TRAVELERS INSURANCE COMPANY AND THE MINUTE MAID COMPANY, APPELLANTS,
v.
WILLIAM B. COLLINS, APPELLEE

Fla. 1st DCA | 2002-07-26
No. 1D01-1879
ERVIN and BARFIELD, JJ„ CONCUR.
825 So. 2d 451 Florida District Court of Appeal, First District (2002) Positive Treatment
Cited by 10 cases

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Synopsis

Travelers Insurance Company and Minute Maid Company appealed an order awarding medical benefits for a lower back condition to employee William B. Collins. The court affirmed, holding that the employer and insurer waived their right to deny compensability by failing to deny the claim within 120 days of commencing payment, as required by Florida Statute 440.20(4).


Holding

The court held that the employer and carrier waived the right to deny compensability because they failed to deny the claim within 120 days after commencing payment. The physician's report constituted competent and substantial evidence that put appellants on notice of the nature of the injury, making reasonable investigation possible within the 120-day period.


Headnotes

[1] An employer and carrier waive the right to deny compensability of a workers' compensation claim if they fail to deny it within 120 days after commencing payment of compen…

[2] A workers' compensation carrier may initiate payment of benefits without prejudice and without admitting liability, but must investigate the entitlement to benefits and a…

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Key Quotes

“A carrier that fails to deny compensability within 120 days after the initial provision of benefits or payment of compensation waives the right to 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.”

This quote establishes the statutory requirement under section 440.20(4) and the waiver rule at issue in the case.

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Facts & Procedural History

Collins suffered a workplace accident on January 9, 1996, when struck by a pallet moved by a forklift, injuring his right foot. After authorized treat…

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Opinion of the Court
VAN NORTWICK, J.

The Minute Maid Company and Travelers Insurance Company, the employer and insurance carrier, challenge an order granting medical benefits for a lower back condition to William B. Collins, appellee and the claimant below. Appellants argue that the judge of compensation claims (JCC) erred in finding that appellants were estopped from denying the compensability of the claim because they did not deny it within 120 days of commencing payment thereon. Because competent and substantial evidence supports the JCC’s findings, we affirm.

Claimant had a workplace accident on January 9, 1996, when he was struck by a pallet being moved by a forklift. Claimant received authorized treatment for the injury sustained to his right foot as a result of the accident, and, thereafter, a physician was authorized to treat the lower back pain the claimant was suffering. After initially providing treatment for claimant’s lower back, appellants later denied the compensability of the lower back condition. Claimant therefore petitioned for additional lower back treatment

The JCC found that the workplace accident was not the major contributing cause of claimant’s lower back condition and, thus, the claim was found not to be compensable. Nevertheless, the JCC found that the employer and carrier waived the right to deny compensability of the lower back condition because they failed to deny compensation within 120 days after commencing payment of compensation as required by section 440.20(4), Florida Statutes (1995).

Section 440.20 provides in part:

(4) If the carrier is uncertain of its obligation to provide benefits or compensation, it may initiate payment without prejudice and without admitting liability. The carrier shall immediately and in good faith commence investigation of the employee’s entitlement to benefits under this chapter and shall admit or deny compensability within 120 days after the initial provision of compensation or benefits. Upon commencement of payment, the carrier shall provide written notice to the employee that it has elected to pay all or part of the claim pending further investigation, and that it will advise the employee of claim acceptance or denial within 120 days. A carrier that fails to deny compensability within 120 days after the initial provision of benefits or payment of compensation waives the right to 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.

(Emphasis added).

In Franklin v. Northwest Airlines, 778 So. 2d 418 (Fla. 1st DCA 2001), this court affirmed a JCC’s finding that the employer and carrier had waived the right to deny compensability of a claim pursuant to section 440.20(4) because the claim was not denied within 120 days. We concluded that the record contained competent and substantial evidence to support the finding of waiver, even though the claimant had not informed her employer of the date on which the accident occurred with any consistency. We observed that such an inconsistency should have been viewed by the employer and carrier as one of the sort of “red flags” which prompts a “reasonable investigation” of the claim. Id. at 422.

Here, the JCC expressly found that a report from the physician authorized to treat the claimant’s back put the employer and carrier on notice that claimant’s lower back condition consisted of a pre-existing degenerative disc condition coupled with an aggravation. As in Franklin, the physician’s report on which the JCC relied is competent and substantial evidence of notice, and a sufficient evidentiary basis for finding that the appellants waived their right to deny compensability after benefits had been paid for substantially longer than 120 days. Further, the instant case is distinguishable from Dunlevy v. Seminole County Dep’t of Public Safety, 792 So. 2d 592, 593-4 (Fla. 1st DCA 2001), relied upon by appellants. In Dunlevy, “there was nothing” in the information provided to the carrier by the claimant or the treating physicians that “raised or should have raised any doubts as to the cause of injury, thereby prompting the need for ‘reasonable investigation.’ ” Id.

AFFIRMED.

ERVIN and BARFIELD, JJ„ CONCUR.


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Citator

Cited By

  • Checkers Rest. & Specialty Risk Servs., Inc. v. Wiethoff, 925 So. 2d 348 (Fla. 1st DCA 2006)
    …ement to benefits. We agree. As explained in Wuelling, the section 440.20(4) waiver of the right to deny compensability does not necessarily establish an entitlement to benefits. Since Wuelling, however, cases such as Travelers Ins. Co. v. Collins, 825 So. 2d 451 (Fla. 1st DCA 2002), and Hutchinson v. Lykes Smithfield Packing, 870 So. 2d 144 (Fla. 1st DCA 2004), have at times blurred the distinction between compensability and entitlement to benefits. Other cases such as Bussey v. Wal-Mart Store # 725, 867 So…
  • Wintz v. Goodwill & Summit Claims Mgmt., 898 So. 2d 1089 (Fla. 1st DCA 2005)
    …Super Markets, Inc., 871 So. 2d 941 (Fla. 1st DCA 2004); Singletary v. Yoder's and Ameritrust Ins. Corp., 871 So. 2d 289 (Fla. 1st DCA 2004); Hutchinson v. Lykes Smithfield Packing, 870 So. 2d 144 (Fla. 1st DCA 2004); Travelers Ins. Co. v. Collins, 825 So. 2d 451 (Fla. 1st DCA 2002); Garner v. Clay County Dist. School Bd., 798 So. 2d 821 (Fla. 1st DCA 2001); Franklin v. Northwest Airlines, 778 So. 2d 418 (Fla. 1st DCA 2001); Bynum Transport, Inc. v. Snyder, 765 So. 2d 752 (Fla. 1st DCA 2000); Hunt v. Exxon C…
  • Singletary v. Yoder's & Ameritrust Ins. Corp., 871 So. 2d 289 (Fla. 1st DCA 2004)
    …da Statutes (2002). Because the carrier did not deny benefits until almost seven months after it initially accepted the injury as compensa-ble and began paying benefits, it waived its right to deny compensability. See Travelers Ins. Co. v. Collins, 825 So. 2d 451, 451-52 (Fla. 1st DCA 2002) (affirming JCC’s finding that the employer/carrier waived the right to deny compensability because “they did not deny it within 120-days of commencing payment thereon” and that the statutory exception to the 120 day deadl…

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