General Tire Serv. v. SPEC. DISABILITY TR. FUND

569 So. 2d 481, 1990 WL 141892
CourtDistrict Court of Appeal of Florida
DecidedSeptember 27, 1990
Docket89-562
StatusPublished
Cited by4 cases

This text of 569 So. 2d 481 (General Tire Serv. v. SPEC. DISABILITY TR. FUND) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
General Tire Serv. v. SPEC. DISABILITY TR. FUND, 569 So. 2d 481, 1990 WL 141892 (Fla. Ct. App. 1990).

Opinion

569 So.2d 481 (1990)

GENERAL TIRE SERVICE and Liberty Mutual Insurance Company, Appellants,
v.
SPECIAL DISABILITY TRUST FUND, Appellee.

No. 89-562.

District Court of Appeal of Florida, First District.

September 27, 1990.
Rehearing Denied December 3, 1990.

*483 Jeffrey A. Stone of Beggs & Lane, Pensacola, for appellants.

Mary E. Ingley, Sp. Disability Trust Fund, Tallahassee, for appellee.

ZEHMER, Judge.

In this workers' compensation case, we review an order denying the employer and carrier reimbursement from the Special Disability Trust Fund under section 440.49(2), Florida Statutes (1987), for excess compensation the carrier claims to have paid for temporary total disability benefits, remedial medical care, and wage loss benefits. We reverse because the order is erroneous in two respects argued by the appellants: (1) there is no requirement under section 440.49(2), read as a whole, that an employer and carrier, having otherwise qualified under the statute to receive reimbursement for excess permanent total disability compensation, actually pay permanent total disability benefits for more than 175 weeks before being entitled to reimbursement for temporary disability and remedial medical benefits previously paid pursuant to section 440.13; and (2) it was error to disallow reimbursement for wage loss benefits, paid pursuant to section 440.15(3)(b) during the first six months after the claimant reached maximum medical improvement with a permanent impairment, for the sole reason that the carrier subsequently agreed to accept the claimant's entitlement to permanent total disability benefits under section 440.15(1) retroactive to the date of maximum medical improvement. Regarding the Fund's crossappeal, there is competent substantial evidence in the record to support the judge's finding of merger as defined subsections 440.49(2)(b)2.a (the "but for" merger) and b (the increased disability merger), and accordingly we affirm that issue.

This case arose out of the following factual situation. On January 20, 1984, the claimant, Eddie Lee Brown, a fifty-six year old mentally retarded tire changer employed by General Tire Services, sustained a severe permanent injury to his right arm because he failed to use a safety device provided by his employer when the rim of a truck wheel exploded due to air pressure in the tire. Brown also sustained a less serious head injury. The employer's workers' compensation carrier, Liberty Mutual Insurance Company, accepted the injury as compensable and paid temporary disability benefits and remedial medical expenses from that date. On July 19, 1985, the carrier filed a BCL-4 form with the Division of Workers' Compensation reporting that temporary total disability benefits had been suspended as of May 30, 1985, because the claimant had reached maximum medical improvement on that date. As a result of the claimant's unsuccessful work searches, permanent wage loss benefits pursuant to section 440.15(3)(b) were paid each month until December 20, 1985, when the carrier filed another BCL-4 form reporting that it had accepted the claimant as entitled to permanent total disability benefits pursuant to section 440.15(1), retroactive *484 to May 7, 1985.[1] These PTD benefits were paid until the claimant's death on February 15, 1987, due to heart failure that had no relationship to the industrial accident of January 20, 1984.

The Special Disability Trust Fund denied the carrier's claim pursuant to section 440.49(2) for reimbursement of the temporary disability benefits, wage loss benefits, and remedial medical care benefits previously paid, asserting as defenses that: (1) the claimant had no preexisting permanent impairment; (2) there was no informed conclusion on behalf of the employer regarding any preexisting permanent impairment; (3) there was no merger within the statutory definitions; (4) the carrier had paid no excess compensation; (5) the carrier had paid less than 175 weeks of PTD benefits and the claimant's death was unrelated to the industrial accident; and (6) there was no basis for reimbursement of medical or temporary disability benefits. An evidentiary hearing was held by the judge of compensation claims on the issues thereby made.

In the order entered shortly after the evidentiary hearing, the judge found the facts essentially as set forth above. He specifically noted that "wage-loss benefits paid were reclassified as compensation for PTD" and concluded that, "based on the facts and the retroactive acceptance [of claimant's PTD status] for the purposes of this claim, no wage loss benefits were paid which would permit reimbursement under F.S. 440.49(2)(c)2." He found that PTD benefits had not been paid for 175 weeks and thus no "excess" PTD benefits had been paid by the carrier. He further found that the claimant, both before and after the industrial accident, was mentally retarded within the meaning of subsection 440.49(2)(f)1.v and that the employer made an informed conclusion prior to the claimant's injury that his preexisting mental retardation was permanent and would be a hindrance or obstacle to his employment. The judge found that "but for" the claimant's preexisting mental retardation condition the claimant would have followed safety instructions and used the safety cage provided by the employer and consequently would not have been injured when the tire blew off the rim, so there was a merger within the meaning of subsection 440.49(2)(b)2.a. He also found that the claimant's preexisting mental retardation "merged with the subsequent job related permanent injury to cause a disability materially and substantially greater than that which would have resulted from the arm injury alone."[2] The order then recites:

12. In order to qualify for entitlement to reimbursement for temporary total disability and medical benefits paid, the e/c must also qualify for reimbursement from the Fund for permanent total disability. F.S. 440.49(2)(e). The Fund argues with considerable persuasion that it is absolutely fundamental to the basic philosophy of the reimbursement concept that some excess must be paid by an e/c based on a merger of the pre-existing and the compensable injury to meet the threshold of entitlement. Southland Corp. v. SDTF, 526 So.2d 1039 (Fla. 1st DCA 1988). It has already been noted that no excess PTD benefits have been paid in this case and that in retrospect no wage-loss benefits at all were paid. Except for some rather curious language contained in F.S. 440.49(2)(c)3, the case should be resolved in favor of the Fund and against the e/c on this point alone, i.e., no excess payment — no entitlement to reimbursement.
13. F.S. 440.49(2)(c)3 requires the Fund to "... immediately reimburse ..." the e/c all "... excess compensation paid for TTD and remedial treatment ... upon determination that a merger has caused permanent total disability ...". The e/c argues that in order to make any sense of this language, the legislature did not intend to create a 175 week waiting period before reimbursement for TTD paid in PTD cases. The *485 e/c goes on to argue that once a merger has been proved compensation for TTD must be "... immediately reimbursed ...". Indeed the Fund concedes that in practice this is frequently done. However, the Fund argues that this practice does not necessarily mandate a statutory interpretation contrary to the fundamental principle that an excess must be paid before entitlement to reimbursement.
14. Needless to say the statutory requirement that the Fund "...

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Bluebook (online)
569 So. 2d 481, 1990 WL 141892, Counsel Stack Legal Research, https://law.counselstack.com/opinion/general-tire-serv-v-spec-disability-tr-fund-fladistctapp-1990.