expenses covered by the respective policies. In 2007, <a href="https://www.congress.gov/" rel="noopener noreferrer" target="_blank">Congress</a> passed legislation imposing reporting requirements on primary payors. The requirements, which involve furnishing Medicare with claim-related information, are laid out in section 111 of the <a href="https://www.congress.gov/110/plaws/publ173/PLAW-110publ173.pdf" rel="noopener noreferrer" target="_blank">Medicare, Medicaid, and Schip Extension Act of 2007</a>. The purpose of the requirements is to keep <a href="https://www.cms.gov/" rel="noopener noreferrer" target="_blank">Medicare</a> from paying for medical care that is otherwise the responsibility of primary payors. <a href="https://www.visitthecapitol.gov/explore/about-congress" rel="noopener noreferrer" target="_blank">Congress</a> has decided that Medicare, which is a taxpayer-funded program, should not bear primary responsibility for medical expenses covered by insurance policies and self-insureds.</p>





<p>The <a href="https://www.cms.gov/" rel="noopener noreferrer" target="_blank">Centers for Medicare & Medicaid Services (CMS)</a> has issued rules for when an MSA must be used in workers’ compensation cases. The guideline is that injured workers must be eligible for Medicare or expect to be eligible within 30 months of the settlement of the workers’ compensation case.</p>



<p>Individuals become eligible for Medicare based on <a href="https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare" rel="noopener noreferrer" target="_blank">age</a> or <a href="https://medicareadvocacy.org/medicare-info/medicare-coverage-for-people-with-disabilities/" rel="noopener noreferrer" target="_blank">disability</a>. The age for entitlement is 65, while individuals under 65 become eligible after they have been qualified to receive <a href="https://www.ssa.gov/disability" rel="noopener noreferrer" target="_blank">Social Security Disability Income (SSDI)</a> benefits for 24 months. Many people injured in accidents apply for <a href="https://www.usa.gov/social-security-disability" rel="noopener noreferrer" target="_blank">SSDI</a>, implicating MSA issues.</p>



<p>CMS has not issued guidelines for personal injury cases. However, as the reporting language and other requirements do not distinguish between workers’ compensation and personal injury cases, it is reasonable to conclude that the MSA law applies equally to both.</p>



<p>An MSA designates portions of the proceeds of a settlement to pay for future accident-related medical expenses. Typically, the set-aside amount is determined by experts employed by the parties — in workers’ compensation cases, the expense is always covered by the carriers — based on medical conditions and anticipated needs. In many instances, <a href="https://www.cms.gov/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" rel="noopener noreferrer" target="_blank">CMS will review the proposed set-aside amount</a> to determine adequacy. It has the option of approving the proposed amount or requiring more. On rare occasions, it will even require a lower amount. To avoid future issues, it is always better to get CMS’s approval. However, <a href="https://www.cms.gov/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" rel="noopener noreferrer" target="_blank">CMS will only review WCMSA proposals that meet the following criteria</a>:
</p>



<ul class="wp-block-list">
<li>The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or</li>



<li>The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00</li>
</ul>



<p>
Medicare Set-Asides are not mandatory. No law is violated for not using one. However, if one isn’t used where the injured person is eligible for Medicare or expects to be eligible within 30 months of the settlement, Medicare will require that 100% of the settlement money be used to pay for accident-related medical services before it will begin to cover any accident-related medical expenses. (Even without an MSA, Medicare will continue to cover the medical expenses of care unrelated to the accident.)</p>



<p>With an MSA, especially one that has been pre-approved by CMS, Medicare will become the primary payor once the MSA money is exhausted. However, CMS places the burden on the Medicare recipient to prove the money was exhausted appropriately. Because the paperwork is onerous and exacting, it may be advisable to use a company to administer the MSA. A number of companies offer the service at a reasonable rate — $1,000 for one we did recently.</p>



<p>An MSA can also be <a href="https://www.cms.gov/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements/self-administration" rel="noopener noreferrer" target="_blank">self-administered</a>. Because of the difficulty in administering the MSA and the consequences of failing to do so correctly, we have our clients who choose this route sign a document acknowledging the risks and their duties and responsibilities.</p>



