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A Florida appellate court on Wednesday overturned a denial of benefits to a sheriff’s deputy for heart disease, finding his failure to follow a course of treatment for conditions that were risk factors did not override the statutory presumption that his ailment was work-related.
Ismael Tiburcio had been working for the Hillsborough County Sheriff’s Office as a deputy for 15 years when on a busy overnight shift in 2019, he suffered a heart attack, according to Tiburcio v. Hillsborough County Sheriff’s Office, filed in the Court of Appeal for the 1st District of Florida in Tallahassee.
Mr. Tiburcio filed a workers compensation claim for heart disease under the state’s presumption for heart and lung conditions for first responders. The county denied the claim, relying on that statute’s reverse presumption provision based on Mr. Tiburcio’s departure from his personal physician’s prescribed course of treatment for related health conditions.
In ruling in favor of the county, the judge of compensation claims found that Mr. Tiburcio had been receiving treatment for a variety of health conditions since 2011. Yet, medical records documented Mr. Tiburcio’s repeated noncompliance with treatment plans designed to address these conditions, as well as a doctor’s caution that he risked suffering complications such as a stroke, kidney failure, heart attack and even death. Those records did not, however, include a diagnosis of heart disease in general or coronary artery disease.
The JCC determined that Mr. Tiburcio’s “prescribed course of treatment was specifically designed to prevent or arrest the development of heart disease, as documented in (medical) records.” He further found that Mr. Tiburcio had “departed in a material fashion” from that course of treatment that led to “a significant aggravation of his heart disease resulting in disability or increasing his disability and need for treatment.”
The appeals court reversed, ruling that the reverse presumption applies only when there is a departure from a prescribed course of treatment for the specific disease or diseases for which a claimant is seeking compensability.
Mr. Tiburcio claimed compensability for heart disease, and his alleged noncompliance was for conditions other than heart disease, so it was error for the JCC to apply the reverse presumption provision, the court said.
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