PAMELA MULLINS, APPELLANT/CROSS-APPELLEE,
v.
7-ELEVEN, INC., AND SEDGWICK CMS, APPELLEES/CROSS-APPELLANTS
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.
In a workers' compensation case, the Florida First District Court of Appeal affirmed that damage to a claimant's breast implant from a workplace accident was compensable as a prosthetic device, but reversed the apportionment of 75% of repair costs based on the implant's aged condition, holding that the apportionment statute applies only to preexisting medical diagnoses, not to the degradation of artificial devices.
Damage to a breast implant caused by a compensable accident is compensable as a prosthetic device under section 440.02(19), Florida Statutes. The apportionment statute (section 440.15(5)(b)) applies only when a claimant's injury results from acceleration or aggravation of a preexisting medical diagnosis or disease, not when it results from degradation of an artificial device, and therefore cannot be used to apportion medical costs based on the aged condition of the implant.
[1] Damage to a prosthetic device resulting from a compensable accident is compensable under workers' compensation law.
[2] A breast implant qualifies as a prosthetic device for workers' compensation purposes, even if it serves a cosmetic purpose.
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“the definition of a compensable 'injury' includes damage to dentures, eyeglasses, prosthetic devices, and artificial limbs when such damage is shown to result from a compensable accident”
Establishes the statutory basis for compensability of damage to prosthetic devices
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceClaimant suffered a compensable workplace accident that caused a partial rupture of her right saline breast implant. The employer/carrier refused to a…
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 Apportionment Of Benefits cases and more on FLexlaw
In this appeal and cross-appeal, the parties challenge an order of the Judge of Compensation Claims (JCC) finding a partial rupture to Claimant’s right breast implant compensable (cross-appeal), and apportioning out 75% of the cost of repairing the rupture due to the aged condition of the implant (appeal). We affirm the JCC’s finding as to compensability, and reverse her application of the apportionment statute.
Background
It is uncontested that Claimant suffered a compensable accident which, among other injuries, resulted in a partial rupture of her right saline breast implant. The E/C refused to authorize a plastic surgeon, asserting the damage to the implant was not compensable. The E/C retained a plastic surgeon independent medical examiner (IME). The IME testified the partial rupture of Claimant’s implant was caused 25% by the accident and 75% by the aged or defective condition of the implant. The IME also testified authorization of a plastic surgeon was reasonable and medically necessary to repair the rupture.
In the order on appeal, the JCC found the workplace accident was the major contributing cause of the partial rupture of a prosthetic device pursuant to section 440.02(19), Florida Statutes (2006), and, relying on the IME’s opinion as to causation, apportioned out 75% of benefits related to treatment for the implant pursuant to section 440.15(5)(b), Florida Statutes (2006).
Compensability of Damage to Prosthetic Device
The definition of a compensable “injury” includes damage to dentures, eyeglasses, prosthetic devices, and artificial limbs when such damage is shown to result from a compensable accident. See § 440.02(19), Fla. Stat. Thus, if damage to dentures, eyeglasses, prosthetic devices, or artificial limbs occurs in conjunction with, *37and as the result of, a workplace accident, the statute indicates that the damage (“injury”) arose out of employment, and was caused in major part by work performed within the course of employment.1 The plain language of the statute further indicates no additional proof is necessary as to the major contributing cause of the damage.2
A “prosthetic device” refers to an artificial substitute or replacement, whether external or implanted, for a missing or defective natural part of the body, and requires a relatively permanent functional or cosmetic purpose. Cash v. Univ. Rivet, 616 So.2d 446, 448 (Fla.1993) (interpreting a now-repealed provision of the statute which tolled the statute of limitations for treatment relating to prosthetics administered to treat the workplace injury). The determination as to whether an artificial device is a prosthesis is an issue for the trier of fact, and findings on this issue will not be disturbed on appeal unless clearly erroneous. See Roe v. City Invest/Gen. Dev. Carp., 587 So.2d 1323, 1325 (Fla.1991) (McDonald, J., special concurrence).
