Checkers Restaurant v. Wiethoff, No. 1D04-193.

CourtCourt of Appeal of Florida (US)
Writing for the CourtDavis
Citation925 So.2d 348
PartiesCHECKERS RESTAURANT and Specialty Risk Services, Inc., Appellants/Cross-Appellees, v. Cheryl WIETHOFF, Appellee/Cross-Appellant.
Docket NumberNo. 1D04-193.
Decision Date16 February 2006

Page 348

925 So.2d 348
CHECKERS RESTAURANT and Specialty Risk Services, Inc., Appellants/Cross-Appellees,
v.
Cheryl WIETHOFF, Appellee/Cross-Appellant.
No. 1D04-193.
District Court of Appeal of Florida, First District.
February 16, 2006.
Rehearing Denied April 10, 2006.

Page 349

Rusten C. Hurd of Zimmerman, Kiser & Sutcliffe, P.A., Orlando, for Appellants.

Laurie T. Miles of Smith, Feddeler, Smith & Miles, P.A., Lakeland; Susan W. Fox of Fox & Loquasto, P.A., Tampa; and Wendy S. Loquasto of Fox & Loquasto, P.A., Tallahassee, for Appellee.

EN BANC

DAVIS, J.


In this workers' compensation appeal, the E/C asserts that the JCC erred by concluding that the E/C, which had not denied compensability within 120 days of initially providing medical care, was estopped from denying the claimant's request for additional treatment including surgery, even though the JCC found that the claimant's preexisting condition was the major contributing cause (MCC) of any need for further treatment or surgery. We agree with the E/C and reverse the JCC's authorization of this additional medical care. Finding no merit to the claimant's issues on cross-appeal, we affirm the JCC's denial of other benefits.

Section 440.20(4), Florida Statutes, provides in relevant part:

. . . 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. . . . 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 . . . .

(emphasis added). In North River Ins. Co. v. Wuelling, 683 So.2d 1090 (Fla. 1st DCA 1996), a case which was decided en banc, this court recognized that there is a distinction between the concept of compensability and a worker's entitlement to benefits as those terms are contemplated in section 440.20(4). The waiver provision of section 440.20(4) pertains solely to the concept of compensability. In failing to deny compensability, the E/C only admits that there was an industrial accident resulting in some injury to the worker. Other issues concerning the worker's entitlement to benefits remain subject to challenge, including the extent of the compensable injury and the causal relationship between the compensable injury and the condition for which the worker seeks benefits.

In the present case, the claimant suffered an industrial accident which exacerbated a preexisting medical condition. The E/C immediately began providing medical care for the injured claimant. The claimant was seen by various doctors, and surgery was recommended. However, some of these doctors indicated that the claimant had reached maximum medical improvement with a 0% permanent impairment rating from the industrial accident. Several of the doctors also opined that the MCC of the claimant's need for surgery was the preexisting condition, and not the industrial exacerbation. The E/C terminated the claimant's benefits, asserting that the claimant was no longer entitled to indemnity benefits or medical treatment because she had returned to her pre-accident state.

The claimant filed two petitions for benefits, both of which the E/C denied by maintaining that it had already furnished appropriate benefits. The claimant then

Page 350

filed a third petition, requesting further medical care with treatment including surgery. The E/C did not respond to this third petition.

After the final hearing the JCC found that the claimant's compensable injury had resolved, but the JCC concluded that the E/C was estopped from denying the requested treatment and surgery. The JCC determined that the E/C's actions did not constitute a deemed denial of the benefits, and the JCC found that the E/C violated the 120-day provision and was thereby precluded from denying responsibility for this medical care.

On appeal, the E/C contends that reversal is warranted because the claimant failed to prove that the industrial injury remains the MCC of her need for continuing medical treatment and surgery. The E/C further contends that the JCC erred in authorizing this medical care because, although section 440.20(4) barred the E/C from denying compensability after the expiration of the 120-day pay and investigate period, it did not preclude the E/C from challenging the claimant's entitlement to benefits. We agree.

As explained in Wuelling, the section 440.20(4) waiver of...

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16 practice notes
  • Childers v. State, No. 1D03-2154.
    • United States
    • Court of Appeal of Florida (US)
    • June 28, 2006
    ...So.2d 448 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Checkers Rest. v. Wiethoff, 925 So.2d 348 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Bay Point Club, Inc. v. Bay County, 890 So.......
  • Childers v. State, No. 1D03-2154.
    • United States
    • Court of Appeal of Florida (US)
    • June 28, 2006
    ...So.2d 448 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Checkers Rest. v. Wiethoff, 925 So.2d 348 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Bay Point Club, Inc. v. Bay County, 890 So.......
  • Babahmetovic v. Scan Design Fla. Inc., No. 1D14–2986.
    • United States
    • Court of Appeal of Florida (US)
    • October 8, 2015
    ...as accident, injury, arising out of work performed in the course and the scope of employment. See generally Checkers Rest. v. Wiethoff,925 So.2d 348, 350 (Fla. 1st DCA 2006)(en banc) (explaining concept of compensability as “the occurrence of an industrial accident resulting in injury”).Cau......
  • Sanchez v. Yellow Transp., No. 1D19-4231
    • United States
    • Court of Appeal of Florida (US)
    • September 21, 2020
    ...that the compensable industrial injury is the MCC for the requested medical treatment. See, e.g., Checkers Restaurant v. Weithoff, 925 So. 2d 348 (Fla. 1st DCA 2006). But, as this Court explained in Meehan v. Orange County Data & Appraisals,once a claimant has established compensability of ......
  • Request a trial to view additional results
16 cases
  • Childers v. State, No. 1D03-2154.
    • United States
    • Court of Appeal of Florida (US)
    • June 28, 2006
    ...So.2d 448 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Checkers Rest. v. Wiethoff, 925 So.2d 348 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Bay Point Club, Inc. v. Bay County, 890 So.......
  • Childers v. State, No. 1D03-2154.
    • United States
    • Court of Appeal of Florida (US)
    • June 28, 2006
    ...So.2d 448 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Checkers Rest. v. Wiethoff, 925 So.2d 348 (Fla. 1st DCA 2006) (en banc decision released without antecedent publication of panel decision); Bay Point Club, Inc. v. Bay County, 890 So.......
  • Babahmetovic v. Scan Design Fla. Inc., No. 1D14–2986.
    • United States
    • Court of Appeal of Florida (US)
    • October 8, 2015
    ...as accident, injury, arising out of work performed in the course and the scope of employment. See generally Checkers Rest. v. Wiethoff,925 So.2d 348, 350 (Fla. 1st DCA 2006)(en banc) (explaining concept of compensability as “the occurrence of an industrial accident resulting in injury”).Cau......
  • Sanchez v. Yellow Transp., No. 1D19-4231
    • United States
    • Court of Appeal of Florida (US)
    • September 21, 2020
    ...that the compensable industrial injury is the MCC for the requested medical treatment. See, e.g., Checkers Restaurant v. Weithoff, 925 So. 2d 348 (Fla. 1st DCA 2006). But, as this Court explained in Meehan v. Orange County Data & Appraisals,once a claimant has established compensability of ......
  • Request a trial to view additional results

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