<p>The need for an MSA can make it more difficult to settle a case. Except to pay for medical care, a portion of the settlement proceeds is beyond the reach of the injured party. Some of our clients decide to use the MSA-earmarked money on unrelated expenses. Where, after thoughtful consideration, it is decided that the medical needs for the accident-related injuries will be nominal, this can be a safe option.</p>



<p>There is no reason to believe that MSAs are not a necessary tool in personal injury cases. It may be time to start treating them like they are.</p>



<p>**********************************</p>



<p><strong>Contact us</strong> at 305-758-4900 or by email to learn your legal rights.</p>



<p><a href="/">Jeffrey P. Gale, P.A.</a> is a <a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noopener noreferrer" target="_blank">South Florida</a> based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Procedure for Florida Workers’ Compensation One-Time (1x) Change Request]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-procedure-for-florida-workers-compensation-one-time-1x-change-request/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-procedure-for-florida-workers-compensation-one-time-1x-change-request/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Wed, 29 Nov 2023 23:07:50 GMT</pubDate>
                
                    <category><![CDATA[Employment Law]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[1x change]]></category>
                
                    <category><![CDATA[440.13(2)(f)]]></category>
                
                    <category><![CDATA[authorized medical]]></category>
                
                    <category><![CDATA[florida bar rule 4-4.2]]></category>
                
                    <category><![CDATA[medical]]></category>
                
                    <category><![CDATA[one-time change]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2023/11/laptop-work-1260785-m-1.jpg" />
                
                <description><![CDATA[<p>For the most part, Florida workers involved in industrial accidents have little control over which medical providers are authorized to treat them under the state’s workers’ compensation system. Control of the medical care is mostly held by the employers and their workers’ compensation insurance carriers (E/C). Section 440.13, Florida Statutes lays out the parameters regarding&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>For the most part, Florida workers involved in industrial accidents have little control over which medical providers are authorized to treat them under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" rel="noopener noreferrer" target="_blank">the state’s workers’ compensation system</a>. Control of the medical care is mostly held by the employers and their workers’ compensation insurance carriers (E/C). <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">Section 440.13, Florida Statutes</a> lays out the parameters regarding the provision and control of medical care.</p>



<p>Control impacts the nature and quality of medical care received, the receipt of indemnity (money) benefits, and settlement value. Doctors selected by E/C tend to render opinions favoring E/C. Injured workers have limited ability to wrest control of their care from E/C.</p>



<p><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">440.13(2)(f)</a> lets injured workers ask E/C to authorize another treating doctor. Barring exceptional circumstances, the request can only be made one time in each case. E/C has five days from receipt of the request to select another doctor of its choosing or lose the right. If the selection is not made within the five days, the injured worker, also known as the claimant, gets to select the doctor. This doctor then becomes authorized. This is a big deal.</p>



<p>Neither the statute nor case law are fully clear on the proper procedure for making the request. The statute reads that “Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident,” so we know the request must be in writing. Case law even tells us that the writing can take many forms — <a href="https://scholar.google.com/scholar_case?case=13138002451994049194&q=Andrews+v+McKim&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Andrews v McKim</em>, 355 So.3d 957, 962 (Fla. 1<sup>st</sup> DCA 2023)</a>:
</p>



<ul class="wp-block-list">
<li><strong>Email.</strong> <a href="https://scholar.google.com/scholar_case?case=7345030962815331787&q=Bustamante+v.+Amber+Construction+Company&hl=en&as_sdt=40006" target="_blank" rel="noopener noreferrer"><em>Bustamante v. Amber Construction Company</em>, 118 So.3d 921 (Fla. 1<sup>st</sup> DCA 2013)</a></li>



<li><strong>Grievance form.</strong> <a href="https://scholar.google.com/scholar_case?case=17420794812393064525&q=Harrell+v.+Citrus+County+School+Board&hl=en&as_sdt=40006" target="_blank" rel="noopener noreferrer"><em>Harrell v. Citrus County School Board</em>, 25 So.3d 675 (Fla. 1<sup>st</sup> DCA 2010)</a></li>



<li><strong>Petition for Benefits.</strong> <a href="https://scholar.google.com/scholar_case?case=7728524808255020140&q=HMSHost+Corporation/Gallagher+Bassett+Services,+Inc.,+v.+Frederic&hl=en&as_sdt=40006" target="_blank" rel="noopener noreferrer"><em>HMSHost Corporation/Gallagher Bassett Services, Inc.</em>, v. <em>Frederic</em>, 102 So.3d 668 (Fla. 1<sup>st</sup> DCA 2012)</a></li>



