| History:
(1) The employer must pay compensation or furnish benefits required by this chapter if the employee suffers an accidental compensable injury or death arising out of work performed in the course and the scope of employment. The injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause of any resulting injuries. For purposes of this section, "major contributing cause" means 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. In cases involving occupational disease or repetitive exposure, both causation and sufficient exposure to support causation must be proven by clear and convincing evidence. Pain or other subjective complaints alone, in the absence of objective relevant medical findings, are not compensable. For purposes of this section, "objective relevant medical findings" are those objective findings that correlate to the subjective complaints of the injured employee and are confirmed by physical examination findings or diagnostic testing. Establishment of the causal relationship between a compensable accident and injuries for conditions that are not readily observable must be by medical evidence only, as demonstrated by physical examination findings or diagnostic testing. Major contributing cause must be demonstrated by medical evidence only.
(a) This chapter does not require any compensation or benefits for any subsequent injury the employee suffers as a result of an original injury arising out of and in the course of employment unless the original injury is the major contributing cause of the subsequent injury. Major contributing cause must be demonstrated by medical evidence only.
(b) If an injury arising out of and in the course of employment combines with a preexisting disease or condition to cause or prolong disability or need for treatment, the employer must pay compensation or benefits required by this chapter only to the extent that the injury arising out of and in the course of employment is and remains more than 50 percent responsible for the injury as compared to all other causes combined and thereafter remains the major contributing cause of the disability or need for treatment. Major contributing cause must be demonstrated by medical evidence only.
(c) Death resulting from an operation by a surgeon furnished by the employer for the cure of hernia as required in s. 440.15(6)[F.S. 1981]shall for the purpose of this chapter be considered to be a death resulting from the accident causing the hernia.
(d) If an accident happens while the employee is employed elsewhere than in this state, which would entitle the employee or his or her dependents to compensation if it had happened in this state, the employee or his or her dependents are entitled to compensation if the contract of employment was made in this state, or the employment was principally localized in this state. However, if an employee receives compensation or damages under the laws of any other state, the total compensation for the injury may not be greater than is provided in this chapter.
(2) Benefits are not payable in respect of the disability or death of any employee covered by the Federal Employer's Liability Act, the Longshoremen's and Harbor Worker's Compensation Act, the Defense Base Act, or the Jones Act.
(3) Compensation is not payable if the injury was occasioned primarily by the intoxication of the employee; by the influence of any drugs, barbiturates, or other stimulants not prescribed by a physician; or by the willful intention of the employee to injure or kill himself, herself, or another.
(4)(a) An employee shall not be entitled to compensation or benefits under this chapter if any judge of compensation claims, administrative law judge, court, or jury convened in this state determines that the employee has knowingly or intentionally engaged in any of the acts described in s. 440.105 or any criminal act for the purpose of securing workers' compensation benefits. For purposes of this section, the term "intentional" shall include, but is not limited to, pleas of guilty or nolo contendere in criminal matters. This section shall apply to accidents, regardless of the date of the accident. For injuries occurring prior to January 1, 1994, this section shall pertain to the acts of the employee described in s. 440.105 or criminal activities occurring subsequent to January 1, 1994.
(b) A judge of compensation claims, administrative law judge, or court of this state shall take judicial notice of a finding of insurance fraud by a court of competent jurisdiction and terminate or otherwise disallow benefits.
(c) Upon the denial of benefits in accordance with this section, a judge of compensation claims shall have the jurisdiction to order any benefits payable to the employee to be paid into the court registry or an escrow account during the pendency of an appeal or until such time as the time in which to file an appeal has expired.
(5) If injury is caused by the knowing refusal of the employee to use a safety appliance or observe a safety rule required by statute or lawfully adopted by the division, and brought prior to the accident to the employee's knowledge, or if injury is caused by the knowing refusal of the employee to use a safety appliance provided by the employer, the compensation as provided in this chapter shall be reduced 25 percent.
(6) Except as provided in this chapter, a construction design professional who is retained to perform professional services on a construction project, or an employee of a construction design professional in the performance of professional services on the site of the construction project, is not liable for any injuries resulting from the employer's failure to comply with safety standards on the construction project for which compensation is recoverable under this chapter, unless responsibility for safety practices is specifically assumed by contracts. The immunity provided by this subsection to a construction design professional does not apply to the negligent preparation of design plans or specifications.
