Mcarthur v. Mental Health Care Inc./summit Claims Ctr.
| Decision Date | 14 May 2010 |
| Docket Number | No. 1D09-4299.,1D09-4299. |
| Citation | 35 So.3d 105 |
| Parties | Sherri McARTHUR, Appellant,v.MENTAL HEALTH CARE, INC./SUMMIT CLAIMS CENTER, Appellees. |
| Court | Florida District Court of Appeals |
Michael J. Winer of the Law Office of Michael J. Winer, Tampa, for Appellant.
Ben H. Cristal and Dixie T. Switzer of the Cristal Law Group, Tampa, for Appellees.
In this workers' compensation appeal, Claimant seeks review of a final order denying all of her claims for benefits pursuant to the so-called “fraud defense” in section 440.09(4), Florida Statutes (2007). Claimant raises three issues on appeal: 1) whether the Judge of Compensation Claims (JCC) erred in finding that Claimant committed fraud by failing to disclose the extent of her prior injuries and medical care; 2) whether the JCC erred in not ruling on Claimant's claim that the employer/carrier (E/C) and its attorney committed fraud in their handling of this matter; and 3) whether Claimant is entitled to a one-time change in physician notwithstanding the finding of fraud. We affirm the first and third issues without discussion, and we affirm the second issue for the reasons that follow.
The final hearing in this case addressed six petitions for benefits filed by Claimant over the course of a year. One of the petitions-the fourth of six-sought a determination that “the employer/carrier and/or its agents/attorney committed workers' compensation fraud by failing to disclose a complete medical history and/or misrepresenting the claimant's medical history to her treating doctors for the purposes of denying her workers' compensation claim.” At the final hearing, in response to the JCC's inquiry regarding the precise relief that Claimant was requesting in this petition, Claimant's attorney argued that the E/C should be penalized just as a claimant would-the denial of all benefits-or, alternatively, that the E/C should be stripped of its defenses. Claimant's attorney acknowledged that chapter 440 did not specifically provide for that sanction, but argued, in effect, that the JCC had inherent authority to make findings on the issue of fraud by the E/C and its attorney and impose appropriate sanctions. The JCC did not make any findings on this issue in the final order.
Section 440.105(4)(b)1. provides that it is unlawful for “any person ... [t]o knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under this chapter.” A person who violates this statute is subject to criminal, civil, and administrative penalties. See § 440.09(4)(a), 440.105(4)(f), 440.106, Fla. Stat.
The process by which an employee may be sanctioned for violating section 440.105 is set forth in section 440.09(4). That statute, which is commonly referred to as the “fraud defense,” provides that the employee is not entitled to any compensation or benefits under chapter 440 if the JCC (or an administrative law judge, court, or jury) determines that the employee knowingly and intentionally engaged in any of the acts prohibited by section 440.105. See § 440.09(4)(a), Fla. Stat. Thus, not only does section 440.09(4) specifically authorize the JCC to determine whether an employee has violated section 440.105, but it also sets forth the sanction that the JCC is required to impose upon finding that a violation occurred.
The process by which an attorney or carrier may be sanctioned for violating section 440.105 is set forth in section 440.106, which provides in pertinent part:
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