The Cardinal Rule in Florida Workers’ Compensation (formerly known as Workman’s Comp.) claims for the injured employee seeking benefits is the same rule that applies to victims of medical malpractice, parties injured in slip and falls at grocery stores or shopping malls, those involved in car or truck accidents, or people making a claims against a cruise line: Don’t lie regardless of whether one is under oath at the time the statement is made. One who is found to have lied under oath risks losing all rights to claim benefits, having the case dismissed, and possibly facing further sanctions. This is known as the fraud defense.
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In Florida someone who is injured at work and makes a claim for benefits under the Worker’s Compensation Statute will be asked to make a statement regarding the accident and the alleged injuries. Generally, an employee’s accident claim is deemed compensable under Florida Workers’ Compensation laws as long as it occurred during the course and scope of the injured worker’s employment.
In a recent case brought by an employee–Tony Bono against his employer, the City of Hialeah–the City and its Workers’ Compensation carrier, Sedgwick, claimed that Mr. Bono made statements that were false, fraudulent, or misleading and made them for the purpose of securing Workers’ Compensation benefits. If true, this would serve as an affirmative defense for the City of Hialeah to avoid making any payments to Mr. Bono.
Unlike a civil personal injury case that is filed in front of a trial judge and jury, Workers’ Compensation cases in Florida are adjudicated by a Judge of Compensation Claims (JCC). In this matter, the JCC rejected the City of Hialeah’s request to dismiss Mr. Bono’s claim. The City then appealed decision.((CITY OF HIALEAH/SEDGWICK CMS, Appellants, v. TONY BONO, Appellee. 1st District. Case No. 1D16-957. Opinion filed January 19, 2017.))
The appellate court found that the JCC had applied the wrong legal analysis in failing to dismiss Mr. Bono’s claim. Under Florida’s Workers’ Compensation law, it is illegal for any person to “knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment.” ((§ 440.105(4)(b)1., Fla. Stat. (2013).)) Accordingly, Florida Workers’ Compensation benefits are barred for any employee found to have “knowingly or intentionally engaged in” such acts “for the purpose of securing Workers’ Compensation benefits.”((§ 440.09(4), Fla. Stat. (2013).))
Getting Workers’ Comp Benefits: How to Determine if Someone is Committing Fraud
Florida law requires that when a JCC is asked to determine if the employee has committed fraud before denying benefits, the determination must withstand a two-pronged inquiry:
- Whether a false or fraudulent or misleading statement was made by the employee claimant, and
- Whether, at the time the statement was made, it was made with the intent to obtain benefits.(( Arreola v. Admin. Concepts, 17 So. 3d 792, 794 (Fla. 1st DCA 2009).))
Statements need not be under oath at the time, provided that the employee/claimant knew at the time he made any of these statements that they were false; then the statements can lead to dismissal of the claim.
In Mr. Bono’s case, rather than engaging in this two-part analysis, the JCC applied the civil tort case law on fraud, and did not mention whether Mr. Bono actually made specific false or misleading statements. Instead, the JCC simply characterized his statements as “inconsistencies” in Mr. Bono’s testimony and as “impeachment.” The appellate court simply sent the case back to the JCC to apply the two-pronged inquiry, which is the proper standard of law.
INJURED AT WORK? YOU MAY HAVE A WORKERS’ COMP CLAIM
We offer free legal consultations to anyone who has been injured while on the job. Typical work-related accident cases include . . .
- Construction-site accidents
- Warehouse and loading-dock accidents
- Driving for a work-related purpose, such as picking up lunch for the office or making deliveries
- Industrial accidents at factories, printing presses, or in restaurants.
CALL US TODAY FOR A FREE INITIAL CONSULTATION
If you have been injured while at work, you might have a viable claim for Workers’ Compensation benefits. Since 1991, our Miami Workers’ Compensation lawyers have fought to protect the legal rights of employees in Florida. Call us today and speak to an experienced Workers’ Compensation attorney who is trained in the intricacies of Florida’s complicated Workers’ Comp laws.
We are available 24/7 by telephone, at 305-441-0440, toll-free at 1-866-597-4529, and by email at [email protected] or SKYPE. Our workplace injury lawyers are ready to help you get the benefits you deserve. Call us today.