Gulfshore Insurance > Gulfshore Blog > Claims Management > Westphal v. St. Petersburg: Will Workers’ Compensation Rates Increase Because of this Court Case?

The economic impact is pretty easy to project. If an insurance company is forced by law to pay over 150% more on high value claims, where do you think they are going to recoup that money? The answer is premium and rate increases, of course. This is exactly what can be expected in light of the February 28, 2013 First District Court of Appeal (DCA) decision regarding a case called Westphal v. St. Petersburg.

For a little background, the primary issue in the case was the state of Florida’s limitation of indemnity (TTD) benefits to 104 weeks. Well, since this firefighter sustained severe injuries to his back and knee, and now progresses through recovery from surgery and medical treatment, the 104 weeks of indemnity benefits have been exhausted. The Judge of Compensation Claims (JCC) denied the claimant’s request for permanent disability benefits because (1) the claimant had not yet reached maximum medical improvement (MMI) and (2) the amount of permanent disability the claimant would have upon reaching MMI status was too speculative. Therefore, the JCC noted that the injured worker fell into a “statutory gap” where no benefits would be available to him since he received the full 104 weeks of temporary disability benefits and wasn’t yet eligible for permanent total disability (PTD) benefits.

Upon appeal, the First DCA noted that the injured worker would not be able to recover disability benefits for the waiting period of the “statutory gap” stating:

“We hold that such a result cannot comport with any legal or natural notion of justice. It does not comport with a notion of legal justice, because it violated Westphal’s state constitutional right of access to courts, and it violated his right to the administration of justice ‘without … denial or delay,’ under article I, section 21, of the Florida Constitution. This system of redress does not comport with any notion of natural justice, and its result is repugnant to fundamental fairness, because it relegates a severely injured worker to a legal twilight zone of economic and familial ruin.”

On Feb. 28, the First DCA found the limitation of TTD benefits, 440.15(2)(a), to be unconstitutional and revived the 260 weeks limitation on TTD benefits. 260 weeks was the amount of time which applied prior to an amendment in 1994.

The decision is still expected to be appealed to the Florida Supreme Court, and wouldn’t be binding until the appeal is resolved, but you can bet if workers’ compensation insurance carriers operating in Florida have to start covering benefits for 150% longer, it will send shockwaves through the workers’ comp marketplace.

John Keller, CRM ARM CIC AAI is the Director of Risk Management and Claims at Gulfshore Insurance. John works with a wide range of business clients to deliver strategic risk analysis and guidance. Comments and questions are welcome at jkeller@gulfshoreinsurance.com

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