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What's Hot in Workers' Comp

Although claimants have a statutory right to file petitions for benefits, a recent order imposing sanctions on a claimant’s attorney highlights the non-frivolous litigation and ‘good faith’ limitations imposed on that statutory right.

Willie Arrington v. Advanced Disposal – West Palm Beach/Gallagher Bassett Services, Inc.; Decision date: 9/11/24

October 1, 2024

by Blake J. Hood

While not a district court opinion, this judge of compensation claims’ order addresses an ever-increasing source of frustration: filing and maintaining petitions for benefits without good faith efforts to either resolve these disputes before filing or to dismiss petitions once the disputes are resolved. In this case, the claimant filed five petitions for benefits within 12 weeks. The employer/carrier filed a motion for sanctions, arguing that either the benefits requested had already been provided before the petitions were filed or benefits were timely provided and the petitions were frivolously maintained thereafter. 

Florida’s Workers’ Compensation Act contends with such concerns in the following sections:

§ 440.192(4), FLA. STAT. (2023): “The petition must include a certification by the claimant or, if the claimant is represented by counsel, the claimant’s attorney, stating that the claimant, or attorney if the claimant is represented by counsel, has made a good faith effort to resolve the dispute and that the claimant or attorney was unable to resolve the dispute with the carrier.” 

§ 440.32(1), FLA. STAT. (2023): “[i]f the judge of compensation claims…determines that the proceedings in response of such claim…have been instituted or continued without reasonable ground, the cost of such proceedings shall be assessed against the party who has so instituted or continued such proceedings.” (Emphasis added.) 

§ 440.32(2), FLA. STAT. (2023): “[i]f the judge of compensation claims…determines that the proceedings were maintained or continued frivolously, the cost of the proceedings, including reasonable attorney’s fees, shall be assessed against the offending attorney.” (Emphasis added.)

§ 440.32(3), FLA. STAT. (2023): “[e]very pleading, motion, or other paper…shall be signed by at least one attorney of record” and that such “signature of an attorney constitutes a certificate by the signer that the signer has read the pleading…; that to the best of the signer’s knowledge, information, and belief formed after reasonable inquiry it is well grounded in fact and is warranted by existing law.” This section further provides, “[i]f a pleading…is signed in violation of this section, the judge of compensation claims..., upon motion or upon its own initiative, shall impose upon the person who signed it an appropriate sanction.”

As an illustration of the sanctioned conduct in this case, the first of the five petitions in dispute were filed fewer than 24 hours after a “good faith” email was sent. Claimant’s counsel filed a notice of appearance on March 20, 2024, while also sending a substitution of counsel to the claimant’s prior counsel. On the same day, she sent an e-mail at 5:41 p.m., in “good faith,” requesting two doctor appointments. The very next day, March 21, 2024, at 3:12 p.m., she filed the petition requesting the appointments. On March 26, 2024, the insurance carrier filed a response, approving the request for authorization, scheduling the appointment and payment of the two doctor appointments. Then on April 1, 2024, and April 2, 2024, the employer/carrier’s counsel sent claimant’s counsel e-mails advising of the two appointments. 

When claimant’s counsel did not dismiss the petition, employer/carrier’s counsel served her with a motion for sanctions and afforded her the 21-day safe harbor period in order to cure the issue, in accordance with Rule 60Q-6.125(3). She did not dismiss the pending petitions, however, as she wanted to review the payout ledger and speak to her client. On June 26, 2024, employer/carrier’s counsel then emailed claimant’s counsel the actual medical records from the appointments at issue along with a payout ledger. Yet, it was not until July 16, 2024, that claimant’s counsel dismissed the petition. 

The judge of compensation claims found that claimant’s counsel’s single e-mail, sent after business hours, the day before filing the petition during business hours, “does not constitute a good faith effort to resolve the matter.” He further found that claimant’s counsel frivolously maintained the petition well after the carrier provided the requested benefits. 

Of note is the judge’s determination that the claimant himself was not in violation of the statute under § 440.32(1), which involves the party instituting or continuing the claim without reasonable grounds. Rather, claimant’s counsel alone was responsible under § 440.32(2) and § 440.32(3) and, therefore, personally bore responsibility for the costs of the proceedings, including reasonable attorney’s fees. 


