What Do You Think: Did Stipulation Bind Carrier to Driver's Later Pain Issues?

Tallahassee, FL (WorkersCompensation.com) – Pain from accidents that occur on the job can cause medical issues for workers years down the road, so employers and carriers might want to think twice about what they stipulate to in accepting compensability.

As one Florida court had to consider recently, whether a “strain” that a worker experienced in 2004 continued to cause pain severe enough to warrant a pain management program in 2018 depended on thin medical evidence supporting an earlier stipulation.

A truck driver for a transportation company experienced several workplace injuries involving the shoulders, neck, and lower back. One of the injuries occurred to the driver’s lumbar spine while driving his truck on a “very bumpy road.”

By stipulation with the driver, the company and its carrier accepted compensability and authorized medical care for the driver, referring to his “lumbar spine” injury. The lumbar injury was consolidated with two other injuries.

Roughly 14 years later, as he continued experiencing pain, the driver visited a doctor who recommended a pain management program. The driver filed a petition for benefits requesting authorization for pain management.

The carrier alleged that the driver’s workplace injury wasn’t the main contributing cause of his need for treatment. It contended that the injury it originally accepted compensability on was “only a … strain.” In response, the driver argued that the carrier didn’t have evidence showing that an intervening or competing cause was to blame for his pain issues.

When the case was before the judge of compensation claims, neither side presented evidence of a specific accepted diagnosis. Based on this, the judge ruled in the carrier’s favor, finding that the driver did not prove that his workplace injury was the major contributing cause of the pain he was experiencing.

The driver appealed to state court.

Under Florida law, the compensable injury must be the major contributing cause of any resulting injuries, meaning that it must be more than 50 percent responsible for the injury as compared to all other causes combined.

However, where a carrier accepts compensability, it cannot later challenge the connection between the workplace accident and a worsening of the condition. It may only question the connection between the injury and the benefit through evidence showing a different cause.

Could the carrier show that the at-work injury wasn’t the major contributing cause of the driver’s continued pain problems?

A.    Yes. The accepted injury was only a minor strain, and the stipulation didn’t accept the worsening of the driver’s condition that occurred over time.

B.    No. The carrier accepted compensability and did not present medical evidence suggesting that that worsening of the condition was not the natural progression of the accepted injury.

If you chose B, you agreed with the court in Sanchez v. Yellow Transportation, No. 1D19-4231 (Fla. Dist. Ct. App. 09/21/20). The court reversed the judge of compensation claims’ decision in the carrier’s favor.

According to the court, the carrier couldn’t escape the fact that it had entered into a broad stipulation “that did not define the accepted compensable injury more narrowly than the lumber spine.” Without evidence that the worsening of the condition was not related to the accepted injury, the carrier was unable to convince the court that the condition did not exist at the time of the stipulation.

“The [carrier] presented no medical evidence suggesting that the degenerative condition here … could not be the natural progression of the accepted injury,” the court reasoned.

This feature does not offer legal advice.

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