SHIFTY BURDENS, TRIGGERING EVENTS & TWO-TIERED ANALYSIS
Workersʼ Compensation Section
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O
n April 13, 2017, the
First District Court of
Appeal decided City of
Jacksonville v. Ratliff,
2017 WL 1371508 (Fla. 1st DCA
Apr. 13, 2017), which deserves a
detailed review by all workers’
compensation practitioners for four
reasons. First, the opinion provides
a detailed analysis and history of
the “Heart and Lung presumption”
set forth in section 112.18, Florida
Statutes. Second, the opinion
explains the varied and complicated
burdens of proof that apply in
workers’ compensation cases. Third,
it applies the multiple burdens of
proof as they shift in presumption
claims (and all occupational disease
claims). Fourth, the court addresses
“triggering events” for cardiac
claims, and again explains how
burdens of proof shift for claims
based on triggering of a pre-existing,
dormant condition.
Ratliff, a firefighter for 26 years,
suffered a myocardial infarction
(MI) at work during an “extremely
stressful” meeting. His employer
initially authorized treatment by
a cardiologist, who noted a pre-
existing history of diabetes, high
cholesterol, smoking, and a family
history of early onset coronary
artery disease (CAD). According
to the cardiologist, the history
evidence” that
of diabetes,
the disease was
smoking, and
not work-related.
CAD (known as
The First DCA
“risk factors”)
made clear that
had risen to the
the major
level of causative
contributing
factors for the
cause burden,
claimant’s CAD
found elsewhere
and MI and were
in Chapter 440,
unrelated to his
did not apply.
work. Thus, the
If Jacksonville
Because the
employer denied
employer offered
the claim.
successfully rebutted
testimony by
So the
the presumption,
the claimant’s
claimant
why was
IME that
brought a “pure
causation was
presumption”
compensability upheld?
unknown,
claim under
as well as
section 112.18,
testimony by
Florida Statutes.
the treating
That is, he
cardiologist that the cause was
established the four elements
pre-existing and non-occupational,
required under the statute, but he
the First DCA held the employer
offered no actual medical evidence
met this burden.
of occupational causation for his
So if Jacksonville successfully
CAD or MI. His independent
rebutted the presumption, why was
medical examination (IME)
compensability upheld? Well, the
physician acknowledged the
First DCA explained its reasoning
pre-existing risk factors, although
in 19 pages and this column is
he opined that no one could
limited to 500 words, so do read the
identify, with any degree of medical
opinion. But the answer lies in the
certainty, which risk factors caused
“necessity of application of a two-
the MI or CAD. The employer
tiered rebuttal analysis” when heart
agreed that the claimant h ad
disease results from a combination
established the “heart-lung”
of an underlying condition with
presumption; however, it argued
a “triggering event,” such as the
the presumption was rebutted
extremely stress-
through the treating cardiologist’s
ful meeting
testimony. The Judge of
underpinning
Compensation Claims disagreed
the Ratliff claim.
and awarded compensability.
In affirming the JCC order, the
First DCA noted that because the
Author: Gray
claimant brought a presumption-
Sanders – Barbas,
only claim (i.e., pure presumption),
Nunez, Sanders,
the employer’s burden on rebuttal
Butler &
was to provide “competent
Hovsepian
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