Geoffrey Meehan v. Orange County Data & Appraisals and Johns Eastern Company, Inc. , 272 So. 3d 458 ( 2019 )


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  •           FIRST DISTRICT COURT OF APPEAL
    STATE OF FLORIDA
    _____________________________
    No. 1D17-1076
    _____________________________
    GEOFFREY MEEHAN,
    Appellant,
    v.
    ORANGE COUNTY DATA &
    APPRAISALS and JOHNS EASTERN
    COMPANY, INC.,
    Appellees.
    _____________________________
    On appeal from an order of the Judge of Compensation Claims.
    Thomas W. Sculco, Judge.
    Date of Accident: September 30, 1997.
    March 20, 2019
    M.K. THOMAS, J.
    In this workers’ compensation appeal, Geoffrey Meehan
    (“Claimant”) argues that the Judge of Compensation Claims
    (“JCC”) erred in denying his claims for medical care, costs, and
    attorney’s fees related to an exposure at work. Because the parties
    entered into a broad stipulation in which the Employer/Carrier
    (“E/C”) accepted compensability of the work-related exposure and
    “building related illness” and the E/C failed to demonstrate a break
    in the causal chain, we agree, and reverse and remand the order
    on appeal.
    I. Facts
    From 1995 through 1997, the Claimant worked on the sixth
    floor of a building in Orlando. The Claimant described the building
    conditions as dismal with leaks in the ceilings and blackish
    growths on wall tiles. Employees in the building began to
    experience breathing problems. Asbestos was later discovered, and
    employees were removed from all floors except for the sixth floor
    where the Claimant worked. The employees hired by the building
    renovation company wore body suits and masks while working on
    the sixth floor near the Claimant’s work space. Yet, the Claimant
    was not provided any protective gear. The Claimant later
    developed breathing problems and reported his illness to his
    Employer.
    Subsequently, the E/C entered into a broad stipulation with
    the Claimant in which it accepted compensability of the work
    exposure. Additionally, the E/C accepted liability for “building
    related illness associated with indoor air quality problems,” with
    an accident date of September 30, 1997. Medical care was
    authorized with a pulmonologist. The JCC approved this joint
    stipulation by order in 1998.
    In 2002, Dr. Varraux, the authorized pulmonologist,
    diagnosed the Claimant with “recurrent sinus, acute bronchitis,
    reactive airway disease, rhinitis, sinusitis, rhinosinopulmonary
    syndrome, and occupational-induced asthma.” He prescribed
    inhaler bronchiodilators, among other medications. The E/C
    continued authorization of the medical care and the treatment
    recommended.
    Fifteen years later, the E/C issued a Notice of Denial
    terminating all further medical treatment to the Claimant. The
    insurance adjuster confirmed the E/C’s decision to deny further
    medical care was based solely on a peer review report. In its Notice
    of Denial, the E/C asserted the work accident was no longer the
    major contributing cause (“MCC”) of the need for medical
    treatment. In response, the Claimant filed petitions for benefits
    (“PFBs”) seeking reauthorization of Dr. Varraux, payment of his
    medical bills, costs and attorney’s fees. The E/C filed a formal
    response to the PFBs asserting the work accident was no longer
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    the MCC and that the treatment and medications were not
    medically necessary.
    After denying all further medical care, the E/C obtained an
    independent medical evaluation (“IME”) with Dr. Brooks, an
    internal medicine specialist with a subspecialty in pulmonary
    medicine. Dr. Brooks diagnosed the Claimant with vocal cord
    dysfunction (“VCD”), unrelated to workplace exposure. In his
    opinion, the Claimant did not suffer from asthma and, therefore,
    did not need the asthma medications prescribed by Dr. Varraux.
    Dr. Brooks testified that he found no evidence of sinusitis, but he
    did diagnose allergic rhinitis, which he opined was also unrelated
    to the workplace exposure.
    Dr. Varraux testified that the Claimant had “got[ten] worse”
    over time. He maintained his opinion on diagnoses and treatment
    recommendations. With respect to Dr. Brooks’ diagnosis of VCD,
    he disagreed. He reiterated his diagnoses, inclusive of asthma, and
    his opinion that the Claimant’s need for ongoing medications for
    all of his conditions and symptoms to be medically necessary and
    causally related to the work exposure.
