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  • Florida Appellate Court Denies Workers’ Compensation Benefits to Employee Based on Fraud and Misrepresentation

Florida Appellate Court Denies Workers’ Compensation Benefits to Employee Based on Fraud and Misrepresentation

In a recent Florida workers’ compensation case, the First District Court of Appeal denied an employee’s disability benefits based on misrepresentations that he made during the investigation phase of the case. The facts of the case are as follows. In May 2013, the employee suffered injuries to his back during the course and scope of his occupation as a marine dock construction worker. After reporting his injury, the employer deemed it compensable under its workers’ compensation insurance policy and authorized the employee to pursue medical attention. At the same time, the employer initiated temporary total disability payments to the employee.

The employee began physical therapy treatments for his back injury. At some point during his therapy, however, the man reported suffering an injury to his hip. The employee’s supervising physician referred the employee to an orthopedic surgeon to determine the nature and extent of his injury. During a consultation with the orthopedic surgeon, the employee stated that the hip injury was not work-related. As a result, the employer refused compensability for the hip injury. 

During October 2013, the employer performed secret surveillance on the employee and recorded evidence of the employee performing several physical tasks that were comparable to the physical duties that the employee performed as a marine dock construction worker. Based on this evidence, in December 2013 the employer ceased all disability benefit payments to the worker and conceded that the employee’s actions constituted fraud pursuant to Florida Statute Sections 440.09 and 440.105.

Roughly one month later, the employee filed a formal petition for disability and medical benefits according to Florida’s workers’ compensation law. A Judge of Compensation Claims (JCC) reviewed the employee’s claim and held a hearing on the matter. During the hearing, the employee testified that he had not performed any marine construction work since reporting his back injury. The JCC concluded, however, that the employee’s actions constituted fraud and that the employee made a number of material misrepresentations in his testimony. As a result, the employee’s petition was denied. The JCC further limited the employee’s right to benefits to the period between the day he suffered the back injury and the day that he made the misrepresentation.

On appeal to the First District Court, the man argued that the JCC erred in finding that he had engaged in fraud and that he made misrepresentations during his testimony. The appellate court reviewed the facts of the case according to the two statutes upon which the employee relied. First, Section 440.105 makes it unlawful to provide an untrue statement for the purpose of receiving a workers’ compensation benefits award. Second, Section 440.09 provides that an employee cannot recover benefits if he or she makes intentional misrepresentations for the purpose of securing benefits.

Based on this, the appellate court concluded that the employee admitted to violating Section 440.105, and the employee argued that he should still be allowed to receive benefits for the period from his back injury to before he made the untrue statement. The court rejected this argument, concluding that the employee had failed to prove that he was entitled to receive benefits during the period prior to his misrepresentation.

According to the court’s review of the factual record, the employee made the misrepresentations in response to his employer’s decision to contest his right to receive disability benefits. Florida’s workers’ compensation laws prohibit an employee from recovering any contested benefits where it is determined that fraud occurred during the course and scope of the workers’ compensation case that is pending adjudication.

If you have suffered an injury while at work, you may be entitled to benefits. Florida’s workers’ compensation system and knowing how to make your workers’ compensation claim can be difficult and confusing to navigate. At The Hoffman Firm, we have provided experienced and sound legal counsel to many South Florida residents who have been hurt on the job. We offer a free, no-obligation consultation, so you have nothing to lose. Call us now at (800) 223-1866 or contact us online to set up your appointment now.

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Evan A. Hoffman

Evan A. Hoffman

Mr. Hoffman’s philosophy is "our knowledge and experience is your best defense." He has been a featured author on criminal law issues such as driving under the influence, domestic violence and illegal searches.

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