Workers Comp and Injuries From Pre-existing Conditions

Many people have pre-existing health conditions. If you have been injured on the job, having a pre-existing condition should not disqualify you from receiving workers’ comp benefits. Nevertheless, some workers’ compensation insurers will use pre-existing conditions as a reason to deny claims. Insurance companies are in business for profit – their goal is to minimize the amounts they pay out.

What Is a Pre-Existing Condition?

A pre-existing condition is a previous medical condition or the worsening of a pre-existing injury. In other words, it is a medical condition or injury that predates the injury or condition for which you are making a workers’ comp claim. Examples of common pre-existing conditions include:

Carpal tunnel syndrome
Neck and back injuries
Arthritis
Asthma
Old sports injuries
Previous auto accident injuries
Previous home injuries
Herniated discs
Torn ligaments
Bone fractures
Spinal degeneration
Sprains and strains

How Will a Pre-Existing Condition Affect Your Workers’ Comp Claim?

The impact of a pre-existing condition on a workers’ comp claim can vary from case to case. For some people, it may lower the amount of benefits they receive, while for others it may have little to no impact. The question is whether the on-the-job injury could have been caused by a pre-existing condition, or if a pre-existing condition was made worse. To receive workers’ compensation benefits in Florida, if your injury is related at all to a pre-existing injury, you must prove that the new workplace injury significantly worsened the older injury.

What Do Insurance Companies Claim About Pre-Existing Conditions?

Insurance companies are on the lookout for ways to reduce or deny workers’ compensation claims, and pre-existing conditions are one of the most common ways. The insurance company, and possibly your employer as well, could claim that an older injury is the main cause of your disability, and the current workplace injury only aggravated the problem. To prove your claim, you will need to provide your doctor with an extensive history and all documentation for the previous injury or condition.

What Benefits Does Workers’ Compensation Pay?

If you need time away from work to recover from a work-related illness or injury, you should be eligible for temporary total disability benefits. Benefits are not paid for the first seven days unless you are off work for more than 21 days. The value of the benefits you receive is two-thirds of your average weekly wage just before the injury occurred, up to a weekly maximum amount. Benefit rates may be higher for severe, disabling injuries, such as blindness or paralysis. Temporary total benefits continue until:

Your doctor says you can return to work;
Your doctor says you have reached maximum medical improvement; or
You have been off work for the maximum time allowed for temporary disability benefits.

What Can You Do to Help Your Workers’ Comp Case?

Although a pre-existing condition can complicate a workers’ comp claim, you should be able to receive benefits if an injury at work made your condition worse. Your workers’ compensation attorney will need to prove that at least 51% of your current disability was caused by the recent workplace accident. You can help your case by:

Filing your workers’ compensation claim promptly -- in Florida, you have 30 days from the date of the injury, after which your claim will be denied
Maintaining all medical records related to the pre-existing condition, as well as all records related to the current workplace injury
Complying promptly with the independent medical examination request made by the insurance company, in which their physician will examine you and your medical records
Hiring an experienced Florida workers’ compensation lawyer to handle your claim

Politis & Matovina is a trusted law firm with a proven track record. If you have been injured on the job with a pre-existing condition, contact us at (386) 333-6613 to find out how we can help with your workers’ compensation claim.