Pinellas County Transit Authority and Commercial Risk Management, Inc., Appellants, v. Annita C. Williams Jackson, Appellee. (2025)

When claimant Annita C. Williams Jackson turned the steering wheel of a bus at work in 2022, she reinjured her shoulder and required medical treatment. The Employer/Carrier (E/C), Pinellas County Transit Authority and Commercial Risk Management, Inc., denied Claimant's claim for benefits because doctors identified Claimant's prior on-the-job shoulder injury in 2021 as the major contributing cause of her need for benefits after the 2022 accident, and because Claimant had made misrepresentations related to her 2021 claim that barred her from entitlement to benefits for that injury under § 440.105, Florida Statutes. The JCC disagreed with the E/C's arguments and awarded benefits. Seeing no error with this award, we affirm.

This court reviews a JCC's interpretations of law de novo and upholds findings of fact if supported by competent substantial evidence. See Andrews v. McKim & Creed, 355 So. 3d 957, 961 (Fla. 1st DCA 2023) (describing the standard of review in workers’ compensation cases). Workers’ compensation benefits are available in Florida when an injury arises out of and in the course and scope of one's work. “[A]rises out of” is defined in terms of a “major contributing cause” (MCC) analysis. § 440.09(1), Fla. Stat. (2021). That is, an occupational accident must be “more than 50 percent responsible for the injury.” Id. (“The employer must pay compensation or furnish benefits ․ if the employee suffers an accidental compensable injury or death arising out of work performed in the course and the scope of employment․ ‘[M]ajor contributing cause’ means the cause which is more than 50 percent responsible for the injury.”); see also § 440.02(36), Fla. Stat. (2021) (“An accidental injury or death arises out of employment if work performed in the course and scope of employment is the major contributing cause of the injury or death”).

This dispute stems from the finding that the Claimant's first rotator cuff injury in 2021 mostly caused Claimant's need for the benefits she now requests, a need she attributes to her injury in 2022. The E/C reiterates on appeal that because the Claimant lost her right to receive benefits for the 2021 workplace injury by making misrepresentations forbidden by § 440.105, she was also foreclosed from receiving benefits she now claims under the 2022 injury. Under § 440.105, Florida Statutes, claimants may not “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 under this chapter.” Section 440.09(4)(a) bars benefits for an employee found to have “knowingly or intentionally engaged in any of the acts described in s. 440.105 ․ for the purpose of securing workers’ compensation benefits.”

The problem with the E/C's argument is twofold. First, both of Claimant's rotator cuff accidents and injuries stemmed from her work on the job. Claimant sought benefits after each of the injuries occurred during the course and scope of her employment, which rendered MCC analysis inapplicable. See Pearson v. Paradise Ford, 951 So. 2d 12, 17 (Fla. 1st DCA 2007) (applying MCC analysis only when a claimant's need for treatment or benefits was caused by the impact of an employment accident combined with a preexisting injury or condition that was unrelated to an employment accident); Pizza Hut v. Proctor, 955 So.2d 637, 638 (Fla. 1st DCA 2007) (holding that the E/C could not rely upon section 440.09(1)(b) because the case involved two industrial accidents and no preexisting injury attributable to a nonindustrial cause). Conversely, there is no injury unrelated to Claimant's work involved with this case. Nor did Claimant fail to seek benefits after her 2021 accident as might have rendered that accident non-compensable and required a MCC analysis to be completed. See Newick v. Webster Training Ctr., 78 So. 3d 108 (Fla. 1st DCA 2012) (upholding the apportionment of benefits where benefits weren't sought for a prior workplace injury so that it was never deemed compensable).

Second, the E/C's misrepresentation-defense argument conflates the concepts of “compensability” and “entitlement to benefits,” which are distinct concepts. See § 440.20(1), Fla. Stat. (providing for the payment of compensation unless a carrier denies “compensability or entitlement to benefits” (emphasis added)); N. River Ins. Co. v. Wuelling, 683 So. 2d 1090, 1092 (Fla. 1st DCA 1996) (noting various cases recognizing that compensability and entitlement to benefits “are separate concepts”). Compensability involves the workplace-related existence and cause of an injury and not benefits-entitlement issues. Babahmetovic v. Scan Design Fla. Inc., 176 So. 3d 1006, 1008 (Fla. 1st DCA 2015). Here, it is true that the E/C's successful misrepresentation defense on the 2021 injury claim foreclosed Claimant's entitlement to benefits for that accident. But that forfeiture of benefits did not render either the 2021 or 2022 accident non-compensable because, again, compensability analysis doesn't directly concern benefit-entitlement but whether a work-caused accident and injury occurred. Nor did the E/C's misrepresentation defense foreclose Claimant from qualifying for benefits stemming from the second, separate workplace accident in 2022. See Paulson v. Dixie Cnty. Emergency Med. Servs., 936 So. 2d 1109, 1110 (Fla. 1st DCA 2006) (holding that § 440.09(1)’s plain language applies the prohibition on benefits when a claimant violates § 440.105 only “to a specific accident” in which fraud was committed and not to a subsequent workplace accident). The JCC found there to be a genuine second accident here that was not merely an attempt to resurrect benefits for a previously benefit-barred claim. Thus, the E/C's successful § 440.105 defense didn't affect the compensability status of either the 2021 or 2022 accidents, nor did it prevent Claimant from qualifying to receive benefits corresponding to the distinct workplace accident and injury in 2022.

Affirmed.

Osterhaus, C.J.

Roberts and Long, JJ., concur.