Case Name: CLOSET MAID and Crawford and Company, Appellants, v. Wallace D. SYKES, Appellee
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 2000-02-15
Citations: 763 So. 2d 377
Docket Number: No. 1D98-660
Parties: CLOSET MAID and Crawford and Company, Appellants, v. Wallace D. SYKES, Appellee.
Judges: BARFIELD, C.J., ERVIN, JOANOS, ALLEN, WOLF, WEBSTER, DAVIS, VAN NORTWICK and PADOVANO, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 763
Pages: 377–392

Head Matter:
CLOSET MAID and Crawford and Company, Appellants, v. Wallace D. SYKES, Appellee.
No. 1D98-660.
District Court of Appeal of Florida, First District.
Feb. 15, 2000.
Mark A. Massey of McConnaughhay, Duffy, Coonrod, Pope & Weaver, P.A., Ocala, for Appellants.
Richard R. Crooke of Chalkley & Crooke, P.A., Ocala, and Bill McCabe of Shepherd, McCabe & Cooley, Longwood, for Appellee.

Opinion:
EN BANC
PER CURIAM.
Closet Maid and its servicing agent, Crawford and Company, appeal a final order awarding indemnity and medical benefits to Wallace D. Sykes, an injured worker. They contend that the judge of compensation claims erred in finding that the workplace accident was the major contributing cause of Mr. Sykes' need for back surgery. To resolve this controversy we must define the major contributing cause requirement and state the applicable standard of proof. We have addressed these issues here, but because the judge of compensation claims did not have the benefit of this opinion or any other controlling precedent, we remand the case for further consideration.
Mr. Sykes was employed by Closet Maid as a warehouseman in the receiving department. As a part of this job, he typically operated a forklift and unloaded heavy items by hand. He was unloading a pallet of boxes on May, 16, 1996, when a box fell and struck him on the head, forcing him down on one knee. Following the accident, Mr. Sykes suffered back and neck pain. Closet Maid and its servicing agent accepted the accident as compensa-ble and agreed to pay temporary disability benefits. They also authorized medical care by Doctor Barry Kaplan, a neurosurgeon.
Medical testing revealed that Mr. Sykes had a pre-existing medical condition known as spinal stenosis. This condition is a form of arthritis of the spinal canal. It is a congenital disease which is also degenerative, in that it usually gets worse with age and deterioration of the spine. In some cases, a traumatic injury to the spine provides the first indication that a person has spinal stenosis. As Dr. Kaplan explained, the "spinal column is compromised by arthritis" and "when the back is wrenched, the nerves that are in the low back can get bruised against the bone spurs."
Until he was injured at work, Mr. Sykes was not aware of the fact that he had spinal stenosis. He was forty-seven years old at the time of the accident and had worked for more than twenty years in manual labor positions, some more physically demanding than his job at Closet Maid. During that time, he had experienced no significant back pain or disability. He had worked for Closet Maid for three and one-half years and, before his injury in the warehouse, he had not missed a day of work.
Dr. Kaplan first recommended a conservative course of treatment including physical therapy and restrictions on lifting. This proved ineffective, however, in that it did not alleviate the pain. Mr. Sykes lost forty-five pounds in an effort to improve his condition but the weight loss also failed to reduce the pain. On January 21, 1997, Dr. Kaplan recommended a lumbar lami-nectomy surgery. At that point, Dr. Kap-lan said that there was little else he could do to ease Mr. Sykes' back pain.
Crawford and Company refused to pay for the surgery Dr. Kaplan recommended. By then Crawford and Company had also stopped paying Mr. Sykes temporary disability payments and had begun to pay him impairment benefits based on a three percent impairment rating. The temporary disability payments ceased on December 31, 1996, after Dr. Kaplan notified Crawford and Company that Mr. Sykes was at maximum medical improvement without the surgery. On April 27, 1997, Mr. Sykes filed a petition for benefits seeking authorization for the surgery and temporary disability benefits from December 31, 1996 through the future date of his maximum medical improvement.
