Appellate Update – Fourth District Overturns Summary Judgment Granting Workers’ Compensation Immunity Because of the Wording of the Denial for Petition for Benefits

December 8, 2016 by on News

In Gil v. Tenet Healthsystem N. Shore, Case No. 4D15-3216, 2016 Fla. App. LEXIS 17127, *4 (Fla. 4th DCA Nov. 16, 2016), the Plaintiff’s husband worked as a carpenter at a hospital and was exposed to hazardous materials.  The husband died of cancer allegedly as a result of the exposure to the hazardous materials.  As a result, the Plaintiff attempted to get workers’ compensation benefits from the hospital.  The hospital denied her petition for benefits because the “claimant’s employment [was] not the major contributing cause of his death.”  When the Plaintiff received this denial, she dismissed the petition for benefits.  Thereafter, the Plaintiff filed a wrongful death suit against the hospital.

The hospital moved for summary judgment asserting worker’s compensation immunity.  In response, the Plaintiff argued that summary judgment was not proper because there remained a question of fact.  Particularly, whether the hospital was estopped from claiming worker’s compensation immunity.  The trial court ultimately granted the hospital’s motion for summary judgment.

On appeal, the Court explained that an employer is generally immune for common law negligence suits from its employees.  However, an employee may seek remedies from its employer under a common law negligence claim if the injuries are not covered within the Workers’ Compensation Act.  Thus, if an employer takes the position that the employee is not entitled to workers’ compensation because “the injury did not occur in the course and scope of the employment, or that there was no employment relationship,” the employer will be estopped from claiming immunity on the grounds that the employee’s exclusive remedy was workers’ compensation.   On the other hand, if the employer asserts a defense that falls within the workers’ compensation proceeding, the employer will not be estopped from asserting immunity.

The hospital argued that it was entitled to the immunity because their denial of workers’ compensation did not deny that the injury occurred in the scope of the decedent’s employment.  Rather, the hospital argued that their denial merely asserted a medical causation defense.  This defense applies where the “accidental compensable injury” is not the major contributing cause.  The Court found that while there is a medical causation defense under the Workers’ Compensation Act, the hospital’s denial was ambiguous and did not clearly allege this defense.

The Court explained that summary judgment is improper if the language used in a denial could give rise to more than one interpretation.  The hospital’s denial did not indicate that there was an accidental compensable injury.  Instead, it simply provided that the “entire claim was denied because ‘claimant’s employment’ was not the major contributing cause for his death.”  As a result, it was “unclear whether the hospital denied benefits because the injury occurred outside the scope of the decedent’s employment or whether the hospital denied benefits because the injury received in the course of his employment did not result in the decedent’s subsequent injury.”  Accordingly, the Court found that the trial court erred in granting the hospital’s motion for summary judgment as the hospital’s reason for denial was still a material issue of fact in dispute.

If you have any questions about this case or would like to refer an appellate matter, please contact our appellate attorneys. 

Kansas R. Gooden
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Loreyn P. Raab
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