JCC Denies Firefighter's Heart-Ablation Reimbursement Claim

In Oscar Gomez v. City of Coral Springs/Davies Claims North America, Inc., OJCC Case No. 25-024151IF, the claimant was a firefighter/paramedic who sought reimbursement for out-of-pocket expenses tied to a March 21, 2025 cardiac ablation at Cleveland Clinic after an atrial-flutter diagnosis.

Judge Iliana Forte denied the claim because the ablation was elective, not emergency care, and the claimant did not notify the City until three days after the procedure. The City later accepted compensability of the heart disease and authorized cardiac treatment, but the order found the pre-notice Cleveland Clinic procedure was not reimbursable under section 440.13(3)(a).

The practical takeaway is that the firefighter heart presumption did not excuse the authorization requirement for a scheduled non-emergency procedure. Even where a disabling event may trigger a section 112.18 claim, the claimant still needed to give the employer/carrier a chance to authorize care or fit within a recognized exception such as emergency treatment or self-help after a wrongful refusal.

Source: Compensation Order