St. Lucie County and its insurance provider responsible for benefits despite firefighter being on leave, court says

By Charmaine Little | Dec 13, 2018

TALLAHASSEE — St. Lucie County and its insurer lost an appeal seeking reimbursement after it covered the heart attack of a firefighter who was no longer on active duty.

The case started after a St. Lucie County firefighter suffered a heart attack in 2015. At the time, Florida Municipal Insurance Trust was the insurance provider for the county, so it paid Williams workers’ compensation leave. He also received full pay as he waited for the green light of his disability pension.

He suffered another heart attack in 2016, but by that time St. Lucie’s provider had changed to PGCS Claim Services, and Florida Municipal refused to pay the benefits.

Instead, PGCS initially paid via the pay-and-investigate clause of the Florida Workers’ Compensation Law, but a couple of months later denied the benefits, saying the second heart attack “was not compensable because its compensability hinges on application of the presumption of occupational causation,” according to the ruling.

St. Lucie and PGCS subsequently filed a motion for indemnification, hoping FMIT would reimburse them as Williams did not meet firefighter status. The Judge of Compensation Claims denied the motion and St. Lucie and PGCS appealed to the First District Court of Appeal for the State of Florida.

Judges L. Clayton Roberts, T. Kent Wetherell, Timothy D. Osterhaus authored the opinion, which was released on Dec. 10.

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