Historically, a Florida workers compensation claimant attorney will enter into pretrial stipulations with the insurance company attorney regarding injuries for which the Florida workers compensation insurance company accepts responsibility and agrees to provide treatment. The workmens comp Judge then enters an order approving the stipulations. For instance, a Florida workers compensation claimant’s lawyer and the insurance company may agree that the employee injured his back when he slipped and fell at work and the insurance company agrees to treat the back which is then approved by the judge in the pretrial order.
As the case progresses, the Florida workers compensation insurance company may contact the doctor and find out that the doctor doesn’t think the need for treatment of the back is caused by the on-the-job accident. As a result, the workers comp carrier cuts off or denies medical care or treatment for the workers compensation claim.
In Jackson v. Merit Electric, 37 So.3d 381 ( Fla, 1st DCA 2010) the court issued the mandate to workers compensation insurance companies that they are bound by their earlier stipulations to treat injuries they accept as caused by the industrial accident.
Jackson originally injured his knee at work in 1984. His back began bothering him in 2003. In 2007, the workers compensation claimant attorney filed a petition seeking care for the back. The parties entered into a pretrial stipulation agreeing to provide treatment to the back and the judge entered an order approving the stipulation. Later, the workers compensation lawyer for the insurance company argued to the judge that it had contacted the doctor and the doctor stated that the need for treatment was due to a subsequent incident and unrelated conditions.
The court held that after the injured worker and the workers compensation insurance company enter into a stipulation to provide treatment to a condition that’s been approved by the judge’s order, the employee has satisfied his burden to obtain treatment from the worker compensation insurance company for the stipulated injuries unless the workers compensation insurance company can establish a break in the stipulated causal connection by a new accident or the need for treatment is from a condition for which insurance company has not accepted responsibility. The court explained that workers compensation insurance companies do not provide treatment as a result of an “accident”. Instead, they provide treatment for “injuries” resulting from accidents. Apparently, once the insurance company stipulates to provide treatment for a condition such as the back, agreeing that it results from the industrial accident, as the insurance company did in Jackson, the court will hold them to it.
The Jackson case has an interesting set of facts. The workers compensation insurance company attorney stipulated to treating the back condition, 20 years after the injury to the knee. Then, several months later, the doctor gave his opinion that his treatment was for injuries that were not caused by the work accident. Instead, the doctor believed that the need for treatment to back was caused by an incident when the employee was shooting pool fourteen years after the accident at work. (The doctor also believed the need for treatment was the normal degenerative process.)
The court rejected the doctor’s testimony as not “competent” on the basis that the doctor had not been made aware of the insurance companies acceptance of responsibility to treat the back condition. As a result, his testimony could not be considered evidence to prove a subsequent intervening accident or unrelated condition to relieve the insurance company of their responsibility to provide treatment to the injuries it had stipulated it would treat .
Workers compensation claimant’s attorneys can expect to see insurance companies advising doctors that they have stipulated to providing treatment to conditions. When the doctor’s deposition is taken later they will have the doctor testify that the treatment is for a subsequent intervening accident or an unrelated condition. Then they will argue to the judge that the opinion is now somehow competent since the workers compensation insurance company has advised the doctor of the pretrial stipulation and order.
In the alternative, it is expected that workers compensation insurance companies will be filing motions to amend the pretrial stipulation and order to undo what they have agreed to provide in the way of treatment for conditions they have stipulated are covered by workers compensation.
Also, Florida Rule of Administrative Procedure 60Q-113(5) allows for amendments of the pretrial stipulations so long as the amendment is served more than 30 days before the trial. Unilateral announcements by the workers compensation insurance company announcing that it is no longer accepting responsibility for a condition which needs treatment will be attempted.