(7)(a) To ensure that the workplace is a drug-free environment and to deter the use of drugs and alcohol at the workplace, if the employer has reason to suspect that the injury was occasioned primarily by the intoxication of the employee or by the use of any drug, as defined in this chapter, which affected the employee to the extent that the employee's normal faculties were impaired, and the employer has not implemented a drug-free workplace pursuant to ss. 440.101 and 440.102, the employer may require the employee to submit to a test for the presence of any or all drugs or alcohol in his or her system.
(b) If the employee has, at the time of the injury, a blood alcohol level equal to or greater than the level specified in s. 316.193, or if the employee has a positive confirmation of a drug as defined in this act, it is presumed that the injury was occasioned primarily by the intoxication of, or by the influence of the drug upon, the employee. If the employer has implemented a drug-free workplace, this presumption may be rebutted only by evidence that there is no reasonable hypothesis that the intoxication or drug influence contributed to the injury. In the absence of a drug-free workplace program, this presumption may be rebutted by clear and convincing evidence that the intoxication or influence of the drug did not contribute to the injury. Percent by weight of alcohol in the blood must be based upon grams of alcohol per 100 milliliters of blood. If the results are positive, the testing facility must maintain the specimen for a minimum of 90 days. Blood serum may be used for testing purposes under this chapter; however, if this test is used, the presumptions under this section do not arise unless the blood alcohol level is proved to be medically and scientifically equivalent to or greater than the comparable blood alcohol level that would have been obtained if the test were based on percent by weight of alcohol in the blood. However, if, before the accident, the employer had actual knowledge of and expressly acquiesced in the employee's presence at the workplace while under the influence of such alcohol or drug, the presumptions specified in this subsection do not apply.
(c) If the injured worker refuses to submit to a drug test, it shall be presumed in the absence of clear and convincing evidence to the contrary that the injury was occasioned primarily by the influence of drugs.
(d) The agency shall provide by rule for the authorization and regulation of drug-testing policies, procedures, and methods. Testing of injured employees shall not commence until such rules are adopted.
(e) As a part of rebutting any presumptions under paragraph (b), the injured worker must prove the actual quantitative amounts of the drug or its metabolites as measured on the initial and confirmation post-accident drug tests of the injured worker's urine sample and provide additional evidence regarding the absence of drug influence other than the worker's denial of being under the influence of a drug. No drug test conducted on a urine sample shall be rejected as to its results or the presumption imposed under paragraph (b) on the basis of the urine being bodily fluid tested.
(8) If, by operation of s. 440.04, benefits become payable to a professional athlete under this chapter, such benefits shall be reduced or setoff in the total amount of injury benefits or wages payable during the period of disability by the employer under a collective bargaining agreement or contract for hire.
History.--s. 9, ch. 17481, 1935; CGL 1936 Supp. 5966(9); s. 3, ch. 18413, 1937; s. 1, ch. 28236, 1953; s. 1, ch. 57-293; s. 2, ch. 73-127; s. 5, ch. 74-197; s. 3, ch. 75-209; s. 2, ch. 77-290; s. 23, ch. 78-300; s. 124, ch. 79-40; s. 21, ch. 79-312; s. 7, ch. 86-171; ss. 4, 5, 6, 43, ch. 89-289; ss. 11, 56, ch. 90-201; ss. 9, 52, ch. 91-1; ss. 5, 55, ch. 93-415; s. 101, ch. 97-103; s. 1, ch. 98-161; s. 3, ch. 98-174; s. 8, ch. 2001-91; s. 14, ch. 2002-194; s. 469, ch. 2003-261; s. 6, ch. 2003-412.
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Relevant Case Law
Note: Suicide arising out of a psychiatric condition that is from a prior compensable consequence of the original injury is compensable.
Note: When, in the usual course of business of a corporation, an officer or other agent is held out by the corporation or has been permitted to act for it or manage its affairs in such a way as to justify third persons who deal with him in inferring or assuming that he is doing an act or making a contract within the scope of his authority, the corporation is bound thereby.
Note: Competent, substantial evidence required to support Deputy's finding;disability in the line of duty is an "injury or illness" arising out of employment.
Note: Appellate court may affirm a deputy's order, given a plausible basis for his doubting Jones Act coverage in fact, without worrying unduly whether, were we instead a federal court, we would extend Jones Act coverage to further the beneficial purposes of that law.
Note: FECA entitlement does not preclude jurisdiction under Florida Workers' Compensation Law.
Note: Injuries that may be compensated under the Jones Act may not be recover workers compensation.
Note: Without evidence that a claimant's drug test was administered properly, the trial court is limited to determining whether injury was occasioned primarily by the influence of drugs.
Note: Knowingly making false or misleading statements to obtain benefits precludes all benefits.
