HORIZONS PAINTING AND PCA SOLUTIONS, INC., APPELLANTS,
v.
DENNIS LESSARD, APPELLEE
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
This case of first impression addresses whether an employer and its workers' compensation insurance carrier could invoke section 440.09(4) to deny benefits based on alleged false statements by the claimant. The court held that the statute requires a prior determination by an administrative hearing officer, court, or jury that the employee knowingly or intentionally made false statements before benefits can be denied under that provision.
Section 440.09(4) requires that before benefits can be denied based on false or fraudulent statements, there must first be a determination by an administrative hearing officer, court, or jury that the employee knowingly or intentionally made false statements for the purpose of obtaining benefits. The employer/insurance carrier's mere presentation of evidence of misrepresentations is insufficient; the statutory prerequisites must be satisfied.
[1] Workers' compensation benefits may not be denied under section 440.09(4), Florida Statutes, unless an administrative hearing officer, court, or jury has previously determ…
[2] The defense under section 440.09(4), Florida Statutes, requires proof of a prior determination by a designated forum that the employee engaged in fraudulent conduct, not…
Previewing 2 of 3 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“An employee shall not be entitled to compensation or benefits under this chapter if any administrative hearing officer, court, or jury convened in this state determines that the employee has knowingly or intentionally engaged in any of the acts described in s. 440.105”
States the statutory requirement for the defense, emphasizing the necessity of a prior determination
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceThe employer and insurance carrier presented evidence that the claimant made various misrepresentations regarding prior back injuries, automobile acci…
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Worker'S Compensation Benefits cases and more on FLexlaw
PER CURIAM.
In this case of first impression, the employer. and its insurance carrier (E/C) complain that the judge of compensation claims (JCC) erroneously failed to apply the defense set forth in section 440.09(4), Florida Statutes (Supp.1994), based on false statements claimant made contrary to section 440.105(4)(b), Florida Statutes (Supp.1994). We conclude that the provisions of section 440.09(4) are inapplicable to the case at bar, because the E/C did not show that an administrative hearing officer, court or jury had determined that claimant had knowingly or intentionally made false statements.
Section 440.09(4) provides:
(4) An employee shall not be entitled to compensation or benefits under this chapter if any administrative hearing officer, court, or jury convened in this state determines that the employee has knowingly or intentionally engaged in any of the acts described in s. 440.105 for the purpose of securing workers’ compensation benefits.
(Emphasis added.)
Section 440.105(4) provides, in pertinent part:
(b) It shall be unlawful for any person:
1. To knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under this chapter. In the instant case, the E/C merely presented evidence that the claimant had made various misrepresentations about prior back injuries and automobile accidents, the use of an alias, and the operation of his own company both during and after the alleged accident. The E/C did not, however, provide any evidence that “any administrative hearing officer, court, or jury” had determined that claimant knowingly or intentionally made any “false, fraudulent, or misleading oral or written statement for the purpose of obtaining ... any benefit or payment.”
Section 440.09(4), by virtue of its plain language, contemplates the existence of a determination in a proceeding collateral to the workers’ compensation matter, by either an administrative agency or a court, that false or fraudulent statements were knowingly made, before its provisions can impact a claim for benefits. The correctness of this interpretation is supported by section 440.105(l)(a), which outlines the procedures that should be employed in obtaining such a collateral determination. Thus, we agree that the JCC correctly found that the statute was inapplicable.1
In so concluding, we are not saying, of course, that the JCC does not retain his or her traditional role as fact-finder in resolving credibility issues of any claim for benefits. We hold only that before benefits can be denied under section 440.09(4) based on false or fraudulent statements, a determination to that effect must first be made in one of the forums delineated in the statute, and evidence of same must properly be submitted in the pending workers’ compensation proceeding.
Finding no error in the JCC’s conclusion that section 440.09(4) was inapplicable in this case, we affirm the order determining that a compensable accident occurred and awarding benefits to claimant.2
AFFIRMED.
BARFIELD, C.J., and ERVIN and KAHN, JJ., concur. . Although the E/C has stated the issue as jurisdictional, asserting that the JCC has jurisdiction to deny workers' compensation benefits under section 440.09(4) based on misrepresentations made by the claimant, the issue is not one of jurisdiction, but rather is whether the prerequisites were satisfied for operation of the statute.
. The E/C did not challenge these two rulings on appeal.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Boca Raton Small Engines & Emp'rs Self Ins. Fund v. Bellak, 692 So. 2d 290 (Fla. 1st DCA 1997)…PER CURIAM. AFFIRMED. Horizons Painting v. Lessard, 688 So. 2d 941 (Fla. 1st DCA 1997); E.H. v. Temporary Labor Source, 687 So. 2d 884 (Fla. 1st DCA 1997). BARFIELD, C.J., and DAVIS and BENTON, JJ., concur.…
-
Mellon Sec. & Sound & PCA Solutions, Inc. v. Custer, 687 So. 2d 1372 (Fla. 1st DCA 1997)…ly made false or misleading statements for the purpose of obtaining workers’ compensation benefits. See this court’s very recent decisions in E.H. v. Temporary Labor Source, Inc., 687 So. 2d 884 (Fla. 1st DCA 1997), and Horizons Painting v. Lessard, 688 So. 2d 941 (Fla. 1st DCA 1997). Finally, we note that the E/C’s ruling on the claimant’s section 440.20(4) estoppel argument was incorrect, see North River Insurance Company v. Wuelling, 674 So. 2d 881 (Fla. 1st DCA 1996), but that this was harmless error in…
-
Cruz Elena Alvarez v. Unicco & Travelers, 958 So. 2d 951 (Fla. 1st DCA 2007)…does not dispute the judge’s findings, cites no authority for holding that the judge erred in this case in not awarding benefits for the period prior to the entry of the order. Further, neither this court’s decision in Horizons Painting v. Lessard, 688 So. 2d 941 (Fla. 1st DCA 1997), nor our decision in Pavilion Apartments v. Wetherington, 943 So. 2d 226 (Fla. 1st DCA 2006), require an award by the judge of compensation claims for a period preceding the determination of a violation of section 440.09(4). Ac…
Previewing 3 of 6 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligence