Paulson v. Dixie County Emergency Medical, 1D05-2337.
| Decision Date | 26 July 2006 |
| Docket Number | No. 1D05-2337.,1D05-2337. |
| Citation | 936 So.2d 1109 |
| Parties | Michael PAULSON, Appellant, v. DIXIE COUNTY EMERGENCY MEDICAL SERVICES and Florida League of Cities, Inc., Appellees. |
| Court | Florida District Court of Appeals |
Victor J. Musleh, Jr., Ocala, and Bill McCabe, Longwood, for Appellant.
Lamar D. Oxford and Alan D. Kalinoski of Dean, Ringers, Morgan & Lawton, P.A., Orlando, for Appellees.
Claimant appeals the dismissal of his petition for benefits. The Judge of Compensation Claims (JCC) found Claimant provided false, fraudulent, incomplete or misleading statements to obtain workers' compensation benefits in a workers' compensation case unconnected to his instant workers' compensation case, and concluded Claimant was barred from receiving benefits. We reverse.
Claimant, a paramedic, obtained benefits for three work-related accidents in three years.1 In February 1999, he claimed injury to his head, neck and back when the ambulance in which he was a passenger hit a semi-truck. In April 2000, he claimed injury to his left wrist and arm while picking up a respiratory bag when responding to an emergency. In June 2001, he claimed injury to his head, shoulder and the left side of his back when the chair in which he was sitting suddenly broke. The third accident is at issue here.
The employer and carrier (E/C) provided benefits for the claims in the first two accidents. The E/C never defended either of those claims on grounds that Claimant committed any of the acts prohibited in section 440.105(4)(b), Florida Statutes. However, the E/C denied the third accident actually occurred and, consequently, argued Claimant did not suffer any injury within the course and scope of employment. See § 440.09(1), Florida Statutes.
Following an evidentiary hearing, the JCC concluded Claimant did suffer a workplace accident, which resulted in the claimed injury. However, the JCC denied the claim, finding Claimant made false, fraudulent, incomplete or misleading statements as defined in section 440.105(4)(b), to obtain workers' compensation benefits for the second workplace accident. Specifically, the JCC found Claimant misrepresented his physical capabilities while he was receiving temporary total disability benefits. Although competent, substantial evidence supports the JCC's conclusion that Claimant committed one of the prohibited acts of section 440.105(4)(b) in a different workers' compensation claim, the JCC erred in applying the exclusion of 440.09(4) to the instant workers' compensation claim.
This court has interpreted section 440.105(4)(b) to include false, fraudulent, incomplete or misleading statements that are immaterial to the claim if the statements were made for the purpose of obtaining benefits. See Village of N. Palm Beach v. McKale, 911 So.2d 1282 (Fla. 1st DCA 2005). However, we have never applied the section 440.09(4) exclusion from coverage to a claim for workers' compensation benefits in a different workers' compensation case than the case in which the 440.105(4)(b) acts were committed. Each case excluding coverage pursuant to section 440.09(4) involved the same case in which the false, fraudulent, incomplete or misleading statements were made, and that claim was currently before the JCC. See id.; Citrus Pest Control & Claims Control, Inc. v. Brown, 913 So.2d 754 (Fla. 1st DCA 2005); Nelson v. Labor Finders, 897 So.2d 501 (Fla. 1st DCA 2005).
This result is mandated by the plain language of section 440.09, which defines when coverage is available. Section 440.09(1), Florida Statutes, in part, mandates coverage when an employee suffers "an accidental injury or death arising out of work performed in the course and the scope of employment." This provision applies to...
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