Note: The standard for assessing psychiatric conditions is that proximate cause be shown by clear and convincing evidence.
Note: False statements, whether or not made under oath, invoke a denial of benefits claimant would otherwise be entitled to.
Note: Only accidents or disablements resulting from occupational diseases are compesable. Asbestosis is neither.
Note: Evidence must be authenticated before being admitted.
Note: JCC erred in failing to address the psychiatric condition and injuries before denying them.
Note: E/C is required to prove 440.09 immunity by proving that liability was assumed by contract before summary judgment can be deemed appropriate.
Note: E/C did not give claimant a drug test in a timely manner so is required to prove that the injury was caused primarily by drug use.
Note: Claimant is not entitled to workers comp benefits after commiting fraud with her prescription medication.
Note: If E/C is unable to prove that a drug test was done in compliance with law, the claimant does not have to prove that drugs did not contrbute to the injury.
Note: Procedural or remedial enactments may apply without regard to the date of accident, because parties do not have a vested right in any particular procedure.
Note: The determinative factor in placing liability under Section 440.42(3) is whether the second compensable accident causes injury which is independent from or an exacerbation of the first compensable accident.
Note: For the dual purpose doctrine to apply the errand needent have been primarily work-related as long as it was concurrently work-related.
Note: There will be workers comp liability if and only if the workplace accident is and remains the major contributing cause of the disability or need for treatment.
Note: There is an intentional tort exception to workers comp immunity and the conduct of the employer must be evaluated under an objective standard.
Note: A workplace injury must have been a major contributing cause to the condition in order to be compensable.
Note: The causal connection between the industrial accident and claimant's injury or disability must be established by a reasonable degree of medical certainty.
Note: Stenosis is not a pre-existing condition and when there is only one cause of injury the major contributing cause standard is inappropriate.
Note: When claimant intentionally injures himself for purposes of obtaining workers comp benefits, he is also barred from benefits obtained by virtue of the illegal conduct and this does not violate excessive fines or double jeopardy clauses.
Note: After claimant suffered 2 work-related accidents and then 1 non-work-related accident, looking at the major contributing cause is inappropriate. It is only used where there is an accident that would not have occured but for the non-work-related accident.
Note: If there is CSE to reach a result, even if the rationale used was wrong, the appellate court will not reverse.
Note: An expert witness should link scientific principles generally accepted in the scientific community that are broad, with a more specific case that is more like the claimant's.
Note: If the carrier says injury was not within the scope of employment, the an employer may not divorce itself from its compensation carrier's representation that an employee's injury did not occur in the course and scope of employment.
Note: Because there is CSE to support the findings that the physical injury arose out of claimant's employment, and that the physical injury, its cause, and its manifestations or disabilitywere established within a reasonable degree of medical certainty and by objective medical findings, the PTD award is proper.
Note: Denial of benefits for fraud can not be imposed under section 440.105 where the defense is raised for the first time at trial.
Note: A collective bargaining agreement is invalid to the extent that it purports to regulate the method of recovering workers' compensation benefits and diminishes their substantive rights to workers comp benefits.
Note: An employee shall not be entitled to compensation or benefits under this chapter if any administrative hearing officer, court, or jury convened in this state determines that the employee has knowingly or intentionally engaged in fraud.
Note: Because the JCC found that the industrial accident had caused only a temporary exacerbation of injuries previously suffered by the claimant in an automobile accident, with no permanent impairment, the industrial accident was not the major contributing cause of either the claimant's disability or his need for treatment.
Note: An injury is compensable even if the employee just began working for the employer.
Note: Psychiatric or nervous illnesses are to be demonstrated by clear and convincing evidence but the appellate court need only decide if there was CSE for the JCC to have decided as she did.
Note: JCC affirmed compensability of doctor claimant saw both before and after her employment who opined that the injury could have resulted from any her daily duties but could not pinpoint exactly when.
Note: Where medical evidence determines the major contributing cause of the injury was a prior condition, it is not compensable.
Note: A JCC has no authority to resolve medical disputes once a claimant makes a request for an Expert Medical Advisor, regardless of the judge's belief as to the value of a contradictory medical opinion.
Note: Recovery under the Longshore and Harbor Workers' Compensation Act precludes any kind of workers compensation recovery.
Note: Before benefits can be denied based on false or fraudulent statements, a determination to that effect must first be made in one of the forums delineated in the statute, and evidence of same must properly be submitted in the pending workers' compensation proceeding.
Note: Where employee was working alone in the store and a customer beat and raped her, she was in the course of her employment.