 

What’s Hot in Workers’ Comp, Vol. 28, No. 10, October 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2024 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.

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Thought Leadership

Ohio Supreme Court Holds That a Binding Appraisal Award May Not Be Set Aside Absent Specific Evidence of Manifest Mistake or Fraud

On July 23, 2026, the Ohio Supreme Court issued a rare opinion on the binding effect of an appraisal award in a property insurance policy.  The Court in One Church held: A binding appraisal award will not be set aside unless an error is so palpably wrong that it undermines the intent of the agreement, such as corruption or gross mistake, not a mere error of judgment—To plead a claim of mistake with particularity as required by Civ.R. 9(B), facts alleged in a complaint must constitute the elements of mistake—Allegation that additional, hidden damage was discovered after appraisal award failed to state a claim of mistake that could justify setting aside binding appraisal.  The case arose out of a claim brought by One Church against its insurer, Brotherhood Mutual Insurance Company for roof damage from a storm. Pursuant to the terms of the insurance policy, the parties agreed to submit the matter to appraisal. The two appraisers inspected the building, and both appraisers agreed that the damages were $313,271.98. The insurer paid the agreed appraised amount.  Thereafter, the insured submitted a claim for an additional $206,663.09 in damages. The insured argued that these additional damages were not discovered until after the repairs began, and that they should be permitted to submit an additional claim, even though there had already been a binding appraisal of damages. The insurer refused to pay the additional damages, and the insured sued for breach of contract and bad faith.  In the trial court, the insurer moved to dismiss for failure to state a claim, arguing that the binding appraisal award barred any further claims. The insured took the position that additional hidden damages could not be discovered until after the repairs began, and therefore there was a mutual mistake. The trial court dismissed the case on the insurer’s motion, because there was no “evidence of fraud, misfeasance, or mistake”. The Court of Appeals agreed that appraisal awards are generally binding, but noted that an appraisal award can be set aside for fraud or manifest mistake. The Court of Appeals reversed and remanded the case to the trial court, finding that the insured had pled mistake with sufficient particularity. The insurer appealed to the Ohio Supreme Court. On appeal, the Ohio Supreme Court reversed the Court of Appeals, and reinstated the trial court decision dismissing the case for failure to state a claim upon which relief can be granted. The Supreme Court found that since the insured had already demanded appraisal, and the appraisal award was binding, “something more than error of judgement, such as corruption in the arbitrator, or gross mistake” must be pled with particularity, and proven for the insured to override the appraisal award. Since the complaint did not allege fraud or manifest mistake with sufficient particularity, something more than a mere error of judgment, the complaint was insufficient to state a claim.  The complaint in this case did not challenge the appraisal award. It pled that additional damages were discovered that were not apparent when the appraisal was done. It did not specify “who discovered the damages, how they were discovered, where they were found, why they were previously hidden, or why they rise to the level of a manifest mistake that the “appraiser would have corrected...had it been called to his attention”. Id at ¶22 citing Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970). Cases deciding the effect of appraisal awards are unusual. The Ohio Supreme Court’s decision in One Church relies primarily on 19th century case law for its conclusion. This emphasizes the fact that there is minimal case law deciding the effect of binding appraisal clauses in property insurance policies, and makes this case all the more significant. A lengthy dissent was written by Justice Fisher, who would have affirmed the Court of Appeals decision reversing and remanding the case for a decision on the merits. Of course, the decision works both ways, and an insurer dissatisfied with a binding appraisal award will likewise be without further recourse absent evidence of corruption, fraud, misfeasance, or manifest mistake, which must be pled with particularity. To constitute manifest mistake, “the mistake must be of such character that the arbitrator or appraiser would have corrected it had it been called to his attention.”  Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970).  The majority opinion does not specifically identify what would have been sufficient to plead mistake with particularity, or if the insured could have amended the complaint to overcome the deficiencies. The dissent argues that this was not really a case alleging mistake, but rather a question of contract interpretation. The insured did not challenge the appraisal, but argued that the hidden damage was not part of the appraisal, and the appraisal only covered the known damages.  However, this argument did not carry the day with the majority.  *Thomas F. Glassman, a shareholder in Marshall Dennehey’s Cincinnati office, filed a brief in the Ohio Supreme Court on behalf of the Ohio Association of Civil Trial Attorneys, in support of the insurer’s position.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict.