A Florida appeals court on Wednesday overturned a denial of benefits to a sheriff’s deputy for heart disease, finding that his failure to comply with treatment for conditions that were risk factors did not override the statutory presumption that his illness was work-related.
Ismael Tiburcio had worked for the Hillsborough County Sheriff’s Office as a deputy for 15 years when, on a busy night shift in 2019, he suffered a heart attack, according to Tiburcio v. Hillsborough County Sheriff’s Officeinto the Court of Appeals for the First District of Florida in Tallahassee.
Mr. Tiburcio filed a workers’ compensation claim for heart disease under the state̵7;s presumption of heart and lung conditions for first responders. The county denied the claim, relying on the reverse presumption provision of that statute based on Tiburcio’s departure from his personal physician’s prescribed treatment for related health conditions.
In ruling in favor of the county, the claims judge found that Mr. Tiburcio had received treatment for a variety of health conditions since 2011. Nevertheless, medical records documented Mr. Tiburcio’s repeated noncompliance with treatment plans designed to manage those conditions, as well as a doctor’s caution that he was at risk of complications such as stroke, kidney failure, heart attack and even death. However, these records did not include a diagnosis of heart disease in general or coronary artery disease.
The JCC determined that Mr. Tiburcio’s “prescribed course of treatment was specifically designed to prevent or halt the development of heart disease, as documented in (medical) records.” He further found that Mr. Tiburcio had “materially deviated” from that course of treatment leading to “a significant worsening of his heart disease that resulted in disability or increased his disability and need for treatment.”
The Court of Appeals amended and held that the reverse presumption only applies when there is a departure from a prescribed treatment for the specific disease or diseases for which a claimant is seeking compensation.
Mr. Tiburcio claimed compensation for heart disease, and his alleged noncompliance related to conditions other than heart disease, so it was wrong for JCC to apply the reverse presumption provision, the court said.
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