Alvarez v. Fort Pierce Police Dep't

• Decision Date: 16 February 2016
• Docket Number: No. 1D15–2115.,1D15–2115.
• Citation: 186 So.3d 581
• Parties: Juan ALVAREZ, Appellant, v. FORT PIERCE POLICE DEPARTMENT, Appellee.
• Court: Florida District Court of Appeals

186 So.3d 581

Juan ALVAREZ, Appellant,

v.FORT PIERCE POLICE DEPARTMENT, Appellee.

No. 1D15–2115.

District Court of Appeal of Florida, First District.

Feb. 16, 2016.

Rehearing Denied March 16, 2016.

Bill McCabe, Longwood, for Appellant.

Lamar D. Oxford and Alan D. Kalinoski of Dean, Ringers, Morgan & Lawton, Orlando, for Appellee.

PER CURIAM.

In this workers' compensation case, Claimant argues that the Judge of Compensation Claims (JCC) erred in denying his claim for payment of medical bills incurred after he was discharged from the emergency room for a workplace injury. Because the JCC's findings of fact are inconsistent with the medical records and doctor's opinion concerning the medical testing reasonably required by the nature of the injury, we agree and reverse the order below.

I

On February 7, 2014, Claimant, a law enforcement officer in training, passed out and fell to the ground, striking his head on the concrete pavement. The Employer/Carrier (E/C) accepted compensability of Claimant's head laceration resulting from the blow to the head and paid for the emergency room treatment up through the time of discharge. The E/C nevertheless denied responsibility for Claimant's later hospitalization and additional diagnostic testing which was ordered after an initial CT brain scan was read as indicative of a stroke. The JCC ruled in the E/C's favor based on his finding that the additional diagnostic testing was not directed at assessing or treating the injuries from the blow to the head. On appeal, Claimant argues that the additional diagnostic testing was necessary to diagnose the nature and extent of his compensable head injury.

II

To the extent this issue turns on resolution of the facts, the review standard is competent substantial evidence; to the extent it involves an interpretation of law, the standard is de novo. See Benniefield v. City of Lakeland, 109 So.3d 1288, 1290 (Fla. 1st DCA 2013).

Under paragraph 440.13(2)(a), Florida Statutes (2013), employers are required to furnish "such medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or process of recovery may require." Medically necessary treatment includes "any medical service or medical supply which is used to identify or treat an illness or injury." § 440.13(1)(k), Fla. Stat. (2013). It is well established in the case law that diagnostic testing is always compensable if the purpose is to find out the cause of the injured worker's symptoms. See Arnau v. Winn Dixie Stores, 105 So.3d 669, 671 (Fla. 1st DCA 2013)citing Nealy v. City of W. Palm Beach, 491 So.2d 585, 586 (Fla. 1st DCA 1986) ("Whenever the purpose of the diagnostic test is to determine the cause of a claimant's symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable."); see also Superior Concrete Constr. v. Olsen, 616 So.2d 183, 183 (Fla. 1st DCA 1993) ; Perry v. Ridgecrest Int'l, 548 So.2d 826, 827–28 (Fla. 1st DCA 1989). This is true even if the tests prove the symptoms are unrelated to the compensable injury. Nealy, 491 So.2d at 586.

This court has held that the same principle applies in cases governed by the major contributing cause standard (MCC) applicable to dates of accident beginning January 1, 1994. See Chance v. Polk Cty. Sch. Bd., 4 So.3d 71, 73 (Fla. 1st DCA 2009) (holding JCC erred in applying MCC standard to bar claimant from additional diagnostic testing to determine cause of symptoms); Grainger v. Indian River Transp./Zurich U.S., 869 So.2d 1269, 1271 (Fla. 1st DCA 2004) (finding JCC applied incorrect standard when he ruled record did not show workplace injury was MCC for requested neurological evaluation because "[a] claimant must establish a causal relationship between his injury and the compensable accident in order to secure treatment, but not to be entitled to diagnostic testing to determine the cause of his symptoms.") (Emphasis in original).

In Grainger, the court articulated the following test: "The correctness of an order refusing a medical evaluation ‘must be tested by whether the claimant adequately demonstrated that the evaluation was reasonably required by the ... nature of the injury....’ " 869 So.2d at 1271 (quoting Sumner v. Gardinier, Inc., 526 So.2d 1068, 1070 (Fla. 1st DCA 1988) ). Cf. Laxner v. Target Corp., 41 So.3d 396, 397 (Fla. 1st DCA 2010) (finding CSE supported JCC's denial of testing where expert medical opinion established that extent and cause of injuries were known and ascertainable). Thus, in the instant case, Claimant had the burden of showing that the diagnostic tests performed during his hospitalization were reasonably required by the nature of his workplace injury. If Claimant meets this burden, then the evaluation should be covered under workers' compensation. See Grainger, 869 So.2d at 1271.

III

Here, the E/C asserted that Claimant's head laceration was the only compensable head injury resulting from the fall; at the same time, the E/C acknowledged the possibility that Claimant's head injury may have involved more than a simple laceration. For that reason, the E/C conceded that the initial head CT scan was compensable as diagnostic testing following Claimant's fall. But, according to the E/C, once the initial head CT scan without contrast was read as indicative of stroke, no further testing was required for the workplace injury.

Claimant...