<li><em><strong>Telefax.</strong> <a href="https://scholar.google.com/scholar_case?case=14763290808112156690&q=Zekanovic+v.+American+II,+Corp&hl=en&as_sdt=40006" target="_blank" rel="noopener noreferrer">Zekanovic v. American II, Corp.</a></em>, 208 So.3d 851 (Fla. 1<sup>st</sup> DCA 2017)</li>
</ul>



<p>
What’s unclear is to whom the request can or must be sent. The main choices are the insurance adjuster and the carrier’s attorney.</p>



<p><a href="https://www-media.floridabar.org/uploads/2023/11/2024_05-NOV-Chapter-4-RRTFB-11-6-2023-1.pdf" rel="noopener noreferrer" target="_blank">Florida Bar Rule 4-4.2(a)</a> provides as follows:
</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>In representing a client, a lawyer must not communicate about the subject of the representation with a person the lawyer knows to be represented by another lawyer in the matter, unless the lawyer has the consent of the other lawyer. Notwithstanding<br>the foregoing, a lawyer may, without such prior consent, communicate with another’s client to meet the requirements of any court rule, statute or contract requiring notice or service of process directly on a person, in which event the communication is strictly<br>restricted to that required by the court rule, statute or contract, and a copy must be provided to the person’s lawyer.</p>
</blockquote>



<p>
In my view, this Rule blocks lawyers from sending the 1x change request to the adjuster of a represented carrier. While the statute requires a written request, it does not mandate that the request be sent to the adjuster. Therefore, notice upon the lawyer should satisfy the statute.</p>



<p>Rule 60Q-6.104 of the <a href="https://www.jcc.state.fl.us/JCC/rules/#60Q-6.104" rel="noopener noreferrer" target="_blank">Rules of Procedure for Workers’ Compensation Proceedings</a>, instructs attorneys on making their email addresses known. In addition to the lawyer’s email, the list may include assistants’ emails and one specifically for pleadings. To avoid challenges regarding the effectiveness of an emailed 1x change request, the safest route is to send the request to all of the emails listed by the attorney. Moreover, to be doubly safe, the subject line should begin with the words “SERVICE OF OJCC DOCUMENT” in all capital letters followed by the name of the injured worker, employer, and OJCC number, to comply with Rule 60Q-6.108(2)(f), and should include language making it explicitly clear that a 1x change is being requested to avoid any implication of trying to sneak the request past the carrier. <em>See <a href="https://scholar.google.com/scholar_case?case=16485745089441008668&q=Gonzalez+v.+Quinco+Elec.+Inc.&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank">Gonzalez v. Quinco Elec.</a></em> <em>Inc.</em>, 171 So.3d 153 (Fla. 1st DCA 2015).</p>



<p>Given the importance of controlling the medical, most E/C lawyers and their staff are on full alert for 1x change requests. Rarely do they drop the ball by failing to respond within five days. In a request we made last week, emailed to the lawyer and his assistant, the lawyer responded within three hours of the request with the name of another doctor and appointment information.</p>



<p><strong>********************</strong></p>



<p><strong>Contact us</strong> at 305-758-4900 or by email (jgale@jeffgalelaw.com and kgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="/">Jeffrey P. Gale, P.A.</a> is a <a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noopener noreferrer" target="_blank">South Florida</a> based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This  information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Florida Workers’ Compensation — Compensability of Accidents During Lunch Break]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-compensability-of-accidents-during-lunch-break/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-florida-workers-compensation-compensability-of-accidents-during-lunch-break/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Thu, 27 Jul 2023 17:39:59 GMT</pubDate>
                
                    <category><![CDATA[Premises Liability]]></category>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[chapter 440]]></category>
                
                    <category><![CDATA[coming and going]]></category>
                
                    <category><![CDATA[course and scope]]></category>
                
                    <category><![CDATA[incidental]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2023/07/IMG_2410.jpg" />
                
