The Claimant’s Burden of Proof; The Causal Connection

A case was decided by the First DCA yesterday that highlights a fundamental concept in Florida workers’ compensation claims: a claimant bears the burden of proof to establish entitlement to benefits and a claimant has the burden to present expert medical evidence establishing a causal connection between the requested benefits and the compensable accident.

florida-work-comp-lawyers-statuteFlorida Statute 440.09(1) sets forth the following: “The employer must pay compensation or furnish benefits required by this chapter if the employee suffers an accidental compensable injury or death arising out of work performed in the course and scope of employment. The injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause of any resulting injuries.”

The underlined portions of the statute above highlight a claimant’s burden of proof when seeking benefits—and the claimant will fail to carry his or her burden of proof if there is no expert testimony regarding the connection between the work injury and the requested benefit.

In MBM Corp/Sedgwick CMS v. Archer Wilson, the claimant sustained an accident in October of 2010. The claimant was injured when he fell backwards out of the truck he was unloading, landing on asphalt and striking his head and right shoulder. Only a right shoulder injury was diagnosed, and treatment was authorized by the insurance company for that injury.[1] Four years after the accident, the claimant filed a claim for evaluation of his head/neck. The insurance company denied the request, as it felt that only the shoulder was injured in the accident and it felt the accident was not the major contributing cause of the head or neck condition.

In response to the employer/carrier’s denial of the claim, the injured worker presented testimony from the authorized treating physician. The doctor testified it would be reasonable, assuming that Claimant’s neck had been symptomatic since the date of the accident, for Claimant to have an evaluation to obtain a diagnosis for his neck condition.[2] The doctor was not questioned as to whether there was any possible causal relationship between the compensable shoulder injury and the cervical spine complaints.[3] The judge accepted the doctor and claimant’s testimony regarding the neck, and ordered the evaluation. The insurance company appealed the decision and the 1st DCA reversed the judge’s decision yesterday. The First DCA held that the claimant failed to carry his burden of proof by not establishing the head or neck condition is causally related to the accident.

If you have questions regarding work injuries, or the rights of an injured worker in Florida, contact our office to speak with one of our Tampa work injury attorneys. We offer free consultations, and have been protecting the rights of Florida’s injured workers since 1989. 

[1] MBM Corp./Sedgwick CMS v. Archer Wilson (Fla. 1st DCA) 1D15-2398.

[2] Id.

[3] Id.

The full MBM Corp/Sedgwick CMS v. Archer Wilson decision can be found here.

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