Utopia Home Care/ Guarantee Ins. Co. v. Beatriz Alvarez
230 So. 3d 72
| Fla. Dist. Ct. App. | 2017Background
- Claimant suffered a compensable shoulder injury (surgery) and reached physical MMI in January 2012, receiving a 2% impairment award.
- Claimant later experienced worsening shoulder symptoms and was recommended a second (remedial) surgery; MMI was reassigned to July 26, 2013.
- A psychiatric evaluation diagnosed major depressive disorder with the compensable accident as the major contributing cause; Employer/Carrier accepted compensability and provided psychiatric treatment.
- Claimant sought temporary indemnity (psychiatric) benefits almost two years after the reassigned MMI; an EMA in 2016 opined claimant was not at psychiatric MMI and recommended three months off work.
- The JCC awarded three months of psychiatric temporary benefits beginning on the EMA deposition date (January 27, 2016); Employer/Carrier appealed, arguing the statutory six-month limit barred that award.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 440.093(3)’s six-month limit is a bank of time or a calendar deadline starting at physical MMI | Claimant: limit applies only when claimant is receiving permanent impairment benefits during the weeks temporary psychiatric payments would be made (effectively allowing benefits beyond six months when permanency not being paid) | Employer/Carrier: six-month period is a calendar-based deadline that begins on the date of physical MMI and bars payments after six months | Court: six-month limit is a calendar deadline beginning at physical MMI; JCC erred in awarding benefits starting in 2016 (award reversed in part) |
| Proper start date when MMI is reassigned after remedial care is recommended | Claimant: JCC permissibly started psychiatric benefit period when psychiatric need and EMA opinion arose | Employer/Carrier: clock runs from physical MMI (including reassigned MMI) and cannot be restarted later | Court: clock begins at physical MMI; whether using initial MMI (Jan 2012) or reassigned MMI (July 26, 2013), the 2016 award fell outside six-month window |
| Whether § 440.093(3) requires linkage to permanent benefits under § 440.15 | Claimant: statute applies only when permanent impairment benefits are being paid during the psychiatric benefit weeks | Employer/Carrier: statute’s introductory reference to § 440.15 shows mental-health benefits are limited and tied to permanency rules | Court: § 440.093(3) is to be read with § 440.15; the statute limits availability and is not expanded by claimant’s reading |
| Constitutionality of six-month limit | Claimant: challenges constitutionality of the six-month restriction on cross-appeal | Employer/Carrier: defends statute as legislative policy | Court: cross-appeal constitutional challenge premature given reversal of the award; not resolved here |
Key Cases Cited
- School Bd. of Lee Cty. v. Huben, 165 So. 3d 865 (Fla. 1st DCA 2015) (statutory six-month limit is a calendar deadline starting at physical MMI)
- Sarasota Cty. Sch. Bd. v. Roberson, 135 So. 3d 587 (Fla. 1st DCA 2014) (Legislature limited duration of temporary disability benefits for psychiatric injuries)
- W.G. Roe & Sons v. Razo-Guevara, 999 So. 2d 708 (Fla. 1st DCA 2008) (addressing compensability issues for psychiatric injuries in workers’ comp)
- Cecil W. Perry, Inc. v. Lopez, 425 So. 2d 180 (Fla. 1st DCA 1983) (statutory provisions should be read in para materia to determine meaning)
- White v. City of Jacksonville, 413 So. 2d 95 (Fla. 1st DCA 1982) (same principle of reading related statutory parts together)
- McKenzie v. Mental Health Care/Summit, 43 So. 3d 767 (Fla. 1st DCA 2010) (mental or nervous injury accompanying a physical injury may in some cases be an independent compensable injury)