MCDONALD'S RESTAURANT # 7160 AND MCDONALD'S CLAIM CENTER, APPELLANTS/CROSS-APPELLEES,
v.
MARYANN MONTES, APPELLEE/CROSS-APPELLANT

Fla. 1st DCA | 1999-07-07
No. 98-3505
WOLF and WEBSTER, JJ., CONCUR.
736 So. 2d 768 Florida District Court of Appeal, First District (1999) Caution
Cited by 16 cases

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.

Synopsis

McDonald's appealed an award of attorney's fees to an injured worker, Maryann Montes, for benefits obtained following a petition filed August 21, 1995. Montes cross-appealed the denial of attorney's fees for earlier petitions. The court affirmed the direct appeal and reversed and remanded one cross-appeal issue, holding that attorney's fees were warranted because McDonald's failed to timely respond to the April 4, 1995 petition for temporary disability benefits.


Holding

The court held that McDonald's was required to respond to Montes's April 4, 1995 petition within 14 days of receipt on April 10. Because McDonald's did not respond or commence payments within that 14-day period, it was deemed to have denied the claim under section 440.192(8). Therefore, Montes was entitled to attorney's fees under section 440.34(3)(b) for successfully prosecuting the claim following the deemed denial, even though the claim for temporary benefits was mature at the time of filing.


Headnotes

[1] A carrier's failure to respond to a claimant's petition for benefits within 14 days is deemed a denial of the claim.

[2] A claimant is entitled to attorney's fees for successfully prosecuting a claim following notice of denial.

Previewing 2 of 4 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

Key Quotes

“Under section 440.192(8), Florida Statutes (1995), a carrier that fails to respond to a claimant's petition for benefits within 14 days is deemed to have denied the claim.”

Establishes the controlling legal standard that silence by the carrier constitutes a statutory denial, triggering attorney's fee entitlement.

Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.

Join FLexlaw to unlock all legal intelligence

Facts & Procedural History

Montes was injured on January 21, 1995. She filed a petition for temporary total disability (TTD) and/or temporary partial disability (TPD) benefits o…

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.


Opinion of the Court
ERVIN, J.

ERVIN, J.

The employer and carrier, McDonald’s Restaurant # 7160 and McDonald’s Claim Center (E/C), appeal a final order awarding attorney’s fees to the claimant, Maryann Montes, in connection with a petition for benefits filed August 21, 1995. Montes cross-appeals the denial of her claims for attorney’s fees connected with her petitions for benefits filed April 4, 1995, and July 17, 1995, and with her request for authorization of her chiropractor. We affirm all issues raised in the direct appeal without discussion, and reverse and remand one of the issues raised in the cross-appeal, because claimant’s attorney successfully obtained temporary benefits pursuant to the petition of April 4, 1995, following the E/C’s denial thereof.

Montes was injured on January 21,1995. She filed a petition for benefits on April 4, 1995, seeking temporary total disability (TTD) and/or temporary partial disability (TPD) benefits, which the E/C received on April 10.

On April 26, the E/C obtained a letter from claimant’s treating chiropractor, Dr. Esposito, stating that Montes was TTD for four weeks commencing April 3, whereupon the E/C began paying TTD benefits on May 3, 1995, for the periods April 3 through April 23, and April 24 through April 30. The judge of compensation claims (JCC) denied claimant’s request for attorney’s fees and costs during this period, because the carrier had paid benefits within 14 days of notice from Dr. Esposito that temporary benefits were due. This was error. Under section 440.192(8), Florida Statutes (1995), a carrier that fails to respond to a claimant’s petition for benefits within 14 days is deemed to have denied the claim. Russell Corp. v. Brooks, 698 So. 2d 1334 (Fla. 1st DCA 1997).

The E/C did not deny or commence payments within 14 days of receiving claimant’s April 4, 1995, petition for benefits, but instead did not respond, which operated as a denial.

