At Work Injury Rights, we focus on helping injured workers across Florida get the workers’ compensation benefits they deserve. I know how hard it can be to deal with a work injury, especially when insurance companies try to deny or reduce your claim. That’s why we fight for you: to make sure you get the medical care, lost wages, and support you need to recover. Whether you’re facing a denied claim or struggling with a pre-existing condition, we’re here to help.
If you get hurt at work in Florida and already have pre-existing injuries, you may worry about whether you can still get workers’ compensation benefits. Many people have chronic illnesses, past injuries, or medical conditions like arthritis, diabetes, or back problems before a workplace accident happens. Insurance companies often try to use these conditions as an excuse to deny or limit coverage. But Florida law protects workers whose job-related injuries make a pre-existing condition worse.
In this blog, we explain how pre-existing injuries affect Florida workers’ compensation claims, how to protect your right to benefits, and why working with an experienced Florida workers’ compensation lawyer can help you fight back against insurance companies that try to deny or reduce your claim.
What Are Considered Pre-Existing Injuries Under Florida Law?
Understanding what counts as pre-existing injuries is important when filing a Florida workers’ compensation claim. Insurance companies often use pre-existing health conditions to deny or reduce benefits, so knowing how the law defines them can help protect your rights.
Definition of a Pre-Existing Condition
A pre-existing condition is any injury, illness, or medical condition that existed before a workplace accident. Florida workers’ compensation law recognizes that workers may have prior injuries or chronic illnesses that can be aggravated by a new accident on the job. Examples of pre-existing injuries include back and neck injuries, arthritis, diabetes, cancer, and even mental health conditions. If a work accident makes these conditions worse, you may still qualify for benefits.
Examples of Common Pre-Existing Injuries
Many workers have pre-existing injuries from car accidents, previous workplace injuries, or natural health conditions. Common examples are:
- Back injuries from prior accidents or wear and tear
- Joint problems like shoulder, knee, or hip injuries
- Chronic illnesses such as diabetes or cancer
- Pregnancy-related conditions that can worsen due to physical work
- Mental health issues that can be triggered or worsened by work stress
These conditions do not stop you from seeking workers comp if a new injury at work makes them worse.
Florida’s “Major Contributing Cause” Standard
Under Florida Statutes § 440.09(1)(b), a pre-existing condition does not automatically disqualify you from coverage. The law requires that the work accident be the major contributing cause of the need for medical treatment. This means the accident must be more than 50% responsible for the injury, compared to the pre-existing condition. A doctor usually helps determine if the work accident aggravated the condition enough to meet this standard.
Why Pre-Existing Injuries Matter in Workers’ Comp Claims
Insurance companies often claim that medical expenses are due to pre-existing injuries, not the work injury. They may try to avoid paying for treatment or deny benefits. To prove your right to receive benefits, you must show that the work accident made the condition worse. This is why medical records and doctor reports are critical to your claim.
Florida Workers’ Compensation Law and Pre-Existing Injuries: The Basics
Florida workers’ compensation law has specific rules about how pre-existing injuries affect an injured worker’s right to receive benefits. Knowing these rules can help protect workers from unfair claim denials.
Florida Statute § 440.09(1)(b): Major Contributing Cause Rule
Florida law uses the “major contributing cause” (MCC) standard to decide if a worker with a pre-existing condition can get workers comp. According to Florida Statutes § 440.09(1)(b), if a work accident makes a pre-existing injury worse, the accident must be more than 50% responsible for the need for treatment and medical expenses. The doctor’s opinion is key in proving whether the work-related injury is the major contributing cause. If the pre-existing condition is a bigger reason for needing care, insurance companies may deny coverage.
Aggravation of Pre-Existing Injuries
Florida law allows workers to recover benefits if a workplace accident worsens pre-existing injuries. This includes chronic illnesses like diabetes, cancer, or arthritis, as well as prior injuries from a car accident or other event. Even if a person was already receiving treatment for an old injury, an on-the-job accident that makes it worse may be covered. The worker must prove that the work injury increased their pain, created new symptoms, or caused additional damage.
Medical Records and Doctor Testimony
Medical records are one of the most important parts of a workers comp claim involving pre-existing injuries. A doctor will need to explain how the work accident aggravated the previous injury or illness. Clear medical documentation showing the difference between the worker’s condition before and after the accident helps support the claim. Insurance companies may challenge the extent of the new injury, so strong evidence is necessary to receive full benefits.
How Insurance Companies Use Pre-Existing Injuries to Deny Claims
Insurance companies often argue that a worker’s medical condition existed before the accident and that the employer should not have to pay for treatment. They may say that health insurance should cover the care instead. Because of this, it is important to have a workers’ compensation attorney to fight back and show that the work-related injury is the real cause of the need for medical treatment and other benefits.
How Pre-Existing Injuries Affect Your Workers’ Compensation Claim
Pre-existing injuries can make it harder to get full workers’ compensation benefits, but Florida law still protects workers if a workplace accident worsens a prior injury or illness.
Insurance Companies May Deny or Limit Benefits
Insurance companies often argue that your medical expenses are from a pre-existing injury, not the accident at work. They may say the employer should not have to pay for your treatment. This is a common way for insurers to avoid covering the full extent of your injuries. If they succeed, you may not get the benefits you need to recover.
The Need to Prove Aggravation of a Pre-Existing Condition
To receive workers comp, you must prove that your work injury made pre-existing injuries worse. Florida law, under § 440.09(1)(b), requires showing that the work accident is the major contributing cause of your need for medical treatment. If you had chronic illnesses like arthritis, diabetes, or cancer, and the work accident increased your pain or caused new damage, you may qualify for benefits. A doctor’s report can show that your injury is now more severe because of work.
How Insurance Companies Use Medical Records Against You
Medical records are critical, but insurance companies may use them to argue that you were already hurt before the work accident. They may claim that you would need treatment anyway, even without the workplace injury. This is why it is important to have updated, clear medical documentation showing how the work incident made your condition worse.
Role of Fault and Other Accidents
Insurers might also point to car accidents or other past injuries to avoid paying benefits. They could argue that your pain or injury is from a previous crash or unrelated health condition. Florida workers’ compensation is no-fault, so you don’t have to prove negligence. But you do need to show that the workplace accident directly caused or worsened your medical condition.
Getting Help to Protect Your Claim
Because of these challenges, many injured workers with pre-existing injuries need an experienced workers’ compensation attorney. A lawyer can help gather evidence, work with doctors, and fight insurance companies to ensure you get the coverage you deserve. Without help, it can be hard to prove that your work injury, and not a prior illness or accident, is the reason for your need for benefits.
Get Help with Your Florida Workers’ Compensation Claim Today!
If you are struggling with a workers’ compensation claim involving pre-existing injuries, don’t face the insurance company alone. Our team at Work Injury Rights knows how to fight for injured workers and make sure you get the medical treatment and benefits you deserve.
Contact us today for a free consultation and let us help you protect your rights!