Note: Where employee was working alone in the store and a customer beat and raped her, she was in the course of her employment.
Note: If an injury arising out of and in the course of employment combines with a pre-existing disease or condition to cause or prolong disability or need for treatment, the employer must pay compensation or benefits required by this chapter only to the extent that the injury arising out of and in the course of employment is and remains the major contributing cause of the disability or need for treatment.
Note: An injured employee who refuses employment suitable to her capacity, which has been offered or procured to her, shall not be entitled to any compensation at any time during the continuance of such refusal unless there is a justifiable reason.
Note: An intoxicated injured worker is entitled to rebut the presumption by presenting clear and convincing evidence that the intoxication or influence of the drug did not contribute to the injury.
Note: Lay testimony can prove dispositive on entitlement to medical benefits, in an appropriate case.
Note: When a statutory employer leases the premises, the claimant can possibly sue the landlord in a separate and distinct capacity as a landlord.
Note: If there is disagreement in the opinions of the health care providers the division may, and the judge of compensation claims shall, upon his own motion or within 15 days after receipt of a written request by either the injured employee, the employer, or the carrier, order the injured employee to be evaluated by an EMA.
Note: In deciding whether an employee is a borrowed employee you must look at the 9 Ruiz factors.
Note: Although a JCC lacks jurisdiction to decide a case based on private contractual rights, the judge may address contractual rights and obligations which impact an award of compensation benefits.
Note: Serum blood test results and their conversion to whole blood equivalents are admissible to prove that an injury was occasioned primarily by the intoxication of the employee.
Note: Claimants must prove the major contributing cause of their injury.
Note: Although the irrebuttble presumption that drugs caused a workplace accident is unconstitutional, that provision can be severed from the remainder of the law, which is sound.
Note: The Workers' Compensation Act precludes compensability for mental or nervous injuries unless there is an underlying physical injury.
Note: An injury is deemed to have occurred in the course and scope of employment if it is sustained by a worker, on the employer's premises, while preparing to begin a day's work or while doing other acts which are preparatory or incidental to performance of his or her duties, and which are reasonably necessary for such purpose.
Note: An injury is deemed to have occurred in the course and scope of employment if it is sustained by a worker, on the employer's premises, while preparing to begin a day's work or while doing other acts which are preparatory or incidental to performance of his or her duties, and which are reasonably necessary for such purpose.
Note: Where an accident happens while the employee is employed elsewhere than in this state, which would entitle him or his dependents to compensation if it had happened in this state, the employee or his dependents shall be entitled to compensation if the contract of employment was made in this state, or the employment was principally localized in this state.
Note: The erroneous payment of Florida benefits cannot create workers' compensation coverage that does not otherwise exist, and absent estoppel the benefits will be denied.
Note: Neither consent, acquiescence, nor waiver can confer jurisdiction of the subject matter, which is not within the power of the court to adjudicate.
Note: When there are pre-existing conditions, the burden is on the employer to prove that the workplace accident was the major contributing cause.
Note: Serum blood test results and their conversion to whole blood equivalents are admissible to establish the claimant's intoxication for purposes of the statutory presumption.
Note: Submitting workers comp claims or even receiving benefits is not enough to bar a tort claim.
Note: In some cases an impulsive act can be construed to show willful intent.
Note: In order for a suicide to be compensable the claimant's suicide must not have been willful.
Note: Where ordinary negligence on a construction site injured a common laborer by a welder, they were not engaged in unrelated works for workers comp purposes.
Note: Holding the city responsible for past offsets is against public policy.
Note: A claimant can receive benefits from FL and another state concurrently as long as the total benefits don't exceed what FL allows.
Note: If a claimant is required by his employer to operate a dangerous instrumentality as part of his employment, then his employment subjects him to an activity which increases the risk of an injury when an accident is caused by an idiopathic, or pre-existing, condition, should such condition manifest itself during the employment, and automobiles are considered dangerours instrumentalities.
Note: When an accident occurs outside Florida, workers' compensation benefits are payable only if the contract of employment was made in Florida or the employee's employment was principally localized in this state.
Note: In this case, a knowing disregard for an employer's safety protocol is not enough to establish a causal connection between the injury and the disregard.
Note: a victim of sexual harassment in the workplace may receive workers' compensation for economic injuries such as lost earnings, but may also sue in tort.
Note: The amount of compensation or rate of compensation paid to a claimant is substantive in nature.
Note: If there is CSE to support the JCC's finding, it will not be disturbed.
Note: The requirements of the Workers' Compensation Act and due process of law are met if the record affirmatively demonstrates that the employer received notice of the claim.