    Prior to merits hearing, the parties filed Uniform Pre-Trial
    Stipulations in which the E/C raised the following specific
    defenses: 1) The industrial accident is no longer the MCC of the
    need for treatment or disability; and 2) the prescriptions are not
    medically necessary. No EMA was appointed. 1
    Following the merits hearing, the JCC entered an order
    denying all claims. The JCC accepted the testimony of Dr. Brooks
    1 Section 440.13(9)(c), Florida Statutes, dictates that the JCC
    “shall” appoint an EMA when there is a “disagreement in the
    opinions of the health care providers.” Here, the parties expressly
    waived appointment of an EMA and stipulated on the record that
    neither would raise the EMA issue on appeal. The JCC did not sua
    sponte appoint an EMA, and as agreed, neither party raised the
    EMA issue on appeal. Because a JCC’s failure to appoint, on his
    own, an EMA is not fundamental error, the issue is not addressed
    on appeal. See Quiroga v. First Baptist Church at Weston, 
    124 So. 3d 936
    , 937 (Fla. 1st DCA 2013).
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    over that of Dr. Varraux, to conclude that, generally speaking,
    “asthma” treatment was not medically necessary because the
    Claimant did not have asthma. The JCC noted the Claimant had
    not made a claim for authorization of treatment for VCD and
    allergic rhinitis. The JCC observed, “The fact that Dr. Varraux’s
    mistake in diagnosis is understandable may make his conduct
    ‘reasonable’, but it does not make his treatment ‘medically
    necessary’ under the statute.”
    On appeal, the Claimant argues that the E/C cannot deny his
    claim for medical treatment because it had previously stipulated
    to compensability of the conditions treated by Dr. Varraux. 2
    Whether the diagnosis is appropriately VCD or not, the Claimant’s
    continued symptoms and need for treatment are simply part of the
    compensable conditions accepted by the E/C. Further, no break in
    the causal chain between the work exposure and the need for
    treatment has occurred because the Claimant’s symptoms and
    conditions have been present since the work exposure and simply
    had not yet been diagnosed or developed as a sequela of the
    compensable conditions. Alternatively, the Claimant argues that
    the VCD diagnostic issue supplants only his asthma and has no
    effect on the other conditions diagnosed and treated by Dr.
    Varraux. Accordingly, Dr. Varraux should remain authorized to
    treat the remaining compensable conditions and the VCD because
    the compensable conditions caused the VCD. The E/C counters
    that VCD is a different condition from asthma requiring different
    medications, therefore, the treatment currently being provided is
    not medically necessary.
    II. Analysis
    Factual findings made by the JCC are reviewable for
    competent, substantial evidence (“CSE”); to the extent the JCC’s
    ruling involved an interpretation of law, review is de novo. See
    Mylock v. Champion Int’l, 
    906 So. 2d 363
    , 365 (Fla. 1st DCA 2005).
    2  Neither of the parties raised argument that the order
    approving the joint stipulation was subject to modification under
    section 440.28, Florida Statutes.
    4
    A claimant has the burden to prove entitlement to workers'
    compensation benefits. See Fitzgerald v. Osceola Cty. Sch. Bd., 
    974 So. 2d 1161
    , 1164 (Fla. 1st DCA 2008). But, once a claimant has
    established compensability of an injury, via prior ruling or a
    stipulation, the E/C cannot challenge the causal connection
    between the work accident and the injury. Engler v. Am. Friends
    of Hebrew Univ., 
    18 So. 3d 613
    , 614 (Fla. 1st DCA 2009). The E/C
    may only question the causal connection between the injury and
    the requested benefit. 
    Id.
     The E/C bears the burden of proof “to
    demonstrate a break in the causation chain, such as the occurrence
    of a new accident or that the requested treatment was due to a
    condition unrelated to the injury which the E/C had accepted as
    compensable.” Jackson v. Merit Elec., 
    37 So. 3d 381
    , 383 (Fla. 1st
    DCA 2010); see also Perez v. Se. Freight Lines, Inc., 
    159 So. 3d 412
    ,
    414 (Fla. 1st DCA 2015) (“a ‘break’ is understood to occur when the
    work-related cause drops to 50% or less of the total cause of the
    need for the requested benefit.”). Here, the E/C did not assert that
    there has been any break in the chain of causation or provide
    evidence to support any such break occurred. By the E/C’s
    stipulation of compensability, the Claimant was excused of the
    burden to reestablish causation.
