Florida Supreme Court Strikes Down State Cap on Temporary Disability Benefits

By | June 9, 2016

The Florida Supreme Court has delivered another blow to Florida’s workers’ compensation system with a ruling today that the state’s statutory 104-week cap on temporary disability benefits is unconstitutional.

The Florida Supreme Court ruled 5-2 in favor of the of the plaintiffs in Bradley Westphal v. City of St. Petersburg (SC13-1930), saying cutting off disability benefits after 104 weeks to a worker who is totally disabled and incapable of working but who has not yet reached maximum medical improvement is unconstitutional.

The justices opted to revive a previous limitation of temporary disability benefits, upping the limit to five years (260 weeks).

The ruling comes only weeks after the state’s high court invalidated the workers’ comp attorneys fee schedule.

In the June 9 court ruling, Justice Barbara Pariente wrote that the statute is unconstitutional under article I, section 21 of the Florida Constitution, “as a denial of the right of access to courts, because it deprives an injured worker of disability benefits under these circumstances for an indefinite amount of time—thereby creating a system of redress that no longer functions as a reasonable alternative to tort litigation.”

The case involves a former City of St. Petersburg firefighter and paramedic Bradley Westphal, who suffered severe injuries to his legs in a 2009 workplace accident. The injury required several back surgeries, which left Westphal unable to return to work.

Under state law, Westphal was eligible for 104 weeks of temporary benefits, a time period that is designed to compensate workers while they heal and then return to work or reach their maximum medical improvement status and become eligible for permanent benefits.

In Westphal’s case, however, he exhausted his temporary benefits and yet was refused permanent benefits because his physicians could not determine the prospects for his long term recovery. As such, he was left without benefits despite the fact that his doctors advised him not to work and with no assurances about the future of his case.

A judge for the Florida First District Court of Appeals, which heard the case in 2013, declared the 104-week limitation unconstitutional and upped the temporary indemnity benefits from 104 weeks to 260 weeks, an increase of three years. However, the Florida First District Court of Appeals overturned the district court’s ruling, thus reinstating the 104-week benefits. That court said the constitutionality of the 104-week benefit limit was not at issue since it could be resolved under other provisions of the workers’ compensation law, and that the District Court had failed to take into effect the legislative intent of the law.

The case then went to the Florida Supreme Court, which heard arguments just over two years ago in June of 2014.

In the 46-page opinion, the justices noted that the First District Court of Appeal “valiantly attempted to save the statute from unconstitutionality by interpreting [the statute] so that the severely injured worker who can no longer receive temporary total disability benefits, but who is not yet eligible for permanent totally disability benefits, would not be cut off from compensation after 104 weeks.” However, the Florida Supreme Court said the judiciary does not have the power to rewrite a plainly written statute, even if it is to avoid an unconstitutional result, thereby quashing the appeals court decision.

“Applying the statute’s plain meaning, we conclude that the 104-week limitation on temporary total disability benefits results in a statutory gap in benefits, in violation of the constitutional right of access to court,” Pariente wrote.

The ruling further says that the temporary disability benefit statute of the state’s workers’ compensation law operates in an opposite manner of the legislative intent of the law to “assure the quick and efficient delivery of disability and medical benefits to an injured worker and to facilitate the worker’s return to gainful reemployment at a reasonable cost to the employer.”

The justices stated the statute instead cuts off a severely injured worker from disability benefits at a “critical time, when the worker cannot return to work and is totally disabled but the worker’s doctors – chosen by the employer – deem that the worker may still continue to medically improve.”

However, the opinion further states that this decision on temporary total disability benefits does not render the entire workers’ compensation system invalid. The court instead opted to employ the remedy of “statutory revival” and directed that the limitation in the workers’ compensation law preceding amendments to the temporary total disability benefits in 1994 be returned to 260 weeks.

The court said allowing for five years of eligibility rather than two years was a limitation they previously held “passes constitutional muster.”

System in Turmoil?

The Westphal case is just one of several that have challenged the state’s workers’ comp law, reformed in 2003 in a cost-savings effort.

The ruling is likely to upset employers as it comes on the heels of another that is expected to raise their costs. In April, the court found the state’s workers’ comp attorneys fee schedule unconstitutional in the case of Castellanos v. Next Door Co.

In response to the Castellanos ruling, the National Council for Compensation Insurance (NCCI) filed a 17.1 percent increase last month for state workers’ comp rates. A hearing is planned for July with Florida’s Office of Insurance Regulation (OIR) to discuss the rate increase.

At the time of the original ruling of unconstitutionality for the Westphal case back in 2013, NCCI projected an increase in workers’ compensation costs of $65 million, which translates into a 2.8 percent rate hike.

Insurers are not pleased with this turn of events.

“PCI and our members are disappointed in today’s decision as it could significantly destabilize Florida’s business environment,” said Logan McFaddin regional manager for the Property Casualty Insurers Association of America (PCI). “The impact of both decisions will likely motivate legislative action either through a special session in 2016 or in the regular session in 2017.”

Kimberly J. Fernandes, a partner in the Tallahassee office of law firm Kelley Kronenberg, said rate increases are just the tip of the iceberg from this ruling.

“The cost of many claims that are more than two years old instantly increased today with this ruling. The indemnity portion of many claims that were long ago closed upon the expiration of 104 weeks of benefits will now have to be re-opened for consideration of re-instituting indemnity payments in light of today’s ruling,” Fernandes said.

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About Amy O'Connor

O'Connor is the Southeast editor for Insurance Journal and associate editor of MyNewMarkets.com. More from Amy O'Connor
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