Practitioners ponder appeals court decision on temporary benefits
While the court said the opinion applies prospectively and only to the limited cases similarly situated, some stakeholders have questioned whether the ruling will open the floodgates to other cases. Additionally, questions are being raised about the potential financial impact on the system and whether a premium increase will be necessary.
The case involved Bradley Westphal, a St. Petersburg firefighter and paramedic who injured his back and knee while working in 2009. Following a series of surgeries, he was told by his doctors to avoid employment.
At the time, he had exhausted his legislatively mandated limit of 104 weeks of TTD benefits. However, since he was still undergoing treatment, he was not considered to have reached maximum medical improvement -- a requirement to obtain permanent total benefits.
That left him in something of a no-man's land in terms of his entitlement to benefits. Also, seeking employment would have positioned him to go against medical advice, and risked his entitlement to workers' comp benefits.
Westphal spent nine months without receiving disability payments before he was declared eligible for PTD benefits. The court said the 104 weeks for TTD benefits is unconstitutional in this scenario and reinstated the previous limit of 260 weeks of TTD. The ruling, however, did not change the 104 combined weeks for temporary partial disability benefits.
"The court clearly focused on the seriousness of the injury and it does not appear that there was intent by the court to also apply this reasoning to TPD," said Mary Ann Stiles, a partner in the Tampa office of Quintairos, Prieto, Wood, & Boyer PA. "TPD is an entirely different standard to collect benefits than TTD.Applying this case to TPD is clearly not a holding in this case."
Stiles questioned the court's decision to strike down the 104 week limit on TTD benefits. The ruling, she explained, seems to imply that a limit of 260 weeks is fine, but 104 weeks is not.
"This totally ignores the holding in [the 1973 case] Kluger v. White and legislative findings written over 20 years ago when the 104 weeks was taken from the Texas law," Stiles said."Kluger held that a reduction in benefits when replaced with a reasonable alternative creates a valid action by the Legislature.Decisions as to limitations are usually left to the domain of the legislative arena after much hearing and debate and legislative findings."
The case is not yet final, as there could be a file for a rehearing or a Motion en Banc. An appeal to the state Supreme Court would place a stay of the date of the decision. Stiles questioned the court's inclusion of language saying the opinion applies prospectively. "In the past, cases that have not had a final ruling or order have had such cases applied retroactively," she said."Prospective application is usually reserved for an administrative change rather than a substantive change which occurred in Westphal."
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April 1, 2013
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