Workers’ compensation generally does not cover pre-existing conditions. However, you may be able to receive benefits if you can prove that your work aggravated or accelerated your condition and you require treatment not previously necessary.
Sometimes, your employer or the workers’ comp insurance company may try to use your pre-existing condition as a reason to delay or deny a valid claim. If this happens, an Orlando workers’ compensation lawyer can help by protecting your rights and fighting for the benefits you deserve.
What Is a Pre-Existing Condition?
A pre-existing condition could be any health concern you had before a workplace injury or before you began working at your current job. Some possible examples include:
- Previous injuries
- Degenerative conditions, such as arthritis or Parkinson’s disease
- Chronic illnesses, like diabetes, asthma, or epilepsy
- Congenital conditions, such as cerebral palsy or cystic fibrosis
- Impairments such as hearing loss or brain damage
It is important to remember that almost any diagnosed and documented injury, illness, or condition could qualify as a pre-existing condition. This is not limited to conditions that cause disability or impairment. Even asymptomatic or well-controlled conditions could qualify.
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How Florida Workers’ Compensation Laws Manage Pre-Existing Conditions
Florida Statutes § 440.09 outlines the rules for when workers’ compensation insurance will pay for work injuries. Under these laws, workplace injuries must arise “out of work performed in the course and the scope of employment.” However, this is not always clear-cut when there is a related pre-existing condition
To receive workers’ compensation benefits, Florida law requires you to show that your job is a major contributing cause of your injuries or illness. This means you must have medical evidence to show your work duties are more than 50 percent responsible for your current condition. To meet this criteria, your job must significantly worsen your pre-existing condition.
When Does Workers’ Compensation Cover a Pre-Existing Condition?
When a workplace accident or your normal work duties make a pre-existing condition significantly worse, your employer’s workers’ compensation insurance company should cover your related necessary medical care and wage losses. Consider these hypothetical examples:
- You have a pre-existing injury in your lower back, but it requires minimal or no ongoing treatment. However, you were lifting heavy boxes at work and suffered a herniated disc that requires surgery. Your claim should be covered regardless of your previous injury.
- You were previously diagnosed with multiple sclerosis (MS), but are currently in remission. However, you slip and fall, suffering a head injury at work. This injury triggers a relapse in your MS symptoms. Workers’ comp should cover any required medical care.
- You have chronic obstructive pulmonary disease (COPD), but your symptoms are generally stable. However, you get a new job that requires you to be exposed to smoke or chemicals that cause your symptoms to worsen significantly, resulting in breathing issues, excessive coughing, and extreme fatigue. You should be able to receive workers’ comp benefits to cover your aggravated symptoms.
When Is Workers’ Compensation Likely to Deny a Claim Because of a Pre-Existing Condition?
Workers’ compensation insurance carriers often deny claims that involve pre-existing conditions by arguing that the patient needs treatment because of their medical condition, not an on-the-job injury. The insurance company may try to use your previous medical records, medical imaging, and even previous workers’ comp claims to support their denial.
Some situations where you may not have a valid workers’ comp claim include:
- You seek benefits after a minor incident at work, although your pain is chronic and ongoing.
- You have been seeing a doctor to treat the condition before the accident and want coverage for continuing the same treatment.
- Medical records show that your injury existed before a work accident, and the incident did not make the injury significantly worse.
While the above situations may result in a reasonable claim denial, some denials based on pre-existing conditions are unfair, and you may actually deserve benefits. If you received a denial but believe you deserve benefits because your job duties changed your condition, you’re experiencing new symptoms, or you require additional treatment because of a workplace injury, you can file an appeal.
In this situation, your best resource is a workers’ compensation attorney who can offer guidance and advocacy throughout this process. Your lawyer will appeal the denial and fight the insurance carrier for the workers’ comp benefits you deserve, including medical care coverage and wage loss benefits.
What Is an Independent Medical Examination (IME)?
Sometimes, the insurance carrier could ask you to attend an Independent Medical Examination (IME). This is an evaluation of your condition performed by a doctor selected by the insurer who will essentially determine whether your workplace injury or your pre-existing condition is the reason you require treatment.
If an IME report disputes your claim, you should speak to an Orlando workplace injury attorney immediately. You will need strong medical evidence to challenge a denial based on an IME.
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How a Workers’ Compensation Attorney Can Help If You Have a Pre-Existing Condition
If you are hurt at work but have a related pre-existing condition, you can expect pushback when you file a workers’ compensation claim. It is a good idea to discuss your case and options with a Florida workers’ comp attorney as soon as you see any hesitancy or delays from your employer or the insurance provider.
When you work with a workplace injury lawyer, they can help you by:
- Gathering evidence that your work injury is a major contributing cause to your need for treatment
- Countering unfair IME opinions
- Fighting for missed wage payments or a fair lump sum settlement
- Representing you in hearings or appeals, as necessary
- Ensuring you get appropriate medical care throughout the process
If your work significantly worsened or aggravated your pre-existing condition, you should receive workers’ compensation benefits for your treatment and lost income. However, we know that proving these claims is often challenging. Our experienced attorneys at Bogin, Munns & Munns know how the workers’ compensation system works in Florida, and we are here to help.
Talk to Our Legal Team About Your Florida Workers’ Compensation Claim
Bogin, Munns & Munns has represented injury victims in Central Florida since 1979. We are a full-service law firm that practices the full spectrum of Florida law, including workplace injuries, workers’ compensation, and employment law. We have numerous offices across Central Florida to serve you.
We provide free consultations for injured workers. Let us assess your options and explain how a workers’ compensation lawyer from our team can help. Contact us today to learn more.
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