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A 104-week time limit on workers compensation temporary total disability benefits is not unconstitutional because claimants are eligible for permanent total disability payments once their TTD runs out, the Florida 1st District Court of Appeals said in a split en banc ruling Monday.
The decision in Bradley Westphal v. City of St. Petersburg et al. reverses a unanimous ruling in February by a three-judge panel of the appellate court. That ruling found that Florida's TTD benefit time limit was unconstitutional because it left injured workers without recourse if their TTD benefits ran out before being declared eligible for PTD benefits.
The plaintiff in the case is a permanently disabled firefighter who received no disability payments for nine months after his TTD benefits lapsed. Mr. Westphal was denied benefits for that time period because his doctor testified that he had not yet reached maximum medical improvement when his TTD benefits ended, and therefore he could not determine if Mr. Westphal would be totally and permanently disabled, according to court records.
The earlier appellate court ruling granted Mr. Westphal back payment of up to 260 weeks of TTD benefits after finding that the 104-week limit was unconstitutional.
In an 8-3 ruling Monday, the appellate court found that injured workers should be able to receive PTD benefits if they remain totally disabled at the end of the 104-week TTD time limit.
The “notion that there can be a period of time during which a disabled worker is not entitled to be compensated for his or her workplace injury is contrary to the basic purpose of the Workers' Compensation Law,” the majority opinion reads.
The new ruling was based on a reinterpretation of Florida's workers comp statutes. The court majority found that the law regards injured workers as reaching maximum medical improvement at the end of the TTD time limit, “regardless of any potential for improvement.”
“While it is true that the Legislature placed a fixed time limit on the right to recover temporary disability benefits, the purpose of this time limit was not to create a gap in which a totally disabled but still improving worker will be uncompensated. To the contrary, it is clear from the overall statutory scheme that the time limit was designed as a deadline on the issue of maximum medical improvement,” the majority opinion reads.
In his dissent, Judge T. Kent Wetherell II wrote that the majority opinion was an “unprecedented flip-flop.” While the TTD benefit time limit could result in a benefit lapse under previous applications of the law, Judge Wetherell said the issue should be dealt with by the Florida legislature rather than state courts.
“Accordingly, we should adhere to the rule announced (previous case law) and leave it to the Legislature to determine whether, and how, to fill the 'gap' in disability benefits to claimants such as Westphal who are unable to meet their burden of proof” for PTD benefits, Judge Wetherell said.
The Westphal rehearing was scheduled based on requests from several insurance and trade groups, including the Property Casualty Insurers Association of America, the American Insurance Association, the National Federation of Independent Business, and Publix Super Markets Inc. The National Council on Compensation Insurance Inc. estimated that the previous Westphal decision could raise Florida's workers compensation costs by $65 million.
A construction worker who was found not guilty of workers compensation fraud cannot sue his employer's workers comp insurer for bad faith based on his acquittal, the Montana Supreme Court has ruled.