A Florida worker who was assaulted on the job is entitled to compensation for those injuries – even if his employer neglected to notify the company’s insurance provider immediately after the incident.

hospitalroom1In Fortune v. Gulf Coast Tree Care, the First District Court of Appeals reversed the Judge of Compensation Claims’ denial of reimbursement for medical expenses, mileage and co-payments occurred in treatment following the May 2011 incident. Although the JCC had deemed the injury compensable, the worker sought follow-up care from Veteran’s Affairs, rather than requesting care from either his employer or carrier.

While it’s true an employer/insurance carrier would have some say over where a worker obtains medical treatment, in this case, neither the employer nor insurer directed him to receive care from any certain provider. The worker did his due diligence in notifying his supervisor right after the attack. The fact that his employer failed to notify the insurer was not a mistake for which the worker should be made to pay.

Our Cape Coral workers’ compensation lawyers know the statute the employer/insurer argued to invalidate coverage was F.S. 440.13. The law says it is the duty of the employer to furnish medically necessary remedial treatment, care, attendance, medicines, supplies, prostheses and anything else a physician deems medically necessary. The law says the carrier has the right (except in emergency situations) to review the proposed course of treatment and determine whether it’s recognized as reasonably prudent.

However, the law also says that if the employer does not provide initial treatment or care as required and the care is compensable and medically necessary, the worker can obtain this treatment at the expense of the employer. There has to be a specific request for initial treatment or care and the employer/insurer has to give a reasonable amount of time in which to provide the treatment or care.

While there are many legal demands made on workers who have suffered injuries if they hope to retain coverage, the bottom line is that a worker shouldn’t be punished just because an employer failed to notify the insurance company.

In this case, the worker was a lawn maintenance professional who was waiting at the entrance of a gated community in order to provide an estimate when he was accosted by a resident of the community (coincidentally, a dentist). It’s not clear from records what the altercation was over, but we do know the dentist reached in and punched the worker in the shoulder.

Worker immediately notified his employer that he was on his way to the hospital after what had happened. Doctors at the emergency room, where his shoulder was placed back into alignment and he was advised to seek follow-up care.

His supervisor even came to the scene and followed claimant to the hospital. However, employer did not complete a notice of injury to the carrier.

Approximately 11 days later, worker sought follow-up care at the V.A. He underwent surgery two months later. During this time, he continued to work for the company.

Sixteen months later, the carrier first received notice of injury.

While it’s true the employee did not seek follow-up medical care guidance from either the employer or the insurer, the 1st DCA found a plain interpretation of the law indicated it was not the worker’s fault the employer did not notify the carrier. The employer knew of the injury, of the surgery, of the worker’s need for limited duties. There is an exception to the rule when employers fail to provide initial treatment.

Plus, if the employer had notified the carrier, the worker would have been provided with statutorily-required informational brochures containing important information about his rights and where he should seek treatment. That did not happen, and thus, worker was entitled to seek treatment elsewhere – and be reimbursed for it.

If you have been injured at work in Florida, call Chalik & Chalik at (954) 476-1000 or 1 (800) 873-9040.

Additional Resources:

Fortune v. Gulf Coast Tree Care, Oct. 13, 2014, Florida’s First District Court of Appeal

More Blog Entries:

Gaytan v. Wal-Mart – Work-Related Fatality Claim to Proceed, Oct. 16, 2014, Cape Coral Workers’ Compensation Lawyer Blog