CLARK
v.
AMAZON.COM SERVICES, LLC; ZURICH AMERICAN INSURANCE COMPANY; ET AL
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A claimant's failure to disclose marital income on a financial affidavit form that does not request such information cannot be grounds for denying relief from costs when the claimant has testified under oath about that income and the totality of circumstances supports insolvency.
[1] A financial affidavit form provided by the Office of the Judges of Compensation Claims that fails to request marital income and assets as required by statute and appellat…
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Join FLexlaw to unlock all legal intelligence“the form provided by OJCC does not include all the necessary information required by the statute”
The court explained that the claimant correctly completed every field on the official form, but the form itself was deficient in not requesting marital income and assets as required by statute.
Amanda Clark sought relief from the cost of the record on appeal in a workers' compensation case. Her financial affidavit, completed using the OJCC-pr…
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FIRST DISTRICT COURT OF APPEAL
STATE OF FLORIDA
AMANDA CLARK, Appellant, v. No. 1D2026-0971
AMAZON.COM SERVICES, LLC;
ZURICH AMERICAN INSURANCE
COMPANY; and SEDGWICK CMS, Appellees.
On appeal from the Office of the Judges of Compensation Claims. Brian J. Anthony, Judge.
Date of Accident: April 18, 2022.
October 7, 2026
ON MOTION FOR REVIEW OF INSOLVENCY DETERMINATION
PER CURIAM.
During the pendency of this workers' compensation appeal, the Judge of Compensation Claims (JCC) denied Claimant's petition for relief from the cost of the record on appeal, and Claimant sought review. We reverse.
The JCC's thoughtful nine-page order explains that, although Claimant's financial affidavit discloses her husband's $1700-a month contribution to household expenses, her admission on crossexamination that he earns $3200 per month reveals that she did not "satisfy all the requirements" of statute or comply with the applicable appellate rule. Section 440.25(5)(b), Florida Statutes, notes that "[f]ailure to state in the affidavit all assets and income, including marital assets and income, shall be grounds for denying the petition with prejudice." And Florida Rule of Appellate Procedure 9.180(g)(3)(D) uses equally forceful language: "With the verified petition to be relieved of costs, the appellant must file a sworn financial affidavit listing income and assets, including marital income and assets, and expenses and liabilities.”
But Claimant argues that “marital assets and income” are not solicited by the affidavit form suggested by the Office of the Judges of Compensation Claims (OJCC). This form, titled “Financial Affidavit in Support of Verified Petition for Relief from Paying Costs" (item 12 at https://www.jcc.state.fl.us/JCC/forms/, visited September 10, 2026), instead states, “If anyone contributes to your income or helps pay your expenses, complete the following," then designates only three fields: “Name of Contributor; Relationship to Claimant/Appellant; Total Monthly Amount of Contribution.” The appendix in the appellate docket confirms that Claimant “completed every field on the official form exactly as written.” In other words, the form provided by OJCC does not include all the necessary information required by the statute. Claimant suggests that correctly completing the provided form should not be used as a basis for denial.
The JCC acknowledged that he “must look at the totality of circumstances" in determining insolvency, yet he concluded that he is "constrained” by statute. The totality of circumstances in this case, however, includes not just the affidavit but also the discrepancy between statute and the OJCC's form—not to mention Claimant's sworn testimony of her spouse's income (which might cure its absence on the affidavit), her testimony that his income was wholly inaccessible to her, and the JCC's own finding that the workers' compensation benefits at issue would accrue solely to Claimant and not her spouse. The true remedy here is to fix the form. In the meantime, we reverse the order and remand for the JCC to reconsider the totality of the circumstances.
REVERSED and REMANDED.
LEWIS, M.K. THOMAS, and LONG, JJ., concur.