                <description><![CDATA[<p>Our client, a construction site supervisor, was injured off-premises at the end of his lunch break. The beginning and end of lunch were signaled by a loud horn. He and his brother traveled by car to a nearby 7-11 to purchase lunch items. They returned to the area near the worksite to eat lunch in&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Our client, a construction site supervisor, was injured off-premises at the end of his lunch break. The beginning and end of lunch were signaled by a loud horn. He and his brother traveled by car to a nearby 7-11 to purchase lunch items. They returned to the area near the worksite to eat lunch in the parked car. When the return-to-work horn sounded, our client went to the trunk of his car to retrieve his hard hat and safety harness. As he was standing there, the car behind him was struck from behind by another vehicle and pushed into him, causing him to be crushed between that vehicle and his own. He sustained significant injuries requiring a one-week stay in <a href="https://rydertraumacenter.jacksonhealth.org/" rel="noopener noreferrer" target="_blank">Ryder Trauma Center</a> in Miami.</p>



<p>Initially, the workers’ compensation insurance carrier balked at accepting compensability of the injury. Its position was that since the accident happened offsite during a lunch break, it did not arise out of and in the course and scope of our client’s employment. After studying the case law and gathering more facts, the carrier reversed course.</p>



<p>For an injury to be compensable under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" rel="noopener noreferrer" target="_blank">Florida’s workers’ compensation system</a>, it must arise out of and in the course and scope of one’s employment. The indicia for making this determination was articulated by the <a href="https://supremecourt.flcourts.gov/" rel="noopener noreferrer" target="_blank">Florida Supreme Court</a> in <a href="https://scholar.google.com/scholar_case?about=3503166643206094312&q=johns+v+state+dept+of+health+and+rehab&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Fidelity & Casualty Co. of New York v. Moore,</em> 143 Fla. 103, 196 So. 495, 496 (1940)</a>:
</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“[1] there must be some causal connection between the injury and the employment or [2] it must have had its origin in some risk incidental to or connected with the employment <em>or</em> that [3] it flowed from it as a natural consequence. Another definition widely approved is that [4] the injury must occur within the period of the employment, at a place where the employee may reasonably be, and while he is reasonably fulfilling the duties of his employment or engaged in doing something incidental to it.”</p>
</blockquote>



<p>
In <a href="https://scholar.google.com/scholar_case?case=13879429393319960985&q=johns+v+state+dept+of+health+and+rehab&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Johns v. State of Florida, Dept. of Health</em>, 485 So. 2d 857 (Fla. 1st DCA 1986)</a>, the claimant was assaulted in the lobby of her place of employment 20 to 30 minutes prior to the beginning of her shift. She sued her employer for negligence, positing that she was not within the course and scope of her employment when the assault occurred. On a motion for summary judgment, the trial court disagreed. The order of the trial court was affirmed on appeal.</p>



<p>In support of its opinion, the First DCA noted that appellant customarily arrived 20-30 minutes early to avoid being late, that the lobby was normally used by employees, and she had no personal reason for being there. The court distinguished these circumstances from those in <a href="https://scholar.google.com/scholar_case?case=9112490232912065689&q=johns+v+state+dept+of+health+and+rehab&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Aloff v. Neff-Harmon, Inc.,</em> 463 So.2d 291 (Fla. 1st DCA 1984)</a>, a case in which the appeals court reversed a summary judgment for the employer where the employee stayed several hours after the closing of a bar where she was a waitress to discuss primarily personal matters with her employer.</p>



<p>In my estimation, our case more closely approximates the <a href="https://scholar.google.com/scholar_case?case=13879429393319960985&q=johns+v+state+dept+of+health+and+rehab&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Johns</em></a> case and qualifies under most if not all of the criteria articulated in the <a href="https://scholar.google.com/scholar_case?about=3503166643206094312&q=johns+v+state+dept+of+health+and+rehab&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Moore</em></a> case. Apparently, the carrier feels the same way.</p>



<p>These cases are especially fact sensitive and there is plenty of case law on the subject.</p>



