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Challenge to law limiting psych benefits

Challenge to law limiting psych benefits

September 23
08:47 2019

Challenge to law limiting psych benefits

In 2014, William Kneer suffered a back injury in an accident that arose out of work performed in the course and scope of his employment. Kneer underwent extensive back surgery. He reached maximum medical improvement (MMI) for his back injury in January 2016, with a 10% permanent impairment. He was assigned permanent physical restrictions, including restrictions related to his ability to lift, carry, and stand.

In August 2017, Kneer filed a petition for benefits (PFB) seeking psychological treatment for depression related to his back injury. The employer/carrier (E/C) accepted compensability and authorized treatment. Kneer filed a PFB in December2017, seeking temporary partial disability (TPD) benefits extending back to January 2016, the date of physical MMI, for his mental injury.

The E/C opposed this petition, asserting that the temporary disability claim was unsupported by the record and precluded by the Florida workers compensation statute, which cuts off temporary benefits for psychiatric injuries six months after a claimant reaches physical MMI. The Judges of Compensation Claims (JCC) agreed with the E/C’s argument and denied temporary disability benefits. Kneer appealed.

On appeal, Kneer brought a constitutional challenge to the statutory six-month limitation on temporary disability benefits for mental injuries once physical MMI is reached. He argued that the statute unconstitutionally denied him access to the courts, due process, and equal protection by prohibiting him from receiving TPD benefits even though his psychiatric injury had not reached MMI.

Under the statute, injured workers can receive temporary disability benefits for mental injuries that accompany qualifying physical injuries for up to 260 weeks. But if the mental injury outlasts physical MMI, temporary benefits are payable for only six more months after MMI is reached (up to the 260-week maximum).

In Kneer’s case, TPD benefits were not available based on his psychiatric injury because it arose more than a year after he reached physical MMI on the back injury. Under the statute and case law, the court said, Kneer missed the window for receiving TPD benefits related to his psychiatric injury. Had his psychiatric injury developed contemporaneously with or closer in time to his physical injuries, he could have qualified for TPD benefits prior to physical MMI, and then for six months after reaching physical MMI. But because his psychiatric injury manifested more than a year after he reached physical MMI, he missed the period in which TPD benefits were available for it.

The court pointed out that Kneer had already qualified for permanent benefits, and he could work. Kneer reached physical MMI and received permanent benefits and an impairment rating based on his physical injury. His benefits did not depend on receiving a favorable decision from an E/C-appointed doctor. Furthermore, Kneer had no work restrictions because of his psychiatric injury. In fact, his doctors believed it was in his best interest from a psychiatric perspective to return to work.

Under these circumstances, the court saw no constitutional problem with the statute’s limitation on psychiatric benefits. It likewise rejected Kneer’s due process and equal protection challenges to the statute, recognizing the state’s legitimate interest in establishing time limits for benefits associated with psychiatric injuries. Finally, the court rejected Kneer’s argument contesting the finding that he lacked psychiatric-based work restrictions. Both psychiatrists who evaluated Kneer opined that he could work and had no work restrictions based on his psychiatric condition. Because competent substantial evidence supported the JCC’s finding, the court affirmed it.

Kneer v. Lincare and Travelers Insur-ance-Court of Appeal of Florida, First District-April 3, 2019-No. 1D18-1988.

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