By Mary Ann Stiles

The First District recently reversed a denial of benefits based upon a statute of limitations defense in Roberson v. St. Johns County School Board and Specialty Risk Services, Inc., Case No. 1D06-5839 (January 23, 2008).

The employer/carrier defended the claim on the basis the claimant had not filed a claim for benefits within two years of the date of accident or within one year of the receipt of benefits. The carrier had initially denied the claim and asserted the claimant’s condition was the result of a pre-existing condition. The appropriate Notice of Denial was filed with the claimant and the state agency. The next day the employer/carrier filed a Notice of Action/Change reflecting a permanent impairment rating of zero percent. Three weeks later, the employer/carrier received a report from the claimant’s doctor that she was at MMI with a ten percent rating. The employer/carrier did not file the appropriate form with the state or the claimant regarding the doctor’s opinion because it had denied compensability of the accident.

The First District held the employer/carrier was estopped from asserting the statute of limitations defense because the claimant relied upon misrepresentation of a material fact. She thought she was not entitled to any permanent benefits because no portion of her condition was related to her employment. Consequently, the employer/carrier could not use the statute to defeat her failure to timely file a claim. The appellate court reversed the trial judge’s ruling and remanded the case for further proceedings.

The First District’s opinion found the claimant had relied to her detriment on the employer/carrier’s failure to tell her about the permanent rating and she had changed her position in reliance upon that lack of information. What the opinion does not address is the trial judge’s findings that the claimant was aware of her rights under the statute; knew the claim had been denied; that she had two attorneys representing her for the four years between her accident and the filing of her first petition; and that the carrier had complied with the statute in all respects.

What is also not clear from the appellate court’s decision is how the fact she did not know about the purported rating affected her waiting over four years to file a petition to seek a determination of whether she had sustained a compensable injury. After all, the right to permanent benefits would only arise if she had an otherwise compensable accident or injury.

It appears that employer/carriers need to notify claimants of any change in their cases, even when the compensability of claim has been denied and the employer/carrier has otherwise complied with the statute. While it is not clear from the opinion that failure of an employer/carrier to take some action will automatically revive an otherwise time-barred claim, if does appear that failure to disclose a material fact might have that result.