JCC Denies TPD Claims Based on Medical Non-Compliance and MMI Status

Abelardo Sandoval, a project manager and supervisor for Spilker Roofing and Sheet Metal, injured his knee on July 28, 2023, while working on a residential roofing project in Palm Bay, Florida. The injured worker sought temporary partial disability (TPD) benefits for multiple periods between December 2024 and May 2026, as well as penalties, interest, costs, and attorney's fees. After receiving authorized treatment in both Florida and Texas (where he relocated), Sandoval was placed at maximum medical improvement (MMI) and eventually released to full-duty work by his authorized treating physician.

Judge Neal P. Pitts heard the case and had to determine whether TPD benefits were owed for three distinct periods, addressing numerous defenses raised by the employer/carrier. The carrier argued that benefits were properly suspended due to medical non-compliance when Sandoval voluntarily canceled a December 2024 appointment, that no benefits were owed after MMI was assigned in January 2025, and that no indemnity was due during periods when the claimant had no work restrictions or was released to full duty. The judge's final ruling would turn on whether the claimant was entitled to TPD during the disputed periods based on work restrictions, medical compliance, MMI status, and whether the industrial injury remained the major contributing cause of any wage loss.

This case highlights the critical importance of attending all authorized medical appointments and the serious consequences of medical non-compliance in Florida workers' compensation claims. Injured workers should understand that carriers can lawfully suspend indemnity benefits when claimants fail to attend scheduled appointments after proper notice, and that once a physician releases a worker to full-duty or assigns MMI status, temporary disability benefits will typically cease. For employers and carriers, this decision reinforces the need to provide clear written notice of appointment requirements and the potential consequences of non-compliance before suspending benefits.

Source: Compensation Order