Meehan v. Orange Cnty. Data & Appraisals

• Decision Date: 20 March 2019
• Docket Number: No. 1D17-1076,1D17-1076
• Parties: Geoffrey MEEHAN, Appellant, v. ORANGE COUNTY DATA & APPRAISALS and Johns Eastern Company, Inc., Appellees.
• Court: Florida District Court of Appeals

272 So.3d 458

Geoffrey MEEHAN, Appellant,

v.ORANGE COUNTY DATA & APPRAISALS and Johns Eastern Company, Inc., Appellees.

No. 1D17-1076

District Court of Appeal of Florida, First District.

March 20, 2019

Rehearing Denied June 3, 2019

Richard H. Weisberg, Sanford, and Bill McCabe, Longwood, for Appellant.

Kristen L. Magana of Broussard, Cullen & Blastic, P.A., Orlando, for Appellees.

M.K. Thomas, J.

In this workers' compensation appeal, Geoffrey Meehan ("Claimant") argues that the Judge of Compensation Claims ("JCC") erred in denying his claims for medical care, costs, and attorney's fees related to an exposure at work. Because the parties entered into a broad stipulation in which the Employer/Carrier ("E/C") accepted compensability of the work-related exposure and "building related illness" and the E/C failed to demonstrate a break in the causal chain, we agree, and reverse and remand the order on appeal.

I. Facts

From 1995 through 1997, the Claimant worked on the sixth floor of a building in Orlando. The Claimant described the building conditions as dismal with leaks in the ceilings and blackish growths on wall tiles. Employees in the building began to experience breathing problems. Asbestos was later discovered, and employees were removed from all floors except for the sixth floor where the Claimant worked. The employees hired by the building renovation company wore body suits and masks while working on the sixth floor near the Claimant's work space. Yet, the Claimant was not provided any protective gear. The Claimant later developed breathing problems and reported his illness to his Employer.

Subsequently, the E/C entered into a broad stipulation with the Claimant in which it accepted compensability of the work exposure. Additionally, the E/C accepted liability for "building related illness associated with indoor air quality problems," with an accident date of September 30, 1997. Medical care was authorized with a pulmonologist. The JCC approved this joint stipulation by order in 1998.

In 2002, Dr. Varraux, the authorized pulmonologist, diagnosed the Claimant with "recurrent sinus, acute bronchitis

, reactive airway disease, rhinitis, sinusitis, rhinosinopulmonary syndrome, and occupational-induced asthma." He prescribed inhaler bronchiodilators, among other medications. The E/C continued authorization of the medical care and the treatment recommended.

Fifteen years later, the E/C issued a Notice of Denial terminating all further medical treatment to the Claimant. The insurance adjuster confirmed the E/C's decision to deny further medical care was based solely on a peer review report. In its Notice of Denial, the E/C asserted the work accident was no longer the major contributing cause ("MCC") of the need for medical treatment. In response, the Claimant filed petitions for benefits ("PFBs") seeking reauthorization of Dr. Varraux, payment of his medical bills, costs and attorney's fees. The E/C filed a formal response to the PFBs asserting the work accident was no longer the MCC and that the treatment and medications were not medically necessary.

After denying all further medical care, the E/C obtained an independent medical evaluation ("IME") with Dr. Brooks, an internal medicine specialist with a subspecialty in pulmonary medicine. Dr. Brooks diagnosed the Claimant with vocal cord dysfunction ("VCD"), unrelated to workplace exposure. In his opinion, the Claimant did not suffer from asthma

and, therefore, did not need the asthma medications prescribed by Dr. Varraux. Dr. Brooks testified that he found no evidence of sinusitis, but he did diagnose allergic rhinitis, which he opined was also unrelated to the workplace exposure.

Dr. Varraux testified that the Claimant had "got[ten] worse" over time. He maintained his opinion on diagnoses and treatment recommendations. With respect to Dr. Brooks' diagnosis of VCD, he disagreed. He reiterated his diagnoses, inclusive of asthma

, and his opinion that the Claimant's need for ongoing medications for all of his conditions and symptoms to be medically necessary and causally related to the work exposure.

Prior to merits hearing, the parties filed Uniform Pre-Trial Stipulations in which the E/C raised the following specific defenses: 1) The industrial accident is no longer the MCC of the need for treatment or disability; and 2) the prescriptions are not medically necessary. No EMA was appointed.¹

Following the merits hearing, the JCC entered an order denying all claims. The JCC accepted the testimony of Dr. Brooks over that of Dr. Varraux, to conclude that, generally speaking, "asthma

" treatment was not medically necessary because the Claimant did not have asthma. The JCC noted the Claimant had not made a claim for authorization of treatment for VCD and allergic rhinitis. The JCC observed, "The fact that Dr. Varraux's mistake in diagnosis is understandable may make his conduct ‘reasonable’, but it does not make his treatment ‘medically necessary’ under the statute."

On appeal, the Claimant argues that the E/C cannot deny his claim for medical treatment because it had previously stipulated to compensability of the conditions treated by Dr. Varraux.² Whether the diagnosis is appropriately VCD or not, the Claimant's continued symptoms and need for treatment are simply part of the compensable conditions accepted by the E/C. Further, no break in the causal chain between the work exposure and the need for treatment has occurred because the Claimant's symptoms and conditions have been present since the work exposure and simply had not yet been diagnosed or developed as a sequela of the compensable conditions. Alternatively, the Claimant argues that the VCD diagnostic issue supplants only his asthma

and has no effect on the other conditions diagnosed and treated by Dr. Varraux. Accordingly, Dr. Varraux should remain authorized to treat the remaining compensable conditions and the VCD because the compensable conditions caused the VCD. The E/C counters that VCD is a different condition from asthma requiring different medications, therefore, the treatment currently being provided is not medically necessary.

II. Analysis

Factual findings made by the JCC are reviewable for competent, substantial evidence ("CSE"); to the extent the JCC's ruling involved an interpretation of law, review is de novo . See Mylock v. Champion Int'l , 906 So.2d 363, 365 (Fla. 1st DCA 2005).

A claimant has the burden to prove entitlement to workers' compensation benefits. See Fitzgerald v. Osceola Cty. Sch. Bd. , 974 So.2d 1161, 1164 (Fla. 1st DCA 2008). But, once a claimant has established compensability of an injury, via prior ruling or a stipulation, the E/C cannot challenge the causal connection between the work accident and the injury. Engler v. Am. Friends of Hebrew Univ. , 18 So.3d 613, 614 (Fla. 1st DCA 2009). The E/C may only question the causal connection between the injury and the requested benefit. Id. The E/C bears the burden of proof "to demonstrate a break in the causation chain, such as the occurrence of a new accident or that the requested treatment was due to a condition unrelated to the injury which the E/C had accepted as compensable." Jackson v. Merit Elec. , 37 So.3d 381, 383 (Fla. 1st DCA 2010) ; see also Perez v. Se. Freight Lines, Inc. , 159 So.3d 412, 414 (Fla. 1st DCA 2015) ("a ‘break’ is understood to occur when the work-related cause drops to 50% or less of the total cause of the need for the requested benefit."). Here, the E/C did not assert that there has been...