Rousseau v. Randstad North America, Inc. and ESIS/ACE American Insurance Company

Kate E. Albin

JCC Forte (Fort Lauderdale) – (3-22-18) – Denied PCP/followup, treatment with an ortho. – The claimant had a compensable right knee injury. She declined medical care at the time of accident, and did not seek authorized care until more than 18 months after the accident. The E/C authorized a PCP, who diagnosed the claimant with a right knee injury, cause undetermined. The E/C denied further care based on a lack of major contributing cause. Both parties obtained IMEs, and subsequently the EMA (Murrah) was asked to address whether the work accident was the MCC of the claimant’s current right knee condition and need for treatment. He examined the claimant and ultimately opined that the current findings were not post-traumatic and not causally related to her industrial injury and the claimant should follow up under her private health insurance for any further care necessary. The JCC specifically rejected the claimant’s arguments that the EMA opinion was equivocal or ambiguous.
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