The First District Court of Appeals, the appellate court for workers’ compensation claims in Florida, upheld a ruling made by a West Palm Beach Judge of Compensation Claims that a registered nurse did not intentionally misrepresent her medical history in order to obtain workers’ compensation benefits.
After a slip and fall injury on wet tile at a patient’s home, a West Palm Beach, Florida registered nurse suffered injuries to her right wrist, elbow, shoulder, neck and jaw. She complied with the law and reported her claim to her employer. She was then provided initial care for her multiple injuries and then referred to two doctors for evaluation of TMJ, jaw pain and provision of a bite plate. In conversation with one of these doctors she mentioned that 11 years prior to the workplace accident she was involved in a motor vehicle accident and was required to bite down on a device that was intended to help her pass an auditory brain stem test.
Solely based on this statement, the workers’ compensation carrier denied further treatment alleging she had misrepresented her past TMJ history to medical providers, specifically that she denied any past medical history of TMJ or treatment for this condition. Further, the carrier alleged that the injured worker intentionally failed to disclose a past medical history of TMJ for the purpose of obtaining benefits under Florida’s workers’ compensation system.
Based on this one statement to her doctor, the insurance company denied further treatment and care. The Judge noted that this was the only defense for the insurance company. The Judge also noted that during the adjuster’s deposition, the defense attorney objected to questions made by the injured worker’s attorney regarding the basis of the misrepresentation denial and noted that the carrier’s position at the time of the deposition was that the defense was not perfected.
After hearing all of the evidence and testimony, the Judge of Compensation Claims found no medical evidence that the injured worker was ever previously diagnosed with TMJ, and that absent such evidence the insurance company failed to establish any misrepresentation made by the injured worker. The judge awarded the injured worker medical care for her face, neck, upper back, right wrist and shoulder and jaw. The case was appealed to the First District Court of Appeals and affirmed.
If you or a loved one have suffered a workplace injury or accident, or have had your medical care denied due to allegations of fraud or misrepresentation, contact one of our experienced workers’ compensation attorney’s today. Call (561) 616-3800 or contact us online to speak with one of the dedicated workers’ compensation attorneys at the Law Offices of Franks, Koenig & Neuwelt today.