KATHLEEN F. JACOBS, APPELLANT,
v.
CLARKWESTERN BUILDING SYSTEMS, AND TRAVELERS INSURANCE CO., APPELLEES
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 this workers' compensation appeal, the claimant challenges a Judge of Compensation Claims' denial of pain management benefits and penalties, interest, costs, and attorney's fees following a compensable low back injury. The appellate court reversed the denial, finding the JCC misread the expert medical advisor's opinion regarding the causation of the claimant's ongoing condition.
The court reversed the JCC's denial of pain management benefits and PICA (except penalties and interest, which are not due on medical benefits), finding the JCC misunderstood the EMA's opinion. The EMA expressly opined that the work injury remains the MCC of the claimant's need for ongoing care, contrary to the JCC's interpretation, and the case was remanded for the JCC to determine whether clear and convincing evidence exists to reject the EMA's actual opinion.
[1] An expert medical advisor's opinion in a workers' compensation case is presumed correct unless there is clear and convincing evidence to the contrary.
[2] A judge of compensation claims may err as a matter of fact by misunderstanding the content of an expert medical advisor's opinion.
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 EMA did not opine that the L4-5 disc bulge had resolved and that the L5-S1 bulge was new and not related to work. To the contrary, the EMA expressly opined that the work injury, for which a permanent impairment rating was assigned, is the MCC of Claimant's need for ongoing care.”
Establishes the court's factual finding that the JCC misread the EMA's opinion regarding causation
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 low back injury on August 14, 2006, with MRIs revealing an L4-5 lumbar disk protrusion. In 2012, authorized pain manag…
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In this workers’ compensation case, Claimant appeals an order of the Judge of Compensation Claims (JCC) that denied her claims for permanent total disability benefits, pain management, and penalties, interest, costs, and attorney’s fees (PICA). On appeal, Claimant challenges the denial of pain management and PICA, and for the following reasons, we agree with Claimant and reverse that ruling (save penalties and interest, which are not due on medical benefits, see section 440.20(6), (8), Florida Statutes).
As background, Claimant suffered a compensable injury to her low back on August 14, 2006. Several MRIs in the ensuing years revealed objective MRI findings of an L4-5 lumbar disk protrusion. When the authorized treating pain management physicians opined in 2012 that Claimant was at maximum medical improvement and the treatment was “not helping,” the Employer/Carrier denied all benefits on the theory the compensable injury is no longer the major contributing cause (MCC) of Claimant’s need for treatment. In the ensuing litigation, an expert medical advisor (EMA) noted that the newest MRI showed a bulge at L5-S1 rather than L4-5, but nonetheless opined that the work accident remains the MCC of Claimant’s back condition and that Claimant has a six percent permanent impairment rating because of the disk bulge “even though it’s a different level.” As to Claimant’s need for palliative care, the *693EMA deferred to pain management physicians, and the authorized pain management physicians opined Claimant in fact needs palliative care. The JCC apparently concluded that the EMA opined the work accident was no longer the MCC of Claimant’s complaints because the L4-5 disc was, as the JCC put it, “no longer involved in the claimant’s current complaints of pain.” Claimant moved for rehearing to inform the JCC that the record did not support his reading of the EMA’s MCC opinion, and the JCC denied rehearing without comment.
The JCC applied the law correctly here, but erred as a matter of fact: the EMA did not opine that the L4-5 disc bulge had resolved and that the L5-S1 bulge was new and not related to work. To the contrary, the EMA expressly opined that the work injury, for which a permanent impairment rating was assigned, is the MCC of Claimant’s need for ongoing care. An EMA’s opinion is presumed correct, see section 440.13(9), Florida Statutes (“The opinion of the expert medical advisor is presumed to be correct unless there is clear and convincing evidence to the contrary as determined by the judge of compensation claims.”), and the JCC did not find clear and convincing evidence to reject that opinion — but because the JCC misunderstood the content of that opinion, we remand for the JCC to review the record to determine whether clear and convincing evidence exists to reject the EMA’s actual opinion.
AFFIRMED in part, REVERSED in part, and REMANDED.
PADOVANO, CLARK, and MARSTILLER, JJ., concur.