Here, the E/C’s IME testified Claimant’s breast implants are prosthetic devices. The JCC relied on this testimony, and the definition provided by the Supreme Court in Cash, in finding Claimant’s damaged implant is a prosthetic device. The E/C urges the JCC’s finding constitutes error as a matter of law, because Claimant’s implants were for cosmetic purposes and not to replace or substitute a missing or defective body part. However, the definition of prosthetics used in Cash includes prosthetic devices which serve only a cosmetic purpose.3 Additionally, this court has referred to breast implants as prostheses. See 3-M Carp.—McGhan Med. Reports Div. v. Brown, 475 So.2d 994, 996 (Fla. 1st DCA 1985). The JCC’s finding that Claimant’s breast implant is a prosthetic device is supported by competent, substantial evidence, and is not clearly erroneous.
Apportionment/ Depreciation of Prosthetic Device
A plain reading of the apportionment provisions of sections 440.15(5)(a), (b), Florida Statutes (2006), entitled “Subsequent Injury,” suggests apportionment is appropriate only when a claimant has suffered a prior injury or has a diagnosed medical condition which is preexisting. Here, Claimant is not alleged to have a preexisting disease, anomaly, or medical diagnosis; rather, it is her prosthetic breast implants that are alleged to have the preexisting condition of being aged.
Section 440.15(5)(b) is applicable only when a claimant’s injury is the result of an *38acceleration or aggravation of a “preexisting condition.” Although the term “preexisting condition” is not specifically defined in the statute, the courts, relative to issues of apportionment, have only applied the term in the context of a medical diagnosis or disease, and never to a condition as that term is used to describe a state of fitness or a general state of being. See Evans v. Fla. Indus. Comm’n, 196 So.2d 748 (Fla.1967).
Based on the plain language of sections 440.15(5)(a), (b), Florida Statutes, and the courts’ historical allowance for apportionment only in the instance of aggravation or acceleration of a preexisting disease or medical diagnosis, we hold the apportionment provisions of the statute do not operate to apportion out that percentage of medical treatment attributable to the degradation of an artificial device.4 For the foregoing reasons, we affirm that portion of the JCC’s order finding the damage to Claimant’s right breast implant compensable, and reverse that portion of the order apportioning out 75% of medical costs associated with repairing the rupture.
AFFIRMED in part, REVERSED in part, and REMANDED for proceedings consistent with this opinion.
HAWKES, C.J., KAHN and BROWNING, JJ, concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Staffmark and Avizent/Frank Gates v. Merrell, 43 So. 3d 792 (Fla. 1st DCA 2010)…failed to present sufficient evidence entitling it to apportionment. [*797] “Section 440.15(5)(b) is applicable only when a claimant’s injury is the result of an acceleration or aggravation of a ‘preexisting condition.’ ” Mullins v. 7-Eleven, Inc., 5 So. 3d 35, 37 (Fla. 1st DCA 2009). As we noted in Mullins, the term “preexisting condition” is not specifically defined in the apportionment statute. Id. at 38. The phrase has been defined, however, and later applied in the context of the “major contributing…
-
Deca Mfg. Corp. & S. Owners Ins. Co./Auto-Owners Ins. Co. v. Faye O. Beckett (Fla. 1st DCA 2021)…ined the phrase as follows: [A]n artificial substitute or replacement, whether external or implanted, for a missing or defective natural part of the body, and requires a relatively permanent functional or cosmetic purpose. Mullins v. 7-Eleven, Inc., 5 So. 3d 35, 37 (Fla. 1st DCA 2009) (finding that a breast implant ruptured in a compensable accident qualified as a prosthetic device). Whether any given object or device satisfies the definition of “prosthetic device” is a question of fact that must be suppor…
Authorities Cited
- Evans v. Fla. Indus. Comm'n, 196 So. 2d 748 (Fla. 1967)
- 3-M Corporation-McGHAN Med. Reports Div. v. Gay Brown, 475 So. 2d 994 (Fla. 1st DCA 1985)
- ROE v. City Investing/General Dev. Corp., 587 So. 2d 1323 (Fla. 1991)
- Cash v. Universal Rivet, Inc., 616 So. 2d 446 (Fla. 1993)