Dr. Kaplan allocated seventy-five percent of Mr. Sykes' "condition," and the resulting impairment, to the pre-existing spinal stenosis, and twenty-five percent to the accident at work. Dr. Kaplan also expressed the view that the pre-existing problem was the "major contributing cause" of the disability and need for medical treatment, and indicated that he felt that Mr. Sykes probably would have needed surgery at some time in the future even had the workplace accident not occurred. But Dr. Kaplan could not say whether surgery would have been required at any time in the near future, and explained that his recommendation for surgery at the present time was precipitated by Mr. Sykes' pain, as resulting from the effects of the accident rather than the underlying deficiency in the spinal column.
Following the hearing on the petition for benefits, the judge of compensation claims found that the workplace accident was the major contributing cause of Mr. Sykes' need for back surgery. The judge relied on the substance of Dr. Kaplan's medical testimony rather than the doctor's conclu-sory assertion regarding major contributing cause. The judge also relied on Mr. Sykes' long history of performing manual labor and the fact that he had not experienced back pain or disability before the accident. The evidence and the inferences drawn from the evidence led the judge to conclude that Mr. Sykes had established the legal requirement of major contributing cause.
Based on these findings, the judge of compensation claims rendered a final order directing Crawford and Company to pay for the back surgery Dr. Kaplan had recommended and to pay Mr. Sykes temporary partial disability benefits from December 31,1996 until the future date of his maximum medical improvement. Closet Maid and Crawford and Company then filed a timely notice of appeal to review the final order in this court.
We begin by examining section 440.09(l)(b), Florida Statutes (Supp.1994),' which defines the coverage that is available to an injured worker if medical treatment is required by the combination of a compensable workplace accident and a pre-existing disease or condition. According to this statute:
If an injury arising out of and in the course of employment combines with a preexisting disease or condition to cause or prolong disability or need for treatment, the employer must pay compensation or benefits required by this chapter only to the extent that the injury arising out of and in the course of employment is and remains the major contributing cause of the disability or need for treatment.
§ 440.09(l)(b), Fla. Stat. (Supp.1994). It is thus no longer enough for an injured worker to show that a workplace accident is causally related a particular injury, as in Reynolds v. Whitney Tank Lines, 279 So.2d 293 (Fla.1973), or that the accident contributed to the need for treatment. Coverage is available under the statute only if the workplace accident "is and remains the major contributing cause of the disability or need for treatment."
Whether the judge of compensation claims properly awarded medical benefits in this case depends on the meaning of the phrase "major contributing cause." When interpreting a statute, the court must look first to the plain meaning of the terms used in the statute itself. See Moonlit Waters Apartments, Inc. v. Cauley, 666 So.2d 898 (Fla.1996); Acosta v. Richter, 671 So.2d 149 (1996). If the language and meaning are clear, the court must interpret the statute according to the ordinary meaning of its terms, and may not resort to extrinsic aides to statutory construction. See McLaughlin v. State, 721 So.2d 1170 (Fla.1998); Rhodes v. State, 704 So.2d 1080 (Fla. 1st DCA 1997).
Although the phrase "major contributing cause" is not defined in the Workers' Compensation Law, the meaning of this phrase is sufficiently clear from the language of section 440.09(l)(b), Florida Statutes (Supp.1994). The first definition of the term "major" listed in nearly all dictionaries is "greater in dignity, rank, importance, or interest." See, e.g., Webster's 3rd New International Dictionary, Unabridged (1971); see also L.B. v. State, 700 So.2d 370 (Fla.1997)(noting that the courts may refer to dictionary definitions to ascertain the plain meaning of a term used in a statute). It follows that if there are two causes for a disability or the need for treatment, the workplace accident must be the "greater" of the two causes. Section 440.09(l)(b) employs the definite article "the" to modify the phrase "major contributing cause." Hence, the statute is not satisfied merely by showing that the workplace accident is among the major causes. The use of the term "the" plainly signifies that the workplace accident must be greater than any other cause contributing to the disability or need for treatment. See Orange County MIS Department v. Hak, 710 So.2d 998 (Fla. 1st DCA 1998).
