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Pre-existing Conditions and Your Workers’ Compensation Claim

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.

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.

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 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.

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