When you suffer an injury on the job, workers’ compensation insurance is supposed to cover your medical expenses and pay a portion of your wages while you recuperate. However, if an insurance company can avoid paying a claim or has an opportunity to reduce the amount, it will do so. This is to their benefit, not yours. When a pre-existing injury or condition is involved, an insurance company may see it as an opportunity to save money.
Workers’ compensation insurance companies employ many methods to deny your claim or minimize the benefits. We are keenly aware of these tactics and will fight to get you the compensation you are entitled to and deserve. If you’ve been hurt at work and have a pre-existing condition, contact us at Berlin Law Firm for a free case evaluation.
What is a Pre-existing Condition?
A pre-existing condition is an injury or illness that was already present before the work injury. It may or may not have healed completely and is not necessarily related to your job.
Examples of Pre-existing Conditions
Examples of common pre-existing conditions that may affect your workers’ comp claim include:
- Arthritis
- Cancer
- Carpal tunnel syndrome
- Depression
- Diabetes
- Heart disease
Prior back, knee, and neck injuries are also among the most frequent pre-existing medical conditions.
How Does Workers’ Comp Cover Pre-existing Conditions?
Pre-existing conditions are covered under workers’ compensation. However, insurance companies often exaggerate the effect of the pre-existing condition, which can reduce your benefits. You must prove that at least 51 percent of your disability results from a recent work accident. If the pre-existing condition contributes more than 51 percent of your disability, the insurer will likely deny your claim.
Employers Must Take Workers as They Are
Many people have some form of a pre-existing condition. But by law, employers must take workers as they are. That means they cannot try to deny workers’ compensation to someone due to this. While they must pay workers’ comp benefits to employees whose work injury worsened a pre-existing condition, they do not have to pay medical expenses relating to the first or underlying condition or injury.
The Challenges of Deadlines with Pre-existing Conditions
Pre-existing conditions may complicate workers’ compensation claims. While work injuries must be reported within 30 days, some are not apparent within that timeframe. Carpal tunnel syndrome, common in many workers who must perform frequent repetitive motions, often falls into this category.
Under Florida law, you have two years to file a workers’ compensation claim after realizing your pre-existing condition has been made worse or exacerbated by the responsibilities of your job. In addition, if your employer intentionally misled you about your rights for workers’ comp benefits, the deadline to file a claim could be extended.
For example, if you were diagnosed with carpal tunnel syndrome and repetitive motions have significantly increased the pain, do not delay filing a claim. Please note you cannot conceal information about a pre-existing condition when filing a workers’ comp claim. Any attempt to hide it can damage your claim and credibility.
Aggravated Conditions and Injuries
Sometimes, a workplace injury aggravates a pre-existing condition or injury. As a result, the employee is in worse shape and may not be able to work. For example, a prior back injury worsened after you suffered a fall at work. Before this accident, you were occasionally in pain. Now, your pain has increased, and your mobility has decreased. Likewise, if arthritis is a pre-existing condition, performing the same repetitive tasks could cause aggravation of joint pain.
Perhaps a knee injury left you with limited mobility. You then fall at work, making the situation much worse. While the limited mobility of your knee did contribute to the fall, the bottom line is that you fell while at work and should receive workers’ comp benefits.
The situation gets tricky when you are still being treated for a pre-existing condition and then experience a work injury affecting the same part of the body. Your employer would not pay for your treatment relating to the original problem.
Pre-Existing Conditions Often Increase the Denial of Workers’ Comp Claims
Insurance companies may argue that your recent injury or illness did not cause your disability but resulted from your pre-existing condition. That leads to the denial of your workers’ comp claim. Your medical records and expert medical testimony can disprove the insurer’s arguments. This is usually addressed during the appeals process.
Improving Your Chances of Maximizing Your Workers’ Comp Benefits
For any workers’ comp injury, thorough documentation is essential. It is even more crucial when a pre-existing condition is involved. If you have been injured while on the job, report it immediately and seek medical attention. Under Florida law, claims require filing within 30 days. You can go to your doctor for an initial consultation but must receive your official diagnosis from the insurer’s chosen physician.
After receiving your diagnosis, follow the doctor’s instructions exactly. Failure to do so can jeopardize your claim. The insurance company can allege that your injuries are not as serious as you made them out to be–and becomes a reason to deny your claim. Our goal is to prove that your work accident is the majority cause of your current injury. Workers’ compensation negotiations in Florida are complex—make sure you have a strong and knowledgeable advocate.
Establishing a Link Between Pre-existing Conditions and a Work Injury
Pre-existing conditions are not grounds for a workers’ compensation claim. Common examples include asthma, neck and back injuries, and herniated discs. However, if your job exacerbates it, a doctor must establish that the workplace injury is more than 50 percent responsible. In other words, to receive workers’ compensation benefits in Florida, you must prove that the new workplace injury significantly worsened the older one.
When it comes to a pre-existing injury and workers’ comp, establishing a link between the pre-existing condition and the work injury is critical to the success of your claim. Insurance companies will use every possible tactic to deny your workers’ comp claim. It is their business model.
Your doctor’s medical records are crucial in establishing this link. They must demonstrate how a work-related injury exacerbated the pre-existing condition. The injured worker should give a detailed and consistent account of how the work injury occurred and how it affected the pre-existing condition.
For example, a nurse has arthritis in their back. Part of the job requires a certain amount of patient lifting. When helping a patient to bed, a disc in the affected area of the nurse’s back herniates or ruptures. This workplace injury is considered new, even though a pre-existing condition exists.
The nurse could perform their duties with their pre-existing condition. Since their disc ruptured, however, they cannot and must prove that a work-related injury caused their current disability. If there are eyewitnesses to the injury, their accounts are also valuable.
If the pre-existing condition is determined to be the primary cause, i.e., greater than 50 percent, the insurance company will almost certainly deny the claim. If it is determined that more than half of the cause is due to the work injury, the employee should be eligible for workers’ compensation benefits. A Florida work injury lawyer can be your greatest resource for these complex claims.
Contact a Florida Workers’ Comp Lawyer at the Berlin Law Firm
If you were denied workers’ compensation benefits due to a pre-existing condition or injury, contact us at Berlin Law Firm in Sarasota or Tampa today and arrange a free consultation. We can help you through the complicated appeals process. Our team helps through fair representation, honest work, and a relentless pursuit of bettering this community. In addition, because we work on a contingency basis, there are no upfront legal fees.
