One-Time Misrepresentation doesn’t Block Paramedic’s Subsequent Claim

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Once upon a time, a paramedic misrepresented a workplace injury, but did that mean he can never receive workers' compensation benefits for any future injury? Simply Research subscribers have access to the full text of the decision.

Case

Paulson v. Dixie County Emergency Medical Services, 936 So.2d 1109 (Fla. Dist. Ct. App. 2006)

What Happened

A paramedic obtained benefits for three work-related accidents in three years, as follows:

+ In 1999, he claimed injury to his head, neck, and back when the ambulanced he was a passenger in hit a semi-truck.

+ In 2000, he claimed injury to his left wrist and arm while picking up a respiratory bag when responding to an emergecy.

+ In 2001, he claimed injury to his head, should and the left side of his back when the chair in which he was sitting suddenly broke.

The employer and carrier provided benefits for the claims in the first two accidents but denied the third accident -- the one involved in this case -- actually occurred.

Following an evidentiary hearing, the Judge of Compensation Claims concluded that the paramedic suffered a workplace accident but denied the claim finding that the paramedic made false, fraudulent, incomplete, or misleading statements to obtain workers' compensation benefits for the second workplace accident.

The paramedic appealed to court.

Rule of Law

The court explained that while it had interpreted the statute at issue to include false, fraudulent, incomplete or misleading statements that are immaterial to the claim if the statements were made for the purpose of obtaining benefits, it had never applied the statute's exclusion from coverage to a claim for workers' compensation benefits in a different workers' compensation case.

What the Court Said

According to the court, the JCC erred in applying the exclusion to the instant workers' compensation claim. The law at issue mandates coverage when an employee suffers "an accidental injury or death arising out of work performed in the course and scope of employment" and applies to a specific accident.

Similarly, the fraud bar can also only apply to one case at a time.

"To be barred from receiving workers' compensation benefits ... any false, fraudulent, incomplete, or misleading statements must have been made in the case for which workers' compensation benefits are currently being sought," the court wrote. "Thus, the bar to receiving workers' compensation benefits based on false, fraudulent, misleading, or incomplete statements is claim specific."

Thus, the paramedic's misrepresentation related to the 2000 injury did not operate to prevent him from receiving benefits for the 2001 injury.

Verdict: The JCC's order dismissing the paramedic's petition was reversed and remanded.

Takeaway

Under Florida law, there is no indication that the legislature intended an exclusion from coverage for fraud or misrepresentation to apply injuries unconnected with the fraudulent acts.

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