Misrepresentations Affected Entitlement to Benefits, not Compensability for Fla. Bus Driver

Case File

When a Florida bus driver made misrepresentations about an injury she experienced in 2021, she lost out on worker's compensation benefits for it. But when she experienced another injury in 2022, for which the 2021 accident was the major contributing cause, was she left without a compensable injury? Simply Research subscribers have access to the full text of the decision.

Case

Pinellas County Transit Authority v. Jackson, No. 1D2024-1522 (Fla. Dist. Ct. App. 11/12/25)

What Happened?

A Florida bus driver reinjured her shoulder while turning the steering wheel at work and required medical treatment. The employer/carrier denied the driver's claims for benefits because doctors identified the driver's prior on-the-job shoulder injury as the major contributing cause of her need for benefits and because the driver had made misrepresentations related to the earlier claim that barred her from entitlement for benefits for that injury.

The Judge of Compensation Claims awarded benefits, and the E/C appealed.

Rule of Law

Workers' Compensation benefits are available in Florida when an injury arises out of and in the course and scope of one's work. "Arises out of" is defined in terms of a "major contributing cause" analysis. Under that analysis, an occupational accident must be more than 50% responsible for the injury.

Workers' Comp 101: In Florida, "major contributing cause," or "MCC," means the cause that is more than 50% responsible for the injury.

What the Court Said

After pointing out that the E/C argued that because the driver lost her right to receive benefits for the earlier injury by making misrepresentations that were forbidden under the law, she was foreclosed from receiving benefits related to the later injury, the court found two problems with the E/C's argument.

Workers' Comp 101: Under Florida law, claimants may not "knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment." Florida law also bars benefits for an employee found to have "knowingly or intentionally engaged in any" false, fraudulent, or misleading statements "for the purpose of securing workers' compensation benefits."

First, the court noted that both of the driver's accidents and injuries stemmed from her work on the job. Thus, there was no injury unrelated to the driver's work involved with the case. Also, the driver did not fail to seek benefits after the first accident "as might have rendered that accident non-compensable and required an MCC analysis to be completed."

Second, the E/C's misrepresentation defense argument conflated the concepts of "compensability" and "entitlement to benefits." The court explained that "compensability" involves the workplace-related existence and cause of an injury and not benefits-entitlement issues.

"It is true that the E/C's successful misrepresentation defense on the 2021 injury claim foreclosed [the driver's] entitlement to benefits for that accident," the court wrote. "But that forfeiture of benefits did not render either the 2021 or 2022 accident non-compensable because, again, compensability analysis doesn't directly concern benefit-entitlement but whether a work-caused accident and injury occurred."

Moreover, the E/C's misrepresentation defense did not foreclose the driver from qualifying for benefits stemming from the second, separate workplace accident because Paulson v. Dixie Cnty. Emergency Med. Servs., 936 So. 2d 1109 (Fla. Dist. Ct. App. 2006) held that the law's plain language applies the prohibition on benefits when a claimant makes a misrepresentation only "to a specific accident" in which fraud was committed and not a subsequent workplace accident.

"Thus, the E/C's successful ... defense didn't affect the compensability status of either the 2021 or 2022 accidents, nor did it prevent [the driver] from qualifying to receive benefits corresponding to the distinct workplace accident and injury in 2022," the court wrote.

Verdict: The court affirmed the JCC's decision.

Takeaway

In Florida, a misrepresentation regarding a workplace accident that forecloses a claimant's entitlement to benefits doesn't render that accident -- or a subsequent accident for which the first accident was the MCC -- non-compensable.

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