<p><strong>********************</strong></p>



<p><strong>Contact us</strong> at 305-758-4900 or by email (jgale@jeffgalelaw.com and kgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="/">Jeffrey P. Gale, P.A.</a> is a <a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noopener noreferrer" target="_blank">South Florida</a> based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This  information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Medical Expenses Incurred in Diagnosing the Nature and Cause of Non-Compensable Injuries Can be the Responsibility of Workers’ Compensation Insurance Carriers]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-medical-expenses-incurred-in-diagnosing-the-nature-and-cause-of-non-compensable-injuries-can-be-the-responsibility-of-workers-compensation-insurance-carriers/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-medical-expenses-incurred-in-diagnosing-the-nature-and-cause-of-non-compensable-injuries-can-be-the-responsibility-of-workers-compensation-insurance-carriers/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Wed, 26 Jul 2023 18:19:41 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[diagnosis]]></category>
                
                    <category><![CDATA[E/C]]></category>
                
                    <category><![CDATA[jcc]]></category>
                
                    <category><![CDATA[MRI]]></category>
                
                    <category><![CDATA[stroke]]></category>
                
                    <category><![CDATA[trauma]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
                    <media:thumbnail url="https://jeffgalelaw-com.justia.site/wp-content/uploads/sites/560/2023/05/surgeon-3-391477-m.jpg" />
                
                <description><![CDATA[<p>We represent a woman who fell at work. The employer sent her to a clinic the same day for treatment. However, because of miscommunications between the employer and the clinic, she never got in to see a doctor despite waiting more than two hours. While in the waiting room, our client began experiencing stroke-like symptoms.&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>We represent a woman who fell at work. The employer sent her to a clinic the same day for treatment. However, because of miscommunications between the employer and the clinic, she never got in to see a doctor despite waiting more than two hours. While in the waiting room, our client began experiencing stroke-like symptoms. She phoned her daughter to take her to the hospital. She was admitted to the hospital and underwent a series of tests mostly aimed at the stroke-like symptoms. She was discharged 24 hours after being admitted. The hospital bill was close to $100,000.</p>



<p>Our client injured her back and feet in the fall. She did not strike her head. The workers’ compensation insurance carrier has accepted responsibility for the orthopedic injuries. However, it is not considering paying the hospital bill. It may have to pay the bill.</p>



<p>It is well established in the case law that diagnostic testing is always compensable if the purpose is to find out the cause of the injured worker’s symptoms. <em>See </em><a href="https://scholar.google.com/scholar_case?case=6261160979929371770&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Arnau v. Winn Dixie Stores,</em> 105 So.3d 669, 671 (Fla. 1st DCA 2013)</a> <em>citing </em><a href="https://scholar.google.com/scholar_case?case=15042884325050483537&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Nealy v. City of W. Palm Beach,</em> 491 So.2d 585, 586 (Fla. 1st DCA 1986)</a> (“Whenever the purpose of the diagnostic test is to determine the cause of a claimant’s symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable.”); <em>see also </em><a href="https://scholar.google.com/scholar_case?case=12973054454621493686&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Superior Concrete Constr. v. Olsen,</em> 616 So.2d 183, 183 (Fla. 1st DCA 1993)</a>; <a href="https://scholar.google.com/scholar_case?case=8783370676487380981&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Perry v. Ridgecrest Int’l,</em> 548 So.2d 826, 827-28 (Fla. 1st DCA 1989)</a>. This is true even if the tests prove the symptoms are unrelated to the compensable injury. <a href="https://scholar.google.com/scholar_case?case=15042884325050483537&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Nealy,</em> 491 So.2d at 586</a>.</p>



<p>The foundation for these principles is found in <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">Florida statute 440.13</a>. Under paragraph <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">440.13(2)(a)</a>, Florida Statutes (2023), employers are required to furnish “such medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or process of recovery may require.” Medically necessary treatment includes “any medical service or medical supply which is used to identify or treat an illness or injury.” <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">§ 440.13(1)(k), Fla. Stat. (2023)</a>.</p>



<p>The case of <a href="https://scholar.google.com/scholar_case?case=18326185423139798274&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Alvarez v. Fort Pierce Police Dept</em>., 186 So. 3d 581 (Fla. 1st DCA 2016)</a>, bears some resemblance to our case. It can also be distinguished. A law enforcement officer in training, passed out and fell to the ground, striking his head on the concrete pavement. A brain CT scan was performed in the hospital emergency room. Acknowledging that Claimant’s head injury may have involved more than a simple laceration, the Employer/Carrier (E/C) agreed to pay for the initial CT. However, once the CT was read as indicative of a stroke, E/C decided that no further testing was required for the workplace injury. As a result, E/C denied responsibility for Claimant’s later hospitalization and additional diagnostic testing which was ordered based on the initial stroke diagnosis.</p>



