How Pre-Existing Conditions Affect A Florida Workers’ Comp Claim

Have you ever wondered what happens to a workers’ compensation claim when the injured worker already had a bad back, an old knee injury, or another lingering condition before the workplace accident? It is a more common scenario than most people realize, and it raises a fair question: does an old injury cancel out a new one?

When Does a Prior Injury Block Your Claim?

The short answer is that it usually does not, at least not entirely. Florida law does not require an employee to be in perfect health before stepping onto a job site. Many workers carry some degree of wear and tear, whether from age, a prior accident, or years of physical labor. What matters under Florida’s workers’ compensation system is not whether a preexisting condition exists, but whether the workplace incident played a significant enough role in the resulting need for treatment or disability.

The Major Contributing Cause Standard

Florida Statute 440.09 sets out what is known as the major contributing cause standard. Under this rule, a work injury that combines with an existing condition is compensable only to the extent that the workplace incident is shown, through medical evidence, to be more than 50 percent responsible for the disability or need for treatment compared to all other causes combined. In practical terms, the workplace event does not have to be the sole cause of an injury, but it does have to carry the majority of the medical weight.

This standard often becomes the central issue in claims involving degenerative disc disease, arthritis, or previous surgeries. Insurance carriers frequently point to these histories in an attempt to reduce or deny benefits, arguing that current symptoms stem from the old condition rather than a recent workplace event.

Common Ways Insurers Challenge These Claims

Workers with a documented medical history should be aware of a few patterns that tend to surface once a claim is filed:

• Requesting years of prior medical records to search for earlier complaints of pain
• Sending the worker to an independent medical examination that may downplay the workplace incident
• Arguing that symptoms reflect the natural progression of a preexisting condition rather than an aggravation
• Delaying authorization for treatment while the major contributing cause issue is disputed

None of these tactics automatically defeat a claim, but they do make clear medical documentation, and a well supported link between the workplace event and current symptoms, especially important.

Contact Our Team Today

A prior injury should not automatically stand between an employee and the benefits Florida law provides after a workplace accident. If a claim has been questioned or denied because of an old condition, our Orlando workers’ compensation attorneys at Hornsby Law Group are ready to help sort through the medical records and insurance pushback that often come with these cases. Reach out to our team today to begin discussing your case in detail.

Source:

flsenate.gov/Laws/Statutes/2024/440.09