Another Setback for Florida Workers’ Comp as Temporary Disability Benefit Cap Struck Down

By | June 20, 2016

The Florida Supreme Court has delivered another blow to Florida’s workers’ compensation system with a ruling 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 came just 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, “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…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 injured his legs at work in 2009 and needed several back surgeries. Westphal was eligible for 104 weeks of temporary benefits, a period that is designed to compensate workers until they can return to work or reach their maximum medical improvement status and become eligible for permanent benefits.

Westphal exhausted his temporary benefits and yet was refused permanent benefits because his physicians could not determine his longterm recovery. He was left without benefits despite the fact that his doctors advised him not to work.

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. However, the Florida First District Court of Appeals overturned the district court’s ruling, thus reinstating the 104-week benefits. It said the constitutionality of the 104-week limit wasn’t at issue since it could be resolved under other provisions, and that the District Court didn’t consider the legislative intent of the law.

The Florida Supreme Court heard arguments in June of 2014.

In the 46-page opinion, the court said the judiciary does not have the power to rewrite a statute, even if it is to avoid an unconstitutional result, thereby quashing the appeals court decision.

“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 said that the temporary disability benefit statute works in the opposite manner of the legislative intent of the workers’ comp law to provide disability and medical benefits to an injured worker and help return them to reemployment at a reasonable cost to the employer.

The statute instead cuts off a severely injured worker from disability benefits “when the worker cannot return to work and is totally disabled but the worker’s doctors… deem that the worker may still continue to medically improve.”

However, the opinion further stated that their ruling does not render the entire workers’ comp system invalid. The court employed the remedy of “statutory revival” and directed that temporary total disability benefits be returned to 260 weeks.

System in Turmoil?

The Westphal case is just one of several challenges to Florida’s workers’ comp law.

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

In response to the Castellanos ruling, the National Council on Compensation Insurance (NCCI) filed a 17.1 percent increase 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 – a 2.8 percent rate hike.

Insurance association PCI said both rulings could destabilize Florida’s business environment.

“The impact of both decisions will likely motivate legislative action either through a special session in 2016 or in the regular session in 2017,” said Logan McFaddin, regional manager for PCI.

Kimberly J. Fernandes, partner with Florida law firm Kelley Kronenberg, said rate increases are just the tip of the iceberg from the Westphal ruling.

“The cost of many claims that are more than two years old instantly increased 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 [this] ruling,” Fernandes said.

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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Insurance Journal West June 20, 2016
June 20, 2016
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Umbrellas – Personal & Commercial; Construction; Medical Professional Liability