JCC Orders Orthopedic Care After Rejecting Misrepresentation Defense

In Rosalia Terez Benn v. ACTS Retirement-Life COMM/CorVel Enterprise Claims, Inc., OJCC Case No. 26-000256KAH, Judge Kimberly A. Hill addressed a request for orthopedic treatment after a May 17, 2024 workplace fall involving the claimant's knees and low back.

The Employer/Carrier accepted a temporary exacerbation but argued the need for orthopedic care was personal, degenerative, or barred by forfeiture based on alleged false testimony about medical history and the claimant's termination. The JCC found the alleged prior-medical-history inconsistencies too nonspecific and concluded the Employer/Carrier did not prove a false, incomplete, or misleading statement.

The order also rejected the termination-based forfeiture defense. The JCC found the claimant acknowledged a company-policy violation, but the disputed facts about resident property were tied to privileged or potentially criminal matters and did not credibly establish that her testimony was false for the purpose of obtaining workers' compensation benefits.

On causation, the JCC credited MD Now and Dr. Robin Simon over Dr. Richard Strain. The order emphasized objective MRI findings, work-related DWC-25 forms, and the absence of credible evidence of a pre-accident need for knee or back treatment, then granted authorization and provision of an orthopedist along with attorney's fees and costs.

Source: Compensation Order