Given this interpretation of the phrase "major contributing cause" in section 440.09(l)(b), Florida Statutes (Supp. 1994), we conclude that coverage is available if the workplace accident contributes more to the disability or need for treatment than any other single cause. This does not mean, however, that the workplace accident must be a greater cause than all other causes combined. Such an interpretation would impose a requirement beyond that which is stated in the statute. The courts have judicial power to interpret statutes, but that power cannot be used as a license to assume the prerogative of the legislature. See Hancock v. Board of Public Instruction, 158 So.2d 519 (Fla.1963). Hence, we do not read into section 440.09(l)(b) a requirement that the industrial accident must account for more than fifty percent of the need for benefits. Instead, by the terms of the statute, the workplace accident must be greater in significance than any other single cause.
Although the major contributing cause standard in section 440.09(l)(b) requires the judge of compensation claims to determine relative degrees of causation, the method of proving causation has not changed. Section 440.09(1), Florida Statutes (Supp.1994), states that "[t]he injury, its occupational cause, and any resulting manifestations or disability shall be established to a reasonable degree of medical certainty and by objective medical findings." This language was not contained in the previous version of section 440.09, but it accords with and confirms the existing law on the subject of causation.
Before the enactment of section 440.09(1), Florida Statutes (Supp.1994), the case law held that causation must be proven to a reasonable degree of medical probability. But many of the opinions also referred to "reasonable medical certainty," and used that phrase interchangeably with "reasonable medical probability." See, e.g., Turner v. Harmon, 438 So.2d 1030 (Fla. 1st DCA 1983); Horse Haven v. Witlit, 438 So.2d 123 (Fla. 1st DCA 1983); Castro v. Florida Juice Division, 400 So.2d 1280 (Fla. 1st DCA 1981). Indeed, Black's Law Dictionary 1273 (7th ed.1998), indicates that the phrases "reasonable medical probability" and "reasonable medical certainty" are merely different ways of expressing the same concept. Consistent with the long-standing usage of this terminology, we conclude that the statutory use of the phrase "reasonable medical certainty" does not reflect any departure from the established standard of proof.
We further conclude that section 440.09(1), Florida Statutes (Supp.1994), does not invariably require medical evidence to show that a workplace accident is the major contributing cause of a disability or need for treatment. In some cases, the connection between the accident and the injury may be so clear that it does not' require medical proof. For example in, Haas v. Seekell, 538 So.2d 1333 (Fla. 1st DCA 1989), we held that a construction worker who had been struck on the head by a truss was not obligated to present medical evidence that the accident caused organic brain damage. Likewise, we doubt that the legislature intended to require medical evidence of causation in a case in which an employee's arm is severed by a machine at work. Such a requirement would compel a needless presentation of evidence.
In contrast, medical evidence may be essential when the circumstances do not permit causation to be determined on matters which are susceptible of observation or other sensory perception by lay witnesses. This is often the case with injuries which are not readily observable. See Crest Products v. Louise, 593 So.2d 1075 (Fla. 1st DCA 1992); Arand Construction Co. v. Dyer, 592 So.2d 276 (Fla. 1st DCA 1991); Computer Products, Inc. v. Williams, 530 So.2d 1006 (Fla. 1st DCA 1988); Vero Beach Care Center v. Ricks, 476 So.2d 262 (Fla. 1st DCA 1985). We have thus held, for example, that medical evidence was required to show that a workplace accident caused a psychiatric condition, see Ackley v. General Parcel Service, 646 So.2d 242 (Fla. 1st DCA 1994), a soft tissue injury, see Peters v. Armellini Express Lines, 527 So.2d 266 (Fla. 1st DCA 1988), or hypertension. See Handy v. Golden Gem Growers, Inc., 454 So.2d 69 (Fla. 1st DCA 1984). The injuries in those cases required medical proof, presumably because the accompanying events would not support a determination of causation based on matters which the lay witnesses were capable of perceiving and understanding.
This distinction, between situations where medical expertise is essential, and other situations where facts established through lay testimony may establish causation, necessarily depends on the particular circumstances of each case. Section 440.09(1), Florida Statutes (Supp. 1994), does not compel a different approach or alter the long-recognized principle that the cause of a workplace injury may be established by either medical or lay evidence. See, e.g., Orange County Bd. of County Commissioners v. Brenemen, 233 So.2d 377 (Fla.1970); Holiday Foliage v. Anderson, 642 So.2d 94 (Fla. 1st DCA 1994); Broadfoot v. Albert Hugo Ass'n, Inc., 478 So.2d 863 (Fla. 1st DCA 1985); Daytona Linen Service v. Davis, 454 So.2d 46 (Fla. 1st DCA 1984).
