Ortiz v. Winn-Dixie, Inc., Travelers Insurance, and Sedgwick CMS

CourtDistrict Court of Appeal of Florida
DecidedDecember 23, 2024
Docket1D2021-0885
StatusPublished

This text of Ortiz v. Winn-Dixie, Inc., Travelers Insurance, and Sedgwick CMS (Ortiz v. Winn-Dixie, Inc., Travelers Insurance, and Sedgwick CMS) 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
Ortiz v. Winn-Dixie, Inc., Travelers Insurance, and Sedgwick CMS, (Fla. Ct. App. 2024).

Opinion

FIRST DISTRICT COURT OF APPEAL STATE OF FLORIDA _____________________________

No. 1D2021-0885 _____________________________

ANNALIE ORTIZ,

Appellant,

v.

WINN-DIXIE, INC., TRAVELERS INSURANCE, and SEDGWICK CMS,

Appellees. _____________________________

On appeal from an order of the Office of the Judges of Compensation Claims. Frank J. Clark, Judge of Compensation Claims.

Date of Accident: September 28, 2003.

December 23, 2024

ON MOTION FOR REHEARING

TANENBAUM, J.

The court grants the appellant’s motion for rehearing and substitutes this opinion for the original. We originally affirmed the final compensation order. Now we set it aside.

* * *

Winn-Dixie, Inc., for years furnished follow-up medical supervision to Annalie Ortiz under the Florida workers’ compensation statutory regime upon Ortiz’s suffering a compensable work-related injury; the injury requiring removal of one of her kidneys; the remedial care that followed having been provided through an authorized urologist to monitor her resultant permanent medical condition. 1 Upon noticing that it had not received a bill from the urologist in over a year, Sedgwick (the servicing agent) concluded that the tolling of the limitation period—tolling that would have started from her last visit to the urologist—had expired, meaning (in Sedgwick’s view) the limitation period had run for filing a petition for benefits (“PFB”) regarding care for her injured urinary tract. See § 440.19(1), Fla. Stat. (barring any PFB that is not “filed within 2 years after the date on which the employee knew or should have known that the injury” was caused by the work). Sedgwick eventually notified Ortiz that it was terminating the authorization of care based on this statute of limitation.

1 In addition to Winn-Dixie, we have two other appellees: Travelers Insurance, which served as Winn-Dixie’s carrier to satisfy its statutory obligation to provide benefits under chapter 440, Florida Statutes; and Sedgwick CMS, which managed the claim as Travelers’s servicing agent. See § 440.13(2)(a), Fla. Stat. (“Subject to the limitations specified elsewhere in this chapter, the employer shall furnish to the employee such medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or the process of recovery may require . . . .”); see also § 440.09(1), Fla. Stat. (requiring the employer to “pay compensation or furnish benefits” as set out in chapter 440 “if the employee suffers an accidental compensable injury . . . arising out of work performed in the course and the scope of employment”); § 440.38(1), Fla. Stat. (requiring the employer to “secure the payment of compensation under this chapter”); § 440.41, Fla. Stat. (providing for the regulation of the discharge by the employer’s carrier of the employer’s “obligations and duties” regarding the liability imposed by chapter 440, treating notice to and knowledge of the employer as notice to and knowledge of the carrier, and providing that “any compensation order, finding, or decision shall be binding upon the carrier in the same manner and to the same extent as upon the employer”).

2 Ortiz challenged this termination of care by filing a PFB. Rather than question up front whether the previously tolled two- year limitation period had run at all—let alone whether there was still time remaining in the limitation period when she filed her PFB 2—she focused on the position Sedgwick was taking: that more than a year had passed since the last day it provided her medical care, in which case the tolling period would have expired and, according to Sedgwick, the statute of limitation at that moment would have completely run with it. In opposition to this position, Ortiz contended she had visited the urologist three more times following the last visit billed to Sedgwick; and, despite those subsequent visits having been billed to her private health insurance, the services provided still fell within the scope of care that had been authorized—each one restarting the one-year tolling period, obviating Sedgwick’s basis for terminating the promised medical care supplied on Winn-Dixie’s behalf. See § 440.19(2), Fla. Stat. (providing that if the employer’s carrier “furnish[es] . . . remedial treatment, care, or attendance” upon being notified of the injury or receiving a PFB, the two-year limitation period is tolled for a year).

Following a final hearing, the judge of compensation claims (“JCC”) dismissed the PFB as time-barred. The JCC found that Winn-Dixie, Travelers, and Sedgwick had “met their prima facie case to establish the Statute of Limitations defense,” the JCC basing that determination entirely on the appellees’ statement in response to the PFB that the “[c]laim is barred by the statute of limitations,” presumably because it was obvious that more than two years had passed between when Ortiz suffered her workplace injury in 2003 and when Ortiz filed her PFB in 2020. It also was undisputed, though, that Winn-Dixie had provided medical care in connection with that injury, but the JCC did not assess to what extent the limitation period had been tolled because of that provision of care—instead simply assuming that when the tolling

2 In the concurring opinion that follows, the majority author

writes for himself to explain how, in his view, this practice of not addressing the two-year limitations period overlooks the supreme court’s clear direction on how to apply “tolling” in any statute-of- limitation context—including this one.

3 period expired—the limitation period necessarily would have run to the end along with it, making any PFB on the kidney injury time-barred. Holding aside the extent to which the original two- year period might have been tolled—a question we need not reach for this disposition—Ortiz irrefutably established, through the medical and billing records, that her three subsequent visits counted as Winn-Dixie’s provision of care, further extending the one-year tolling period. Winn-Dixie’s limitation defense having been conclusively avoided, the JCC failed to draw the correct legal conclusion from that evidence. The JCC’s dismissal is unsupported by the record and the law, so we must set it aside.

I

While working at a Naples Winn-Dixie in 2003, Ortiz tripped and fell, the box she was carrying hitting her right side, causing internal injury. Emergency medical services treated her on site and then transported her to the emergency room at a hospital known at the time as Cleveland Clinic, where she was further treated. She was sent home but received follow-up care through doctors at Cleveland Clinic, her injury ultimately requiring the removal of her right kidney (a procedure known as a nephrectomy) later that same year. Winn-Dixie did not dispute compensability for this injury and authorized long-term remedial care in the form of annual “kidney follow-ups” with a urologist, more frequent visits being allowed if Ortiz needed them. 3 Cf. § 440.13(2)(a), Fla. Stat. (requiring an employer to “furnish to the employee such medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or the process of recovery may

3 The kidneys, two organs part of the urinary tract, filter the

blood and excrete “end-products of body metabolism in the form of urine.” W.A. NEWMAN DORLAND, DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 943, 1860 (29th ed. 2000) (defining “kidney” and “urinary tract”); cf. id. 1781 (defining “urinary system” in terms of “the organs concerned in the secretion of urine”). The workplace injury, then, was to one of Ortiz’s kidneys as part of her urinary tract or system, the removal of one then leaving the tract or system in a permanently diminished, but still functional, condition.

4 require”); Tower Chem. Co. v.

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Ortiz v. Winn-Dixie, Inc., Travelers Insurance, and Sedgwick CMS, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ortiz-v-winn-dixie-inc-travelers-insurance-and-sedgwick-cms-fladistctapp-2024.