Sanchez v. Yellow Transportation / Gallagher Bassett, (Fla. 1st DCA 9/21/20)
MCC / Burden of Proof
Scott Miller / Bill Rogner
The DCA reversed the JCC’s finding that the claimant failed to prove his 2004 workplace accident was the MCC of lumbar spine treatment recommended in 2018. Claimant began working with the employer in 1991. In 2004, the E/C authorized orthopedist Dr. Cohen to evaluate the lumbar spine. Later that year, the lumbar spine injury was consolidated with two other injuries with the employer. By 2014, a new servicing agent took over, but many of the old records apparently were not transferred. The DCA noted that the E/C entered into a stipulation in 2016 that agreed Dr. Cohen remained authorized to treat the cervical and lumbar spines, and attempted to reserve the right to challenge causation. Dr. Cohen’s records (the only admissible medical evidence) showed complaints of lumbar pain in 2014 without treatment or diagnosis, and a 2018 visit where the claimant alluded to the 2004 claim, and the doctor diagnosed L5-S1 DDD. The E/C subsequently paid for a lumbar MRI, and further visits where Dr. Cohen recommended a referral to pain management and ESIs. At the trial on those requested recommendations, the E/C argued per the Pre-Trial that the lumbar spine was no longer accepted, and that the claimant had suffered an intervening event. The claimant argued proof of MCC was unnecessary, as there was no intervening or competing cause. The JCC found Dr.Cohen’s records unreliable and that the claimant failed to prove MCC. The DCA noted the key was the identity of the accepted medical condition. They rejected the E/C’s position as unsupported by evidence that they accepted only a “lumbar sprain”, and noted they specifically accepted the lumbar spine. The DCA similarly dismissed arguments that a body part is not a specific injury diagnosis, and that they could not have accepted a degenerative condition that was unknown until the June 2018 MRI. The court found instructive similar broad language in Meehan (accepting “building related illnesses….”) and Jackson (“back injuries”) as binding upon a party, which thus remove the need for further proof by the claimant of MCC. In such cases, the burden then shifts back to the E/C to show a break in the causal chain/intervening event, which did not exist here.