First District Applies a “Reasonable and Necessary” Test in Awarding Handicap Accessible Housing and Automobile Insurance in Workers Compensation Claims
Oct 20, 2016 in Case Law Updates by bronsteincarmona
The First District Court of Appeal recently addressed whether the Judge of Compensation Claims (JCC) is required to consider the reasonableness and necessity of a petition for benefits in determining a workers’ compensation claimant’s entitlement to relief.
In Kilyn Construction, Inc./FRSA SIF v. Dedrick Pierce, Case No. 1D15-5851 (Fla. 1st DCA 2016), Pierce fell from a roof while performing work for Kilyn. Paralyzed and confined to a wheelchair, the JCC ordered Kilyn to provide Pierce handicap-accessible housing and a handicap-accessible van. Per the terms of the order, Kilyn was obligated to make a monthly payment calculated as the difference in rent between Pierce’s apartment at the time of the accident and his handicap-accessible apartment. However, as time passed, this arrangement collapsed when Pierce lost his apartment and later secured a new residence that was more expensive. Pierce also procured a new insurance policy for the van. Pierce then filed two separate petitions requesting financial assistance from Kilyn on the new home and insurance policy. Kilyn denied both petitions claiming the JCC’s prior order precluded Kilyn from paying duplicate housing benefits and that the amount of insurance sought by Pierce was unreasonable.
After reviewing both denials, the JCC determined that since Kilyn failed to provide adequate assistance to Pierce in securing both housing and insurance despite Pierce’s affirmative requests for same, Pierce was entitled to the full amount sought in both petitions.
On appeal, the First District Court of Appeal analyzed Kilyn’s res judicata argument as it pertained to Pierce’s housing. Res judicata is a legal doctrine designed to bar continued litigation of a case in which a final judgment has been entered on the same cause of action between the same parties. The purpose of this doctrine is to create finality and to avoid the costs and confusion associated with multiple lawsuits on the same operative facts. Kilyn argued the award of housing in the JCC order already set the parameters of its obligations to Pierce. However, the Court on its own accord disagreed and found that the facts and evidence did change because Kilyn had a continuing obligation to provide housing despite the fact that the previous JCC order did not guarantee the monthly payment would be sufficient to provide Pierce adequate housing.
Even though Kilyn had a continuing obligation to provide handicap-accessible housing, the Court noted that the claimant has the burden to prove entitlement to workers compensation benefits. As such, the Court criticized the JCC’s failure to provide a specific explanation as to why Pierce acted reasonably when he decided to secure a more expensive residence and insurance policy.
Further, the Court applied Florida Statute Section 440.13, which requires employers to provide injured workers with medically necessary treatment, to the housing and insurance context. As such, the Court remanded the case to determine the reasonableness and necessity of Pierce’s decision to upgrade his residence. However, with respect to the Pierce’s insurance policy, the Court reversed the JCC decision because the JCC did not consider the fact that Pierce sought greater coverage than required under state law.