A Florida appellate court held that misrepresentations regarding a claimant’s medical history can disqualify the claimant from receiving benefits even if there is no direct link between the allegedly false or misleading statements and the particular injury for which benefits are being sought [Cal-Maine Foods v. Howard, 2017 Fla. App. LEXIS 10681 (1st DCA, July 26, 2017)]. Moreover, oral or written misrepresentations to a physician about a claimant’s prior medical history cannot be excused or “nullified” because the doctor actually possessed accurate medical information from some other source. Florida’s fraud statute [§ 440.105(4), Fla. Stat.] places no affirmative duty on an evaluating physician to interrogate the claimant regarding known misrepresentations.
In early November 2014, Claimant apparently suffered injuries while operating a front-end loader for the Employer. There was conflicting evidence as to whether Claimant reported any injuries to the Employer. In any event, in August 2015, following termination by the Employer for reasons unrelated to the accident, the Claimant filed a Petition for Benefits (PFB) seeking payment of TTD or TPD benefits, and authorization of a neurological/orthopedic physician to evaluate and treat his lower back symptoms. In his PFBs, the Claimant indicated that on the date of his injury, the front-end loader had mechanical issues and, when the brakes went out, the Claimant had to jump from the machine, causing his face to be pushed into the pavement and the rear tire of the machine to hit him in the head.
The Claimant did not seek immediate medical treatment, but rather waited one month after his termination (and two months after the November 2014 work accident) to see a doctor. Initial medical treatment was received on January 22, 2015, at a local hospital, where the Claimant reported a head injury/pain with frustrated memory and headaches due to being hit in the head with a baseball bat “eight days prior.”
At his initial deposition, when confronted with the hospital records, the Claimant testified his description of the baseball bat incident was false and contrived. He asserted he later “corrected” this false account and told hospital staff that the injuries actually occurred from an accident at work. He said he made the misrepresentation due to his belief that he would not receive medical treatment if he reported a work-related accident. No “correction” was documented, however, in the hospital’s medical records.
On February 4, 2015, the Claimant visited another hospital’s emergency department, where he was seen for left-sided facial pain, advising he received a facial fracture “one month earlier.” He requested pain medications and denied back pain or headaches. He did not report a work accident. Still later, the E/C scheduled an IME with a nurosurgeon. The Claimant completed patient intake/history forms upon which the Claimant did not disclose the “baseball bat” incident. The neurosurgeon actually confronted the Claimant about his report of being struck in the head with a baseball bat, the Claimant indicated he was “kind of foggy when it happened.”
In separate medical examinations with two other neurosurgeons, the Claimant did not disclose anything regarding the baseball bat incident. At the final hearing before the JCC, the Claimant announced he was seeking compensability of the lower back injuries only, thus dropping other claims relating to facial and neck injuries, and concussion with brain injury.
JCC: Misrepresentations Were “Moot”
Although the JCC determined the Claimant had committed multiple misrepresentations, she ultimately declined to terminate the Claimant’s entitlement to workers’ compensation benefits. Specifically, the JCC held the misrepresentations were moot and not committed for the “purpose of obtaining workers’ compensation benefits.”
Appellate Court Disagreed
Acknowledging that not all prohibited acts contained in § 440.105 entailed a “fraud” element, the Court nevertheless said amendments to the statute in 2003 had broadened its disqualifying effect. Specifically, it was not necessary that the misrepresentation be material in actuality. The issue is whether the misrepresentation was made to secure benefits.
The Court added that it was undisputed that the Claimant provided multiple false and/or misleading written and oral statements. The JCC had acknowledged this. From the appellate court’s perspective, the JCC had regarded the Claimant’s oral and/or written misrepresentation(s) to the physicians regarding prior medical history as excused or “nullified” because the doctors actually possessed accurate medical information, regardless of the source. The court held that the JCC erred in placing an affirmative duty, not statutorily mandated, on the evaluating physicians to interrogate the Claimant regarding known misrepresentations. Furthermore, a plain reading of §§ 440.105(4) and 440.09(4), Fla. Stat. provided no basis for the JCC’s exoneration of the misrepresentations. The court said it mattered not whether the doctors were provided with accurate information regarding etiology of injuries or pre-existing medical conditions and treatment by a source other than the Claimant.
Dropping Part of Claim Did Not Shield the Claimant
Nor could the Claimant be shielded by the fact that he had abandoned his claim regarding facial and neck injuries, and concussion with brain injury. Indeed, said the court, “A party may not strategically manipulate pleadings to circumvent its sanctions.” It added, “Honesty is not a luxury to be invoked at the convenience of a litigant.”