    Dr. Brooks opined that asthma is no longer the MCC of the
    need for treatment as he contests that the Claimant suffers from
    asthma. However, he declined to testify that the “building-related
    illness” was not the MCC of the need for treatment. Dr. Brooks also
    clarified that “as far as I understand” the Claimant was taking
    only asthma medications. In contrast, Dr. Varraux testified that
    he was prescribing medications for multiple conditions, in addition
    to asthma. Granted, despite the E/C’s acceptance of compensability
    of the work-related exposure and illness, the Claimant retained
    the burden to establish other aspects of proof required by statute,
    such as the medical necessity of the requested benefits. See §
    440.13(2)(a), Fla. Stat. (2013). He did so through the testimony of
    Dr. Varraux. Dr. Varraux testified that all of the prescriptions the
    Claimant is currently being prescribed are medically necessary for
    “the conditions for which” he was being treated. Yet, Dr. Brooks
    opined only that the VCD exists instead of the asthma. With
    respect to the rhinitis, Dr. Brooks agreed that the Claimant did, in
    fact, suffer from this condition. Dr. Varraux diagnosed and has
    treated the Claimant for this condition since 2002. The E/C did not
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    elicit any testimony from Dr. Brooks as to any break in the causal
    chain relating to diagnosis and continued treatment of rhinitis.
    The Claimant does have compensable injuries, by stipulation.
    He has a “building related illness associated with indoor air
    quality problems.” Notably, the stipulation does not specify
    “pulmonary” conditions. However, the JCC failed to recognize the
    legal significance of the E/C’s broad stipulation. See Jackson, 
    37 So. 3d at 383
    . The JCC interpreted Dr. Brooks’ testimony as
    satisfying the E/C’s burden of proving a break in the causal chain.
    However, Dr. Brooks’ testimony clearly demonstrates his belief
    that the Claimant was misdiagnosed and that he suffers from
    VCD, not asthma. The Claimant’s symptoms have not
    substantially changed since the compensable exposure. The E/C
    may not now escape its acceptance of compensability with an
    argument of misdiagnosis. Of note, Dr. Brooks testified that the
    Claimant suffers from the alternative diagnosis of VCD which
    “may simulate asthma.” Thus, Dr. Brooks’ testimony is not CSE
    to support the JCC’s ruling that the medical treatment was not
    necessitated by the “building related illness associated with indoor
    air quality problems” or that a break in the causal chain had
    occurred since the joint stipulation. Dr. Brooks established only
    that there may exist a dispute in the appropriate diagnosis but
    that the “building related illness associated with indoor air
    quality” suffered by the Claimant, albeit potentially varying in
    degree, remained. The conditions and symptoms for which the E/C
    accepted responsibility continue to be experienced by the
    Claimant.
    As in Jackson, this dispute might never have arisen if the
    parties took care to define the compensable injury. A broad
    stipulation of this kind “does little in limiting the E/C’s area of
    responsibility, nor does it give the Claimant guidelines as to what
    treatment he should be requesting from the E/C.” Jackson, 
    37 So. 3d at 383
    . Asking the doctor whether the current treatment is
    related to the 1997 accident without providing the legal posture of
    the case is not likely to result, as it failed to do here, in an opinion
    supporting a break in the causal connection. Likewise, the JCC
    failed to address: 1) the medical necessity of the other treatment
    Dr. Varraux was providing for conditions other than asthma; and
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    2) the distinction, if any, between the rhinitis Dr. Varraux had
    been treating since 2002 and that which Dr. Brooks diagnosed.
    Because CSE does not exist to support the JCC’s denial of all
    medical care, the order on appeal is reversed. Although Dr. Brooks
    testified that the Claimant did not have asthma, he opined that
    the Claimant had been misdiagnosed and the correct diagnosis
    was VCD. Dr. Brooks declined to testify that the “building-related
    illness” was not the MCC of the Claimant’s need for ongoing
    treatment. No evidence was introduced by the E/C that the
    Claimant’s symptoms changed since the date of the joint
    stipulation or that new, unrelated conditions or symptoms had
    arisen since the exposure was accepted as compensable.
    Accordingly, the order of the JCC is reversed and the matter is
    remanded for entry of an order granting the claims requested.
    REVERSED and REMANDED for entry of an order consistent
    with this opinion.
    B.L. THOMAS, C.J., and JAY, J., concur.
    _____________________________
    Not final until disposition of any timely and
    authorized motion under Fla. R. App. P. 9.330 or
    9.331.
    _____________________________
    Richard H. Weisberg, Sanford, and Bill McCabe, Longwood, for
    Appellant.
    Kristen L. Magana of Broussard, Cullen & Blastic, P.A., Orlando,
    for Appellees.
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