The judge's determination of major contributing cause in the present case is supported by both medical and lay testimony. Dr. Kaplan indicated that the recommended surgery was intended to alleviate the ongoing pain which was occasioned by the workplace accident. The doctor identified the internal process which produced such pain, and Mr. Sykes described the manner in which he was struck by the fading box at work. In addition, Mr. Sykes noted that he had not experienced such back pain in the past. There was evidence indicating that Mr. Sykes had an exemplary work history, performing manual labor for many years without prior physical problems, and suggesting that he is not an opportunist or malingerer. The judge was entitled to rely on all of these circumstances in finding that there was sufficient proof as to the statutory requirement of major contributing cause.
Although Dr. Kaplan, in a letter prepared by counsel for Closet Maid and Crawford and Company, described Mr. Sykes' pre-existing condition as the major contributing cause of the need for medical treatment, this recitation is not conclusive and is negated by the substance of the doctor's testimony. Indeed, during the course of Dr. Kaplan's testimony it was recognized that the courts had not yet fully defined the major contributing cause concept. And the judge's determination of reasonable medical certainty depends on the substance of the evidence, rather than the use of the "reasonable medical certainty" terminology, or any other so-called "magic words," by a medical witness. Willit, 438 So.2d at 124; see also, e.g., Caldwell v. Halifax Convalescent Center, 566 So.2d 311 (Fla. 1st DCA 1990); Daytona Linen Service v. Davis, 454 So.2d 46 (Fla. 1st DCA 1984). As explained in Bradley v. Kraft Foods, Inc., 609 So.2d 748 (Fla. 1st DCA 1992), which notes that medical testimony sometimes contains legal terminology used in a manner which does not encompass the proper legal standard, the evidence should not be turned into a game of semantics. Instead, the resolution of such factual issues remains within the adjudicatory function of the judge based on the substance of the evidence presented, as measured against the specific statutory requirements regarding the evidentiary standard applicable to the determination. See Tampa Bay Moving Systems v. Frederick, 433 So.2d 628 (Fla. 1st DCA 1983).
Because the determination of major contributing cause is an issue of fact, the decision is one that is reviewable on appeal by the competent substantial evidence test. A finding of major contributing cause will ordinarily be affirmed if the record contains competent substantial evidence that the workplace accident contributed more to the claimant's disability or need for treatment than any other single cause. The evidence in the present case is sufficient to support a finding of major contributing cause under the standard we have articulated here. However, the judge of compensation claims did not have the benefit of this opinion or other controlling precedent when he decided the issue. In order to be certain whether the judge would have awarded benefits under the major contributing cause standard as it is now defined, we remand the case in light of this opinion.
In summary, we conclude that the term major contributing cause in section 440.09(l)(b), Florida Statutes (Supp.1994), refers to a cause that contributes more to the claimant's disability or need for treatment than any other single cause. A finding of major contributing cause can be supported by medical or lay testimony, or both, depending on the circumstances involved. Whether the workplace accident is the major contributing cause of a particular disability or need for treatment is a factual issue that is reviewed on appeal by the competent substantial evidence test. The decision in this case is remanded to the judge of compensation claims in light of these standards.
Remanded.
BARFIELD, C.J., ERVIN, JOANOS, ALLEN, WOLF, WEBSTER, DAVIS, VAN NORTWICK and PADOVANO, JJ., concur.
KAHN, J., concurs with written opinion.
BENTON, J., concurs in part and dissents in part with written opinion, in which BOOTH and MINER, JJ., concur.
BROWNING, J., concurs in part and dissents in part with written opinion, in which LAWRENCE, J., concurs.
. The phrase "major contributing cause" is also used in section 440.02(32), Florida Statutes. This section provides that "[a]n accidental injury or death arises out of employment if work performed in the course and scope of employment is the major contributing cause of the injury or death."