Sanchez v. Yellow Transp., No. 1D19-4231

CourtCourt of Appeal of Florida (US)
Writing for the CourtPER CURIAM.
PartiesJULIO SANCHEZ, Appellant, v. YELLOW TRANSPORTATION/GALLAGHER BASSETT, Appellees.
Decision Date21 September 2020
Docket NumberNo. 1D19-4231

JULIO SANCHEZ, Appellant,
v.
YELLOW TRANSPORTATION/GALLAGHER BASSETT, Appellees.

No. 1D19-4231

FIRST DISTRICT COURT OF APPEAL STATE OF FLORIDA

Date of Accident: April 21, 2004
September 21, 2020


On appeal from an order of the Judge of Compensation Claims.
Walter J. Havers, Judge.

PER CURIAM.

In this workers' compensation case, Julio Sanchez ("Claimant") appeals the Judge of Compensation Claims' (JCC's) order denying his claims for medical care for his lumbar spine. In the order, the JCC found that Claimant did not prove entitlement because he did not satisfy his burden of showing that the workplace accident was the major contributing cause of the need for the requested treatment. Because we find merit in Claimant's argument that he met his burden and was not required to provide additional medical evidence of major contributing cause under the circumstances presented here, we reverse.

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I.

Under workers' compensation law, the employer must pay compensation and furnish medical benefits if an employee suffers an accidental compensable injury arising out of and in the course and scope of employment. See § 440.09(1), Fla. Stat. (2003). But the accidental compensable injury must be the major contributing cause (MCC) of any resulting injuries. Id. As defined in the statute, MCC is "the cause which is more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought." Id. Here, the JCC concluded that Claimant had the burden to prove MCC but failed to do so. To the extent this issue involves the resolution of facts, our standard of review is for competent substantial evidence (CSE); to the extent it involves an interpretation of law, our standard of review is de novo. See, e.g., Benniefield v. City of Lakeland, 109 So. 3d 1288, 1290 (Fla. 1st DCA 2013).

II.

Claimant, a truck driver, began working for Yellow Transportation, Inc. ("Employer") in 1991. Over the years, he sustained several workplace injuries involving various body parts, including the shoulders, neck, and low back. As found by the JCC, one of these injuries occurred on April 21, 2004, when Claimant "injured his lumbar spine while driving his truck on a very bumpy road." The Employer and its insurance carrier ("E/C") accepted compensability and authorized medical care with Dr. Cohen, an orthopedic surgeon. At some point, this workplace injury was consolidated with two other accidental injuries under a date of accident of December 8, 2004.

In June 2014, the E/C changed servicing agents, but the former servicing agent evidently did not transfer all the records for the April 21, 2004, lumbar injury to the current servicing agent. Although Claimant deposed two adjusters with the current servicing agent, both adjusters, as found by the JCC, "had tremendous difficulty explaining what happened in this claim" before the 2014 transfer. Despite this lack of information, in January 2016, the E/C entered into a stipulation with Claimant

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that addressed several issues involving Claimant's various workplace injuries, including the lumbar spine.

In the stipulation, the parties first agreed that Claimant's cervical injury remained the MCC of the need for treatment, but that the E/C were not precluded from challenging causation in the future "should evidence of an intervening cause or unrelated condition arise." Pertinent to other injuries, the parties stipulated that the E/C "continues to authorize Drs. Cohen and Wachsman to treat the left shoulder, right shoulder, cervical and lumbar spines, subject to the right to challenge causation in the future, as mentioned above." (Emphasis added).

According to Dr. Cohen's medical records, Claimant received treatment for his cervical spine in May 2014. Although Claimant also complained of low back pain, Dr. Cohen did not provide a related diagnosis or make any treatment recommendations for the low back at that time. In February 2018, Claimant again reported low back complaints to Dr. Cohen, but explained further that the pain resulted from the truck driving incident that occurred sometime before December 2004. At that visit, Dr. Cohen diagnosed Claimant with intermittent low back pain syndrome and L5/S1 degenerative disc disease. Upon Claimant's return visit in May 2018, Dr. Cohen expressly noted that he had been following Claimant's low back complaints "for a long time." Dr. Cohen subsequently recommended a lumbar MRI, which was performed in June 2018.

In a follow-up visit that same month, Dr. Cohen reviewed the MRI results and diagnosed Claimant with lumbar degenerative disc disease and spondylosis with stenosis, most prominent at L5-S1 and slightly less severe at L3-4 and L4-5. He recommended a referral to pain management for the lower back complaints. Approximately one year later, he recommended an L5-S1 epidural steroid injection (ESI). Although the E/C paid for the lumbar MRI and for all of Claimant's visits with Dr. Cohen, they did not act on either recommendation.

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III.

In December 2018, Claimant filed a petition for benefits (PFB) requesting authorization of the pain management recommended by his authorized treating physician, Dr. Cohen. In May 2019, Claimant filed a second PFB seeking authorization of the ESI, which was also recommended by Dr. Cohen. In support of both PFBs, Claimant attached DWC-25 medical reporting forms completed by Dr. Cohen and listing his recommendations.

In the pretrial stipulation, the E/C conceded Claimant sustained a compensable accident on April 21, 2004, but asserted that the resulting injury was initially a lumbar strain that was "no longer accepted." In addition to disputing that the workplace injury was the MCC of the current need for treatment, the E/C also raised the defense that Claimant "suffered an intervening event" which is the MCC of the need for any continued lumbar spine treatment. In response, Claimant asserted, among other things, that proof of MCC is unnecessary because the E/C cannot show any intervening or competing cause.

At the final hearing, Claimant relied on medical records from Dr. Cohen in...

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