Navigating Florida’s worker’s compensation claims process is already a challenge, but it becomes even more complex when pre-existing conditions are involved as they can affect your claim. To help you secure the disability benefits you deserve, let’s go through and cover what constitutes a pre-existing condition, Florida’s legal framework and the Statute of Limitations, as well as the claim process and potential outcomes.

What Is A Pre-Existing Condition? Medical Examples Listed

A pre-existing condition refers to any medical issue or injury that existed before a workplace incident. Common examples include:

  • Chronic Back Pain
  • Arthritis
  • Degenerative Disc Disease
  • Repetitive Strain Injuries (e.g., carpal tunnel syndrome)
  • Prior Surgeries (e.g., knee or hip replacements)
  • Diabetes
  • Epilepsy
  • Cardiac Disease
  • Multiple Sclerosis
  • Parkinson’s Disease

Having a pre-existing condition does not disqualify you from receiving workers’ compensation benefits in Florida, although it does complicate the process.

Florida’s Legal Framework – Does Workers Comp Cover Pre-Existing Conditions?

Florida Statute §440.09 protects workers with pre-existing conditions but requires proof that the work-related injury is the major contributing cause (MCC) of your current medical condition. The MCC rule stipulates that your workplace injury must be at least 51% responsible for your current condition, compared to all other causes combined. To establish this, you must provide medical evidence through physical examinations or diagnostic testing, ensuring fair treatment in cases where workplace injuries interact with pre-existing health issues.

Florida’s Statute of Limitations Also Applies

Florida enforces a statute of limitations for filing workers’ compensation claims. You have two years from the date of injury to file a claim, and after receiving benefits, you must not allow more than one year to pass without treatment from an authorized provider. There are exceptions for mentally incompetent individuals and minors.

Insurance Company Tactics to Watch Out For

Insurance companies often scrutinize claims involving pre-existing conditions to minimize payouts. Common tactics include requesting an unreasonable amount of documentation to delay the claim, hiring private investigators to gather evidence, arguing that there’s insufficient evidence, and extending investigative periods. These tactics can overwhelm an injured worker, so having a workers’ compensation attorney by your side can help counter these strategies and advocate for your rights.

The 5-Step Claim Process For When You Have a Pre-Existing Condition

Filing a workers’ compensation claim when you have a pre-existing condition requires careful preparation. Follow these steps:

  1. Notify your employer immediately, detailing how the injury aggravated your pre-existing condition.
  2. Consult an approved medical provider for an evaluation.
  3. Keep careful record of your health before and after the incident. This helps to show the state of your pre-existing condition.
  4. It might be helpful to get input from medical professionals who can explain how your work injury made your existing health issues worse.
  5. Write down everything you can remember about your symptoms, the treatments you’ve received, and any conversations you’ve had with doctors or insurance companies. This information is very valuable in supporting your claim.

Your employer or their insurance company may request an Independent Medical Examination (IME) to evaluate your condition objectively. This examination, performed by a neutral physician, can significantly impact your claim’s outcome, particularly in establishing the major contributing cause of your injury.

How Pre-Existing Conditions Affect Workers’ Comp Claim Outcomes

  1. Compensation Amounts. If it’s proven that your workplace injury worsened your pre-existing condition, you may receive compensation for medical expenses, lost wages, and rehabilitation costs.
  2. Reduced Benefits. Insurers may approve benefits, but reduce them based on their assessment of how much your workplace injury contributed to your current condition.
  3. Denial of Claims. If an insurer denies your claim based on a pre-existing condition, you can appeal this decision by presenting additional evidence.

The Appeals Process – What If Your Claim Is Denied?

If your claim is denied due to a pre-existing condition, it’s important to take these next steps:

  1. Review the denial letter to understand the reasons; this will guide your appeal.
  2. Gather additional evidence that supports your case (medical documentation or expert opinions).
  3. File a formal appeal through the insurance company’s process.
  4. Consult an experienced workers’ compensation attorney to navigate the appeals process effectively.

Read more about the entire workers’ compensation claims process here, including what happens with a claim denial.

Don’t Face Your Case Alone – Protect Your Rights With Frank Eidson Law

Knowing how pre-existing conditions affect workers’ compensation claims in Florida is vital for securing the benefits you deserve. If you’re facing challenges with your claim—or if it’s been denied—don’t wait to seek help. At Frank Eidson Law Firm, we have decades of experience helping Central Florida workers navigate complex claims involving pre-existing conditions. Get a free case review by calling us at 407-245-2887 and let us guide you through every step of the process.