Note: A JCC can find that but for claimant's intoxication a fight would not have taken place, therefore there would be no injury.
Note: When a union and an employer enter into an agreement that the employer will hire only union workers, "the union becomes the agent of the employer for employment purposes and is authorized to make a job offer for the latter.
Note: No compensation shall be payable if the injury was occasioned primarily by the intoxication of the employee.
Note: If a compensable injury occurs in Florida, it is covered by Florida workers comp law.
Note: For workers compensation, all that is required is that the "obligations or conditions" of employment create the "zone of special danger" out of which the injury arose.
Note: When an assault results in a workplace injury, if the animosity or dispute leading up to it originated in the claimant's private life and was not exacerbated by the employment, the assault does not arise out of the employment under any test.
Note: In determining jurisdiction under 440.09, it is the principal location of the claimant's employment and not the principal location of the employer's business which is relevant.
Note: Presumption in section 440.09(7)(b) inapplicable where chain of custody required per 59A-24 of the FL Administrative Code breached.
Note: Awards for attendant care are erroneous where they allow for
Note: Evidence demonstrates claimant made false statements, precluding him from recovering benefits.
Note: Judge cannot rule on defense to claim he has no jurisdiction to hear.
Note: Referral for RSD evaluation granted only where medically necessary and causally related to work accident.
Note: Awards for attendant care are erroneous where they allow for
Note: No TPD benefits for hours in which claimant refuses suitable employment.
Note: Specific impairment rating required to determine amount of benefits.
Note: Employment can be major contributing cause of disability if it aggravates preexisting disease.
Note: Immunity does not apply to employer/carrier's intentionally harmful actions.
Note: Employer/carrier must only prove fraudulent activity by a preponderance of the evidence.
Note: Denial of a 'fraud' defense upheld if supported by substantial evidence, regardless of the competency of other persuasive evidence.
Note: Attorney entitled to fees for work in connection with relevant criminal matter.
Note: JCC has no jurisdiction over an issue relating to a voluntarily dismissed petition for benefits.
Note: Waiver of right to deny compensability under section 440.20 does not preclude the E/C from challenging entitlement to benefits.
Note: Fraudulent statements/actions not related to the obtainment of benefits do not disqualify the claimant from receiving workers' compensation benefits.
Note: Medical evidence must support JCC's award.
Note: Pay and investigate provision erroneously applied where treatment is attributable to pre-existing condition.
Note: Even if any classification scheme is created by the statutes, they would advance the elimination of fraud.
Note: The judge's finding rendered moot the employee's contention that the judge erred when declining to appoint an expert medical examiner to resolve alleged conflicts in opinions regarding appellant's psychiatric condition.
Note: Although the JCC seemed less than impressed with the evidence supporting the fraud defense, there was no alternative finding based upon a lack of evidence.
Note: The record fully supports the findings that the judge of compensation claims made with regard to Mr. Wetherington's customary use of the cane and the more general finding and conclusion that the claimant did not knowingly make false, fraudulent or misleading oral or written statements for the purpose of obtaining benefits.
Note: Because Claimant was working, albeit at a reduced number of hours, he did not have a disability that was total in character, and there is no competent, substantial record evidence establishing that Claimant believed he could not work.
Note: Claimant's employment was localized in Alabama, and the proper jurisdiction was in Alabama.
Note: Because claimant was not aware he was to return to work before the date of the merits hearing, he should have been awarded benefits through that date.
Note: Because no evidence was submitted as to number of deliveries claimant would make on an average day, the decision that his heart-attack came on an unusually strenuous day is not supported, and the matter is remanded for a determination of this issue.
Note: Claimant's hypertension has not caused him to miss any work, thus he cannot demonstrate an incapacity resulting in actual wage-loss and cannot show disablement.
Note: A claimant found to have knowingly and intentionally made a false or misleading statement for the purpose of securing workers' compensation benefits is not required to receive her benefits up to the time her misrepresentation was discovered.
Note: While the employer/carrier refer to the major contributing cause standard in section 440.09(1)(b), Florida Statutes, that statutory provision does not apply here as this as this case involves two industrial accidents and injuries without any preexisting injury or condition attributable to a nonindustrial cause.
Note: It was error for the JCC to award attorney fees to claimant because the employer-carrier did not properly raised a misrepresentation defense, and the claimant's PTD benefits were never at issue.
Note: The court concluded that the 3rd District erred in reversing the judgment based solely on the plaintiff's failure to demonstrate that the employer concealed a danger.
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