First District Court of Appeal holds that judge erred in applying the reverse presumption provision to heart disease case.

The claimant was hired and worked in corrections in 2004 before being transferred to patrol in 2005. In January and December 2004, he had pre-employment physicals which revealed no evidence of hypertension or heart disease at that time.

In February 2019, the claimant suffered a heart attack and sought compensability of his heart disease under the Heart and Lung Statute. The employer/carrier initially accepted compensability under the pay and investigate provision, but later denied compensability.

The matter was then presented to the judge of compensation claims, who found that, since 2011 the claimant had been treating with a personal physician for hypertension, high cholesterol, hyperlipidemia, diabetes, obesity and sleep apnea. These records indicated repeated noncompliance and that the doctor had cautioned the claimant he could suffer a stroke, kidney failure, heart attack and even death. However, the records never included a diagnosis of heart or coronary artery disease.

In May 2011, the claimant saw a cardiologist, who pointed out the claimant has a positive family history of early cardiac disease. However, the claimant was not found to have any obstructive disease himself, and it was indicated his chest pain could have been GI related. He was noted to have some early artherosclerotic disease and was told to be aggressive in controlling risk factors. He was advised to stop smoking and lose weight. Again, there was no specific diagnosis relative to heart or coronary artery disease.

The parties obtained independent medical examiners in preparation for the final hearing. One doctor indicated the claimant’s risk factors caused his heart disease, while the other said there was no way of telling the cause. 

The judge held that the employer/carrier met their burden of proving the reverse presumption applied because the claimant departed in a material fashion from a course of treatment, which led to a significant aggravation of his heart disease, resulting in disability or increasing his disability and need for treatment.

On appeal, the First District Court of Appeal reviewed the issue of statutory interpretation de novo. Florida Statute, 112.18(1)(b)1 states, in relevant part, that heart disease is presumed not to have occurred in the line of duty if the claimant departed in a material fashion from the prescribed course of treatment of his personal physician. The phrase “prescribed course of treatment” is given a specific meaning within the statute as “prescribed medical course of action and prescribed medicines for the specific disease or diseases claimed.” Because the claimant was seeking compensability for heart disease and his alleged noncompliance was for conditions other than heart disease, the First District Court of Appeal held that the judge erred by applying the reverse presumption provision. The case was reversed and remanded for entry of an order consistent with the opinion.

_{What’s Hot in Workers’ Comp, Vol. 26, No. 11, November 2022 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 © 2022 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.}