<p>The law enforcement officer filed a workers’ compensation claim for the hospitalization and testing. Finding that the accident was not the major contributing cause <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" rel="noopener noreferrer" target="_blank">(MCC)</a> of the stroke, the Judge of Compensation Claims (JCC) ruled in E/C’s favor. The First DCA reversed, holding that the MCC analysis does not govern whether diagnostic testing to determine the cause of symptoms must be authorized. Instead, the standards for this determination are those set forth in the third paragraph of this blog. (The MCC standard was fashioned by the <a href="http://www.leg.state.fl.us/Welcome/index.cfm" rel="noopener noreferrer" target="_blank">Florida Legislature</a> to apply to dates of accident beginning January 1, 1994. MCC means “the cause which is more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought.” <em>See</em> <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.09.html" rel="noopener noreferrer" target="_blank">§ 440.09(1)(k), Fla. Stat. (2023)</a>.)</p>



<p>For the reason that our client did not strike her head in the fall, our claim for payment of the hospital bill may be weaker than the Claimant’s position in the <em>Alvarez</em> case. Nevertheless, given the temporal relationship of the symptoms to the accident, we appear to have a shot under the <a href="https://scholar.google.com/scholar_case?case=15042884325050483537&q=perry+v+ridgecrest+intern&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Nealy</em></a> standard: “Whenever the purpose of the diagnostic test is to determine the cause of a claimant’s symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable.”</p>



<p><strong>********************</strong></p>



<p><strong>Contact us</strong> at 305-758-4900 or by email (jgale@jeffgalelaw.com and kgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="/">Jeffrey P. Gale, P.A.</a> is a <a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noopener noreferrer" target="_blank">South Florida</a> based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This  information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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                <title><![CDATA[Jeffrey P. Gale, P.A. // Limited Medical Choices for Claimants in Florida Workers’ Compensation Cases]]></title>
                <link>https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-limited-medical-choices-for-claimants-in-florida-workers-compensation-cases/</link>
                <guid isPermaLink="true">https://www.jeffgalelaw.com/blog/jeffrey-p-gale-p-a-limited-medical-choices-for-claimants-in-florida-workers-compensation-cases/</guid>
                <dc:creator><![CDATA[Jeffrey P. Gale, P.A.]]></dc:creator>
                <pubDate>Tue, 16 May 2023 18:05:33 GMT</pubDate>
                
                    <category><![CDATA[Workers' Compensation]]></category>
                
                
                    <category><![CDATA[440.13]]></category>
                
                    <category><![CDATA[doctor selection]]></category>
                
                    <category><![CDATA[florida workers compensation system]]></category>
                
                    <category><![CDATA[jcc]]></category>
                
                    <category><![CDATA[judge of compensation claims]]></category>
                
                    <category><![CDATA[medical authorization]]></category>
                
                    <category><![CDATA[one-time change]]></category>
                
                    <category><![CDATA[workers' compensation]]></category>
                
                
                
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                <description><![CDATA[<p>Florida Statute 440.13 governs the provision of medical care under Florida’s workers’ compensation system. For the most part, the Employer and its insurance carrier — “E/C” — control the provision of medical care. The most dominant aspect of this control is the right to select the injured worker’s treating doctors. Unfortunately, most of these doctors&hellip;</p>
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<p><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">Florida Statute 440.13</a> governs the provision of medical care under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440ContentsIndex.html&StatuteYear=2019&Title=%2D%3E2019%2D%3EChapter%20440" rel="noopener noreferrer" target="_blank">Florida’s workers’ compensation system</a>. For the most part, the Employer and its insurance carrier — “E/C” — control the provision of medical care.</p>



<p>The most dominant aspect of this control is the right to select the injured worker’s treating doctors. Unfortunately, most of these doctors suffer from the incurable “Don’t Bite the Hand that Feeds You” disease. All too frequently, the opinions expressed by these doctors benefit the E/C to the detriment of the Claimant.</p>



<p>On rare occasions, E/C loses control of the medical. The most frequent situation is where the worker has suffered substantial injuries requiring emergency surgery in the hospital. The natural sequence is that the surgeon, especially if he or she maintains a private practice, will remain the primary physician after the patient is discharged from the hospital. While this doctor is not hand-picked by E/C, he or she is also not hand-picked by the Claimant.</p>



<p><a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">440.13(2)(c)</a> gives E/C a “reasonable time period” to provide initial medical treatment and care. If E/C fails to provide the initial treatment and care, Claimant “may obtain such initial treatment at the expense of the employer.” Even still, E/C can regain control of the medical under this provision. In <a href="https://scholar.google.com/scholar_case?case=6265342161636717559&q=carmack+v+state+dept+of+agriculture&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Carmack v. Department of Agriculture</em>, 31 So.3d 798 (Fla. 1st DCA 2009)</a>, Claimant suffered a compensable accident, but E/C refused to authorize medical care for psychiatric issues arising from leg and back injuries. Claimant sought care with a psychiatrist and filed a Petition for Benefits seeking authorization of past and future care with the psychiatrist. The <a href="https://www.jcc.state.fl.us/JCC/judges/" rel="noopener noreferrer" target="_blank">Judge of Compensation Claims (JCC)</a> ordered E/C to pay for treatment through the date of the final hearing (workers’ compensation trial), but not for continuing treatment with the particular doctor. Instead, E/C was able to choose another psychiatrist. The JCC’s ruling was upheld on appeal.</p>



<p>
<a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">440.13(2)(f)</a> may be the only true opportunity for the Claimant to select a doctor who will remain authorized in the future. Unfortunately, it takes a mistake by E/C for the opportunity to arise. The pertinent parts of this section read as follows:
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<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident…. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary.</p>
</blockquote>



<p>
In <a href="https://scholar.google.com/scholar_case?case=14763290808112156690&q=Zekanovic+v.+AMERICAN+II,+CORP.&hl=en&as_sdt=40006" rel="noopener noreferrer" target="_blank"><em>Zekanovic v. American II, Corp</em>., 208 So.3d 851 (Fla. 1st DCA 2017)</a>, E/C failed to respond within five days to Claimant’s request under <a href="http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.13.html" rel="noopener noreferrer" target="_blank">440.13(2)(f)</a> for a one-time change of physician. Claimant then filed a petition for benefits requesting authorization of a particular doctor as his one-time change. The <a href="https://www.jcc.state.fl.us/JCC/judges/" rel="noopener noreferrer" target="_blank">JCC</a> found that Claimant was entitled to his one-time change, but because Claimant had not actually obtained treatment with the physician of his choice prior to the entry of his ruling, the JCC found that E/C retained the right to choose Claimant’s one-time change. Claimant appealed and the <a href="https://1dca.flcourts.gov/" rel="noopener noreferrer" target="_blank">First District Court of Appeal</a> reversed the JCC’s ruling.</p>



<p>We request a one-time change of physician in many of our workers’ compensation cases. Knowing the consequence of failing to respond timely — losing control! — E/C rarely fails to respond timely. When it responds timely, it gets to select the one-time change doctor. I can count on the fingers of one hand the number of times E/C has failed to respond timely. Coincidentally, one of those times happened just recently. Interestingly, because the oversight was by a friendly lawyer rather than the disagreeable adjuster in the case, I have offered to work with the lawyer to select an alternative both of us can agree on. However, because I won’t agree to one of the usual suspects, we may not reach an agreement. In the meantime, my client is scheduled to see the doctor we helped her select at the end of the month. Opposing counsel understands that if we can’t agree on another doctor by then, E/C will have to authorize our doctor.</p>



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<p><strong>Contact us</strong> at 305-758-4900 or by email (jgale@jeffgalelaw.com and kgale@jeffgalelaw.com) to learn your legal rights.</p>



<p><a href="/">Jeffrey P. Gale, P.A.</a> is a <a href="https://www.google.com/search?q=south+florida&rls=com.microsoft:en-US:IE-Address&rlz=1I7MXGB_enUS635&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj_sKjTobrQAhUBhiYKHea4CPIQ_AUICigD&biw=1097&bih=498" rel="noopener noreferrer" target="_blank">South Florida</a> based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.</p>



<p>While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.</p>



<p><strong>DISCLAIMER</strong>: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This  information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.</p>
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