Cespedes v. Yellow Transportation, Inc.
130 So. 3d 243
| Fla. Dist. Ct. App. | 2013Background
- Claimant injured his L5-S1 lumbar spine at work in 2006; Employer/Carrier (E/C) accepted compensability and treated him conservatively with Dr. Brown for years.
- In March 2011 Claimant presented to Kendall Regional MC ER with severe back/leg pain; neurosurgeon Dr. Acebal ordered MRI showing a massive L5-S1 herniation and performed surgery the same day as emergent treatment.
- E/C denied liability for the surgery, deauthorized Dr. Brown, and contested compensability, arguing the work accident was not the major contributing cause (MCC) of the need for surgery, the surgery was unauthorized and not emergency care, lack of timely notice to E/C, and lack of medical necessity/causation.
- The JCC excluded Dr. Acebal’s medical opinion as inadmissible under section 440.13(5)(e) but admitted his factual testimony; the JCC found Claimant’s compensable lumbar condition established but concluded Claimant failed to prove the compensable injury was the MCC of the need for surgery and that the surgery constituted compensable emergency care.
- The First DCA reversed in part and remanded, holding the JCC applied incorrect legal standards for MCC analysis, misapplied the definition of “emergency services and care,” and misapplied the admissibility rule for emergency providers’ opinions.
Issues
| Issue | Claimant's Argument | E/C's Argument | Held |
|---|---|---|---|
| Whether claimant bore the burden to prove the compensable injury was the MCC of the need for surgery | The compensable L5-S1 herniation was established and, with no competing subsequent cause, MCC follows; JCC should weigh only established causes | E/C argued the compensable injury was no longer the MCC and relied on Dr. Brown and other opinions to show a break in causation | Court: JCC used incorrect MCC analysis; when only compensable and preexisting causes are found, JCC must compare their relative contributions per §440.09(1) and decide MCC; remand for proper analysis |
| Whether services by Dr. Acebal constituted “emergency services and care” compensable under chapter 440 | Dr. Acebal performed evaluation, MRI, and surgery to determine/relieve an emergency condition (severe pain, immobility, risk of cauda equina); emergency care includes screening/evaluation under §395.002(10) | E/C relied on testimony that back pain is not an emergency and that surgery was not emergent (e.g., no cauda equina) | Court: JCC used incorrect legal test by focusing solely on whether surgery was emergent; emergency services include screening/exam to determine an emergency; remand to apply statutory test (licensed physician did screening/evaluation with intent to determine emergency) and then decide compensability and medical necessity |
| Whether Dr. Acebal’s medical opinion testimony was admissible under §440.13(5)(e) | If admissible evidence (lay/expert or operation of law) establishes that Acebal provided compensable emergency care, his opinion becomes admissible as an "authorized treating provider" | E/C argued Acebal was unauthorized and thus his medical opinions were inadmissible | Court: Adopted a reading allowing admission if the record (without relying on Acebal’s opinion) proves he provided compensable emergency care; remand to determine admissibility after fact-findings |
| Whether failure of emergency provider to notify carrier within 3 business days bars compensability | Claimant: statutory notice requirement does not render care non-compensable or penalize claimant; notice affects provider/carrier billing, not claimant’s entitlement | E/C: absence of timely notice renders the emergency care non-compensable or otherwise bars recovery | Court: Section 440.13(3)(b)’s notice requirement does not make treatment non-compensable nor impose a penalty on the claimant; billing/ reimbursement disputes are for DFS, not the JCC |
Key Cases Cited
- Engler v. American Friends of Hebrew Univ., 18 So.3d 613 (Fla. 1st DCA 2009) (once compensability of injury is established carrier cannot contest that accident is MCC of injuries at issue)
- Jackson v. Merit Elec., 37 So.3d 381 (Fla. 1st DCA 2010) (carrier seeking to avoid responsibility must show a break in causation or unrelated condition)
- Lanham v. Department of Envtl. Prot., 868 So.2d 561 (Fla. 1st DCA 2004) (where only one cause exists, claimant need not present additional MCC evidence)
- Bysczynski v. United Parcel Servs., Inc., 53 So.3d 328 (Fla. 1st DCA 2010) (error to apply MCC standard where medical evidence shows only occupational causes)
- Miller Electric Co. v. Oursler, 113 So.3d 1004 (Fla. 1st DCA 2013) (unauthorized provider’s opinion inadmissible absent proof that care was compensable and medically necessary)
- Chudnof-James v. Racetrac Petroleum, Inc., 827 So.2d 369 (Fla. 1st DCA 2002) (emergency physician’s opinion inadmissible where only evidence of causation/necessity was that opinion)