Therefore, pursuant to section 440.34(3)(b), Florida Statutes (1995), which authorizes fees to a claimant who successfully prosecutes a claim following notice of denial, Montes is entitled to fees for securing these benefits.

The E/C relies upon Indian River County School Board v. Baker, 695 So. 2d 898 (Fla. 1st DCA), review denied, 703 So. 2d 475 (Fla.1997), which is inapposite. This case involved the former 21-day rule provided by section 440.34(3)(b), Florida Statutes (1991), which stated that a claimant was entitled to fees in cases wherein the E/C failed or refused to pay a claim “on or before the 21st day after receiving notice of the claim.” The JCC in that case acknowledged that the claim for permanent total disability (PTD) benefits was premature, because Baker was not yet at maximum medical improvement (MMI).

Nevertheless, the JCC held that the E/C was on notice of the ripened claim when it called Baker’s doctor and could have learned that Baker was at MMI, had the E/C asked the right questions.

This court disagreed and determined that the operative date was instead the date that the doctor actually informed the E/C that Baker was at MMI, and thus the E/C’s commencement of PTD benefits within 21 days was timely. Id. at 899.

The JCC in the case at bar similarly concluded that the E/C was first placed on notice of Montes’s claim for TTD/TPD benefits on April 26, 1995, when it received Dr. Esposito’s letter. This case, however, differs from Indian River, because the claim for TTD/TPD benefits was mature when filed on April 4, Dr. Esposito having found that Montes was TTD from April 3 forward. The E/C was therefore on notice of claimant’s petition upon receipt thereof on April 10. See also Soriano v. Gold Coast Aerial Lift, Inc., 705 So. 2d 636 (Fla. 1st DCA 1998).

AFFIRMED IN PART, REVERSED IN PART and REMANDED for further proceedings consistent with this opinion.

WOLF and WEBSTER, JJ., CONCUR.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • Checkers Rest. & Specialty Risk Servs., Inc. v. Wiethoff, 925 So. 2d 348 (Fla. 1st DCA 2006)
    …concur. KAHN, C. J., concurs in result with written opinion in which BARFIELD, J., concurs. PADOVANO, J., concurs in result with written opinion in which WEBSTER, BENTON and VAN NORTWICK, JJ., concur. . See McDonald’s Restaurant # 7160 v. Montes, 736 So. 2d 768 (Fla. 1st DCA 1999); Allen v. Tyrone Square 6 AMC Theaters, 731 So. 2d 699 (Fla. 1st DCA 1999).…
  • Mitchell v. Sunshine Cos., 850 So. 2d 632 (Fla. 1st DCA 2003)
    …al equivalent of a notice of denial. Russell Corp. v. Brooks, 698 So. 2d 1334 (Fla. 1st DCA 1997); see also Alachua County Bd. of County Comm’rs v. Starling, 699 So. 2d 310 (Fla. 1st DCA 1997). As indicated in McDonald’s Restaurant # 7160 v. Montes, 736 So. 2d 768 (Fla. 1st DCA 1999), the claimant was therefore entitled to a fee award if his attorney then successfully prosecuted the permanent total disability claim. Rather than proceeding to an evi-dentiary hearing, the parties participated in mediation and…
  • …12, § 26, at 3943-3944, Laws of Fla. Here, there is no dispute that the e/sa failed to accept or deny the petition within 14 days of its receipt. Consequently, the e/sa are deemed to have denied the petition. See McDonald’s Rest. # 7160 v. Montes, 736 So. 2d 768, 769 (Fla. 1st DCA 1999); Russell Corp. v. Brooks, 698 So. 2d 1334, 1335 (Fla. 1st DCA 1997). Successful prosecution is achieving “acceptance and payment of the claim.” See Mitchell v. Sunshine Cos., 850 So. 2d 632, 633 (Fla. 1st DCA 2003). The part…

Previewing 3 of 8 citing cases — full citator treatment, depth of discussion, and citing context are member features.

Join FLexlaw to unlock all legal intelligence

Authorities Cited

Full citator, related cases, and AI research tools

Open in FLexlaw