NCCI Court Case Update — Florida, Texas, West Virginia

Florida—Requirement to Seek Initial Relief Within the Workers Compensation System

On June 13, 2025, the District Court of Appeal of Florida, Fifth District, in Steak 'N Shake, Inc. v. Spears, ruled that an employee may not file a tort lawsuit against an employer without first seeking a determination of whether the employee i​s entitled to workers compensation (WC) benefits.

In this case, an employee alleged she sustained severe emotional distress after a robbery that occurred at her workplace while she was within the course and scope of employment. The employee filed a lawsuit against the employer asserting that the claim was outside of the WC system because the injuries sustained were not physical and the employee was only seeking damages for mental distress. The employer asserted, however, that it was entitled to WC immunity because the employee had not made a request for benefits to determine whether the injuries were compensable.

The trial court allowed the lawsuit to move forward after determining that the employee's mental injuries were not compensable in WC. On review, the appellate court analyzed Florida statute 440.13—which defines compensable as "a determination made by a carrier of judge of compensation claims (JCC) that a condition suffered by an employee result from an injury arising out of the court and scope of employment"—and concluded that the statute clearly provides that only a WC carrier or a JCC has the authority to determine compensability. As a result, the appellate court held that claimants must first seek remedial relief within the WC system, rather than filing a civil tort claim in court.

The court vacated the trial court's order, finding that the employee was not entitled to WC benefits and therefore could file a tort claim directly in civil court.

Texas—Jurisdiction of the Division of Workers' Compensation (DWC)

On June 13, 2025, the Supreme Court of Texas, in University of Texas Rio Grande Valley v. Oteka, clarified that the DWC does not have exclusive jurisdiction to determine if an injury is work related.

An employee sued an employer for injuries after being struck by a vehicle while leaving the employer's premises after voluntarily attending an employer event. The employee did not petition for workers compensation (WC) benefits, but the employer reported the claim to its third-party administrator, which denied benefits, in part, on grounds that the injury did not arise in the course and scope of employment. Nonetheless, as an affirmative defense to the employee's lawsuit, the employer asserted WC benefits as the exclusive remedy. The employer further argued that the lawsuit should be dismissed because the DWC, and not the courts, has exclusive jurisdiction to determine whether an injury is sustained in the course and scope of employment.

The supreme held that the DWC does not have exclusive jurisdiction to determine whether an injury occurred in the course and scope of employment when (1) the employer raises the issue as an affirmative defense and (2) the employee's requested relief does not depend on any entitlement to benefits. With this holding, the supreme court resolved a split that existed between intermediate appellate courts in the state regarding the issue of whether an employee's failure to exhaust administrative remedies with the DWC deprives a trial court of subject matter jurisdiction over an employee's personal-injury claims against the employer.

West Virginia—COVID-19 as Occupational Disease

On May 27, 2025, the Supreme Court of Appeals of West Virginia, in Foster v. Primecare Medical of West Virginia, Inc., affirmed a decision that a nurse who contracted COVID-19 was entitled to workers compensation (WC) benefits.

In this case, a nurse alleged she contracted COVID-19 as a result of work-related exposure to coworkers and patients who had tested positive for the virus. The employer contested the claim, arguing that the employee could have contracted the disease not from workplace exposure, but from exposure that occurred on two occasions the employee engaged in nonwork-related outings.

The Workers' Compensation Board of Review (the Board) found that the claim was compensable. However, on appeal, the Intermediate Court of Appeals (ICA) denied the claim. The ICA found that based on West Virginia statute 23-4-1(f)—which establishes that occupational diseases do not come from a hazard which the employee would have been equally exposed outside of the employment—the employee failed to prove that healthcare workers exposure to COVID-19 in the workplace resulted in a higher occurrence of the illness than that experienced by nonhealthcare workers.

On appeal, the state supreme court reasoned that when determining whether a claimant's exposure to COVID-19 came from a hazard to which an employee would have been equally exposed outside of work, statistical evidence as to the incidence of workplace-related risk versus outside risk is relevant, but not dispositive. The court further held that a WC COVID-19 claim may be compensable, notwithstanding the fact that workers generally were exposed to the disease outside of their employment, when a preponderance of the evidence establishes that the claimant contracted the disease from the employment and establishes the rest of the elements set forth in Virginia statute 23-4-1(f).

With this decision, the court reversed the ICA's ruling and reinstated the Board's order, which concluded that the preponderance of the evidence established that the nurse contracted COVID-19 as a result of multiple and known workplace exposures.

For more information on other cases monitored by NCCI's Legal Division, visit previous Court Case Updates and Court Case Insights under the Legal section of INSIGHTS on ncci.com.

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